More codswallop from the Nursing and Midwifery Council
The nursing and midwifery council (NMC) is at it again. Last week, we looked at how it made a fool of itself by making facile pronouncements on the British National Party:
Political affiliations Following the recent publication of the membership of the British National Party BNP, the NMC would like to remind nurses and midwives that while you are free to join the BNP which is a lawful political party, as part of your Code of Conduct you must demonstrate a personal and professional commitment to equality and diversity.The BNP espouses repugnant political views and I see no reason why the NMC and other professional organisations could not at least recommend that their members do not join the BNP.
The NMC does not forbid anyone on the register from being a member of any lawful political party or organisation. However, your fitness to practise could be called into question if you allow your political views or personal beliefs to contribute to behaviour that was contrary to your Code.
NMC
Today's extraordinary pronouncement from the NMC starts...
…nurses should treat people as individuals and respect their dignity which includes finding out what they would like to be called and then using their preferred name rather than just using terms of endearment.I have no problem at all when a genuinely caring nurse, looking after an elderly, frail old lady, occasionally calls her "love". Seems harmless to me, and infinitely preferable to the presumptuous use of a first name. Think about it. If your 87 year old, frail, slightly demented granny is in the nursing home, and a twenty-two year old nurse is trying to persuade her to eat her lunch, which do you prefer to hear:
Not just about saying ‘love’ or ‘dearie’
"Come on, love, try to eat a little bit more"
or
"Come on, Doris, try to eat a little bit more."
I have always hated the way that midwives in particular, and some nurses (usually the nurse-specialists), automatically assume the right to use a patient’s first name. Just because Mrs Jones is naked from the waist down with her legs apart trying to push out a baby does not mean that she has given global permission to an assembled collection of midwives to call her “Mary”. Indeed, her particular circumstances mean that it is even more important to observe the normal courtesies of life. But try telling that to nursey.
Protocols these days are everything. Yesterday, I was discussing the current nonsense of automatically referring all new young diabetics to the psychiatric department. Barely had I put my pen down, so to speak, that the attacks began. I must be wrong because the protocol recommends referral. Look at the comments made in defence of such referrals:
The National Service Framework for diabetes (as a matter of priority) calls for: "the provision of emotional and PSYCHOLOGICAL support as an integral part of a diabetes care package" [Standard 3]. The annual Diabetic UK survey of PCTs found that "only 38% of PCTs provide emotional and psychological support for adults and 51% of PCTs provide this for children and young people".It’s in the NSF. It’s a protocol. Therefore it is right. Therefore it should be done. Please do not think. Please just do it. And it must be right because there is a “package”. God, I hate that word. What does it mean? What is the difference between saying “the provision of emotional and PSYCHOLOGICAL support as an integral part of a diabetes care package” and “the provision of emotional and PSYCHOLOGICAL support as an integral part of diabetes care”
But nursey does not understand that. I saved the craziest part of the most recent psychobabble from the NMC until last:
Not just about saying ‘love’ or ‘dearie’- NMC to approve guidance for nursing care of older peopleIt has come to this. Because we are now surrounded by nursey rather than nurses the NMC has to issue a protocol to remind their members to provide basic nursing care. Call me old fashioned, but I look back fondly to the days when we had real nursing. When patients were not lying in their own excrement, slowly dying of malnutrition. Sadly, stupidly, I took it all for granted, and now it has all gone.
Although most nurses know what they should be doing they do not always do it. For example it is essential that nurses, in a hospital or community setting, always provide fundamental care by ensuring adequate fluids, help to eat and give assistance with personal hygiene when required. Nurses should also ensure continence needs are met, observing for signs of pain and providing pain relief, and above all ensure that older people’s privacy and dignity is respected.
Nursing and Midwifery Council
+++++++++++
I have had some comments from both nurses and nurseys complaining about my use of the work “nursey”. It is not meant to give offence. It is an abbrieviation used for convenience. Let me define the words as I use them
DefinitionsSee The Witch Doctor's brilliant exposition of the NHS skills' escalator in "Is the escape to heaven closed?"
Nurse
A highly trained professional providing hands-on skilled nursing care to sick patients.
