Is it ok for nurses to make do and just be good enough? Not do anything wrong but avoid too much hassle and make sure that responsibility for decision making is passed on from shift to shift? What would you do if you discovered that the myth and mythology surrounding the clinical care was just that, a myth? What would be your reaction be if after 30+ years you found yourself reminded of the nursing care you witnessed as an 18 yr old student? If as a manager you are distressed by this experience would you expect colleagues to be kind and supportive or would you be surprised and distressed if they got irritated and exploited your vulnerabilities?
I have learnt to trust my BS gauge. If clincians think what they do is “special” and “beyond understanding” then they’re not being honest and hiding in plain sight their lack of excellence. I believe that excellent care should be clearly understood and all managers should be able to engage in what constitutes excellent care. No CEO or executive/Trustee should be excused from scrutinising clincial care and understanding what the requirements of excellence might be. Just because you do good doesn’t always mean you are good and I always think there is room for improvement in anything we do. I will always be wary of practitioners who actively reject reflection and I will also be very concerned about practitioners who become defensive and difficult when it comes to implementing best practice initiatives. They may need support and understanding but they might also be not as good as they think they are and that needs attention. Practitioners who delude themselves and get caught up in their own mythology can be extremely toxic and their inability to be kind and curious can be dangerous to vulnerable colleagues.
There are many wounded healers out there in the caring environment and many will respond to positive support and a challenge to be more self aware etc. but there are also some people who are irredeemably damaged and need to stop doing the work they are doing. They continue to harm people around them and they are not good role models for the next generation of practitioners . I think COURAGE is about addressing these issues not in a punitive way but in helping people to leave a job and admit they are no longer as good as they think they are or have been. The only problem with this is that I have witnessed a singular lack of courage and that some people are spineless and cowardly but they cloak this with arrogance and contempt. They pretend to be outraged by issues but are actually more than happy to let things be as they are, not rock the boat and keep the status quo. It suits all of them as you can keep blaming each other and stay in your drama triangle playing games and never taking any personal responsibility. This type of situation can be seen time and time again in close knit and isolated groups who have not had their working cultures challenged. People might be content to let things continue but it will lead to corrosion of quality and the absence of innovation and person centredness.
No regulator will spot this culture but it will lead to minor incidents and a culture of collusion and cover up. We need to be capable of questioning this approach and finding constructive ways of helping practitioners come out of their comfort zone and embrace new ways of working. I don’t have any pithy answers nor do I point the finger at anyone but what I do know is that if we continue to ignore these issues then we will continue to delude ourselves to think that Mid staffs was a one off and an aberration – we need to learn that less than optimal care doesn’t happen over night and that a culture of looking the other way is pernicious and insidious. We can not afford to be complacent and we can all learn and improve each day – that’s what I hope for and trust that others will expect excellence not put up with what is just “good enough”.