Nursey
A highly trained professional who considers that her/his real skills are of no value and now devotes her/his time to trying to do other jobs for which he/she is not trained and therefore can only do, after a fashion, by rigidly adhering to a predefined protocol which s/he has neither the intellect nor the training to understand at anything other than a superficial level. Because nursey is no longer doing nursing, the skilled nursing jobs are now done (badly) by auxiliaries, who call themselves nurses, even though they are not. This whole process is seen throughout the NHS and is known as the “skills' escalator”. It is the embodiment of the Peter principle
Labels: nursey, peter principle, protocols, psychobabble, the bleeding obvious
38 Comments:
So a GPwSI, too, should also be called "nursey"?
It does say "finding out what they would like to be called and then using their preferred name" not "finding out what they would like to be called and then using their first name instead".
Jayann
Absolutely.
GPwSI are a particularly strong example of the species. I suspect I need to find a different word for them to avoid confusion, but it will need to be something that encapsulates their need to be something they are not.
John
Anonymous said...
It does say "finding out what they would like to be called and then using their preferred name" not "finding out what they would like to be called and then using their first name instead".
Wednesday, November 26, 2008 11:30:00 AM
+++++++
difficult to find out what a demented patients wants to do about anything; and demented patients are patronised nearly as much as women in labour
John
Oh god, Nursey
there's one at my Gp's surgery and I had the distinct lack of luck to have to talk to her.
After losing my job and what followed, I had a bout of bad depression which made my insomnia worse ( my insomnia has been there for 21 years. for the ebst part of the last 3, ach time I complain to my GP about it, I get a "if you're tired you sleep" from my Indian GP. Grrrr. So I changed my Gp to the other partner in the clinic, who isn't much better.
So, gained weight and I want to lose it. I have blood tests, they all come back normal, and the GP, otherwise friendly and mostly competent except for the insomnia thing, tells me that they will support me , and gives me an appointment to see nursey.
Nursey sucks. Amongst the pearls she spewed were "your main meal in the evening" and then she gave me a list of foods and the corerspondent calories. Also, she thinks that "pickles" = "pickle", that disgusting paste thing that you brits eat in sandwiches.
I tell her that my weight problem is related to the lack of sleep- which I know because duh, if i sleep 3 hours a night the body will need more food to compensate for the lack of rest- and what does she say "they use exercise for that nowadays"
I wanted to scream at her "shut up you dumb fucking cow". I have Insomnia. I had it for most of my life. My old GP back home had me on all possible sleeping pills - they work for 2 months after which they don't. My insonia is the result of PTSD. Long story. Also applies for depression. I was in the UN troops in Yugoslavia for 2 years.... and I come from a very broken family. caring for a parent with Schizophrenia as a tween will do that to you.
Last year, I had a bad bout depression which combined with the insomnia led me to suicidal ideation. What did my GP do? He gave me a leaflet from a counselling clinic thingy. They offered me an appontment in 3 months. Fucking moron.
As for nursey? I could have rcited that dumbshit list back to her in a minute. She knew fuck all about dieting, food, weight gain and weight loss. She is a moron who should not be allowed near a patient. "main meal in the evening " my ass
Eh, doesn't seem to take much account of considerable regional differences in accepted and natural turns of phrase.. I mean, if I addressed someone as "dear", my accent being just about detectable east anglian, I'd sound patronising. Because I'd be being patronising... it's not part of my natural vocabulary. But I know people who address all and sundry as "dear" or "love", their friends and contempories, their elders, the woman behind the counter in the shop, whoever. English, and especially spoken English, is not particularly homogeneous.
So if your batty old dad in a nursing home is called love that's ok? (Even if his name is Dr Smythe). Has the NHS lost all sense of common courtesey and decency.
Right ducky this has to stop. Across the board. Now. Otherwise I'm going to start calling everyone in the medical profession 'lovey' and 'chuck'.
Last time I was in hospital the staff absolutely refused to call me 'Mein Fuhrer'.
I was inspired by my grandfather who was once greeted by a house officer saying 'Hello Bill, my name's Dr Roberts'.
Granddad's response was 'Yes laddie, and my name's Sergeant Major Armstrong'.
Use of a patients first name, without them specifically inviting you to use it, is demeaning and insulting. It's designed to put a patient in their place, not put them at ease. As a doctor I have never used a patients first name unless they were under 15. I have very rarely come across doctors who do it automatically-its virtually always nurses. I was an in-patient a few years ago with a rather intimate problem and I asked to be called Dr XXX-this was duely noted in the nursing notes, and every single one of them, from students to sister called me by my first name regardless. A letter of complaint went unanswered-it left me feeling belittled and powerless.
It's all go here in NSW.
http://www.smh.com.au/news/national/nsw-public-hospitals-in-crisis-report/2008/11/27/1227491701647.html?page=2
How do you feel about colour coded uniforms for staff, Dr C?
How I agree with Anonymous' comments that
"Use of a patients first name, without them specifically inviting you to use it, is demeaning and insulting. It's designed to put a patient in their place, not put them at ease. As a doctor I have never used a patients first name unless they were under 15."
Quite.
My wife, who is in her mid-50s, was a "patient" on a "Pain Management Programme" recently. She was never asked what she would like to be called, and was given a large badge with her first name on it. It was not a matter of privacy - there was a printed list with the full names of all participants, left on the "restroom" table for all to see. Even when the clinical director wrote to her (following some unpleasantness initiated by him), it was "Dear (first name)", not "Dear Mrs Robinhood". The "Pain Management Programme", btw, was useless, patronising, stressful, demeaning and degrading.
I thought there were NHS guidelines from long ago that insisted that patients be asked what they wanted toi be called - and then were called that. I've looked for links but can't find any. Any ideas, Dr C?
I look forward to the day when Drs can diagnose a child with a broken back.
The use of patients first names by nurses, is due to the nurse-patient relationship, which is quite different from the doctor patient-relationship. Nurses, strive to put themselves on an equal footing with patients, and so whilst they refer to patients by their first names, patients usually do like wise to them. Doctors on the other hand are refered to by their honorary title, creating quite a different power balance.
It is certainly the case that some patients do not wish to be addressed in this way, and so it is a nurses responsability to ascertain this. However, i do not beleive the decision to use first names is a patronising one. Rather it is a nurses way engaging with a patient as they would with an equal.
The use of afection-terms such as duckie and love can be seen as being patronising, and so is discouraged. However the lengthy discussion of local cultures associated with these terms has muddied the debate.
The issue of demented patients is again difficult. However, good practice is to ask relatives / friends as to how a patient should be adressed. Again, I do not beleive that the choice of first names is a patronising one.
I take your point, tiniebras, where someone is a sick patient undergoing care in a hospital. My wife was herself a nurse a long time ago, was very caring, and even then called patinets by the name they wanted to be called.
However, the context of my wife's recent experience was a sort of "training course", and the use of first names certainly aimed to make the patients (35-65 in age) feel subordinate. The ethos was that of the first few weeks at a nasty secondary school. No criticism allowed, people penalised for speaking out of turn, bullying by fellow-participants etc.
I'm sure there are guidelines somewhere.
R
"It's designed to put a patient in their place, not put them at ease."
This is utter claptrap!
Anonymous 12:55:00
Get a life!
“The BNP espouses repugnant political views and I see no reason why the NMC and other professional organizations could not at least recommend that their members do not join the BNP.”
The NMC is not adopting or supporting the BNP in any way it is remaining strictly neutral on the subject while reminding it’s members of their obligation to promote a personal and professional commitment to equality and diversity. It is an open question if such a commitment is compatible with membership of the BNP but what I have a problem with is the NMC telling me what my personal obligations should be. Just as doctors have no business telling me how much I should drink the NMC has no business in telling me what political parties I should be a member of or how I should conduct myself in my private life.
“I have always hated the way that midwives in particular, and some nurses (usually the nurse-specialists), automatically assume the right to use a patient’s first name.”
Most patients in my experience prefer to be on first name terms but I do think it is polite to ask first.
Yesterday, I was discussing the current nonsense of automatically referring all new young diabetics to the psychiatric department.
The protocol merely calls for psychological support it does not specify where that support is to be obtained.
In Derbyshire everyone calls everyone else man or woman "Duck" which can be a bit confusing.
How people are addressed depends on the local culture. In the USA the use of first names is common. Since in some circumstances this preserves a modicum of anonymity many people prefer it. It is polite to ask, though.
ZT
"it is even more important to observe the normal courtesies of life. But try telling that to nursey"
Courtesy is of the utmost importance indeed.
Regardless of your definition of the word "nursey" it is quite clearly patronising. Why not choose a less objectionable word?
Still looking for clues about those guidelines..........anyone, please??
My wife was nursing 30 years ago (in perhaps more paternalistic times) and everyone in the hospital asked patients what they would like to be called. A pity this couldn't be extended to her today.
I don't expect anyone to ASK me how I prefer to be addressed. I think it would be ridiculous if they did so. I expect strangers to address me as Mr... and leave it to me to decide whether and when I wish an alternative to be used. I am an adult and can make these arrangements for myself.
I think that when the question is posed it suggests, in itself, a preferred response.
it is even more important to observe the normal courtesies of life
I think something in my head just exploded at the irony of Dr Crippen wibbling on about courtesies. Remind me - what was it you called Christine Beasley?
nurse lecturer said...
It is even more important to observe the normal courtesies of life
I think something in my head just exploded at the irony of Dr Crippen wibbling on about courtesies. Remind me - what was it you called Christine Beasley?
++++++++++
Hello nursey.
Let me try to explain. But first of all, let me remind you that I have variously described Dame C as being "in the money", as being "well-nourished" and also as "Flabby jowls".
Now the explanation. Dame C is a high profile nurse politician who is supposed to be formulating policy to help develop the nursing profession and also, as the chief nurse, supposed to be looking after her own profession. She has been responsible for such arrant botty wipe as "productive ward" which is the kind of psydhobobabble that nurse lectures try to insert into trainee nurses rather than teach them about nursing. Dame C has also just take a gargantuan pay rise when her members, for whom she is supposed to be acting, have been awarded a pay cut.
When you go into high profile politics, you must expect slings and arrows from outraged critics who regard your performance as dire beyond words. Take a look at what the cartoonists do with Gordon Brown. I can't draw pictures to lampoon people so instead I use words. Like flabby jowls.
Looking after a frail elderly patient with diarrhoea, or indeed a woman in labour, is entirely different, and that is when the normal courtesies of life must be adhered to.
It depresses me that you don't understand the difference. But then you are a nursey rather than a nurse and so do not live in the real world. Never mind.
John
Now the explanation
The explanation being that courtesy is not due those people Dr Crippen personally disapproves of. Gotcha.
But then you are a nursey rather than a nurse
You know nothing about me, Doctory.
nurse lecturer said...
Now the explanation
The explanation being that courtesy is not due those people Dr Crippen personally disapproves of. Gotcha.
But then you are a nursey rather than a nurse
You know nothing about me, Doctory.
+++++
Oh dear, oh dear, you STILL don't understand, do you. Patients (I know, I know, you like to call them clients) should be treated courteously.
Politicians, on the other hand, must be prepared to take the rough and tumble of political life. Dame Flabby Jowls is a politician, not a patient
John
Oh dear, does noone know?
What is the NHS guideline that respects patients' wish to be called by the name that they prefer?
Broan, I quite agree with you. It's Mr or Ms/Miss/Mrs until the person insists on first names.
I know, I know, you like to call them clients
You see, this is what happens when you babble on on the basis of what you imagine people think rather than what they actually DO think. Prostitutes and hairdressers have clients; nurses look after patients, always have done always will in my book.
What is the NHS guideline that respects patients' wish to be called by the name that they prefer?
That would be covered by this new guideline, Robinhood.
Brian,
Maybe in your niche it is normal to be called Mr. Surname unless you specify differently. In other cultures this is not necessarily true. I hope this doesn't shock you.
ZT
Thanks nurse lecturer
And I hope it's true.
But - I'm sure there were national guidelines a long time ago, perhaps 20-25 years ago. I recall, as a youth being quite surprised, as my impression was that in those days patients just did what they were told and accepted whatever they were given.
The NMC is right in it's statement that the BNP is a political party and therefore cannot tell you not to join. Could you imagine it if they sent out leaflets banning registrants from the labour party? In any case, I believe that Jackie Griffin is a nurse.
As for the name business. I always address people formally when I introduce myself. I then tell them my first name as that is hoe I am addressed. They usually invite me to do likewise then.
I think it is due to nurses being seen on a more even level with them than doctors.
Brian,
Maybe in your niche it is normal to be called Mr. Surname unless you specify differently. In other cultures this is not necessarily true. I hope this doesn't shock you.
ZT
Dear Anonymous ZT,
Thank you for your concern. I am not shocked. My "niche", as you call it, is that of a middle-aged man, born in South Wales, currently resident in London, having worked along the way in Northamptonshire and Yorkshire. In my "niche", as I have described it, it is indeed normal to address people by title and surname. I would be very interested to know more about the "other cultures" where "this is not necessarily true".
Please be completely honest with me, I really will not be shocked.
Dear Old Gits,
I include my father amongst you (who commands respect as a retired GP would normally receive) (called Dr * senior)
i have posted about this before. I have audited what patients would like to have as their calling name.
Over 99% of my practice prefer to be addressed by their first name. There is no age or class bias. They are welcome to address me as Dr Ian, to distinguish me from my medical relatives. I don't feel castrated by informal calling. My ego is not insulted, we are all human. We are not Dr ; patient we are equal human beings looking at (life threatening) symptoms or issues.
In my view Doctors who insist on 19th century formalities are either old, arrogant or insecure.
Move on Dr Crippen ) I guess you are older than 52 and have either an odd practice population or haven't bothered auditing patient opinion)
Dear Anonymous "Dr Ian",
I have audited what patients would like to have as their calling name.
Is this something you ask patients? If so is it possible they may conclude that the question suggests a preferred response?
Over 99% of my practice prefer to be addressed by their first name.
Do you include babies/ infants/ adolescents in this statement?
They are welcome to address me as Dr Ian, to distinguish me from my medical relatives.
Are they equally welcome to address you as Ian?
We are not Dr ; patient we are equal human beings looking at (life threatening) symptoms or issues.
Do you really believe that Doctor/ patient relations are equal? Do you think that you, with your years of professional education and training, your day to day association with other members of your profession, your professional title, your ability to diagnose, prescribe and treat and a patient who is unlikely to have these advantages are "equal"?
In my view Doctors who insist on 19th century formalities are either old, arrogant or insecure.
Your view is very interesting but apart from the fact that I don't really think we're talking about 19th century formalities I don't quite see how your conclusion follows from the starting point that some doctors think it is polite to address patients by their titles. You haven't really told your readers why you think it's a good thing for e.g. young doctors or nurses, in their 20s or 30s say, to address people in their 80s or 90s say, by their first names. I'd quite like to know what you believe to be good about this informality.
Brian,
Why would Ian object to being called Ian by his patients? Yes, he may have all the training, education etc etc but that doesn't make him better than his patients, as you seem to suggest, so why should he be accorded any more respect than you'd expect to offer anyone else? They may not be equal in terms of education, training and what have you, but Ian and his patients are equal as human beings, right?
Why does asking "What would you like to be called" suggest a preferred response?
I think nmost adults are quite comfortable with being called by their first names, and especially in situations where intimate care is being offered. If someone is wiping my bum, I think being called "Mr Lecturer" would be a little too formal. I would suspect people in their 70s and 80s aren't all that different.
Dear Nurse Lecturer,
Why would Ian object to being called Ian by his patients?
I don't know whether he would or not. He wrote that "his patients" were welcome to address him as Dr Ian. This mode of address includes a title and a name. I merely wondered whether the patients were equally welcome to drop the title.
Yes, he may have all the training, education etc etc but that doesn't make him better than his patients, as you seem to suggest, so why should he be accorded any more respect than you'd expect to offer anyone else? They may not be equal in terms of education, training and what have you, but Ian and his patients are equal as human beings, right?
I was trying to point out that relations between doctors and patients are not equal. In general doctors bring professional power to their relations with patients. Patients do not have such power. As to whether they are equal as human beings, well I'm not sure they are really. For example the human relationship between a fit, healthy doctor and a sick, frightened patient is not equal.
Why does asking "What would you like to be called" suggest a preferred response?
Because of what I have already said about power in the doctor/ patient relationship. I think the question itself is bizarre and its strangeness attracts attention to itself - how many normal human contacts include this question? I think that in most human relationships people switch between modes of address as the relationship develops, not according to some protocol. I think that patients, having noticed that this question is qualitatively different from e.g. "Where does it hurt" might conclude that the questioner prefers a particular response and might also hazard a guess as to what that preference might be. I wonder how many patients, on hearing the question "What would you like to be called" from their doctor would feel that "Mr/ Mrs/ Ms/ ..." was the right response. I do know that some nurses would respond negatively to such a patient - at the very least there would be sneering comments around the nurses' station. More generally there is a substantial literature on the construction of questions for surveys and other data collection activities which demonstrates quite adequately that questions are not automatically neutral. I feel that the what would you like to be called question is not neutral.
I think nmost adults are quite comfortable with being called by their first names, and especially in situations where intimate care is being offered. If someone is wiping my bum, I think being called "Mr Lecturer" would be a little too formal. I would suspect people in their 70s and 80s aren't all that different.
I think that many people find it difficult to respect an incontinent adult and that many incontinent adults find their condition demeaning and humiliating. Some people even think that their incontinence represents a loss of some of the qualities that characterise an adult human. I think that addressing an incontinent adult by their title is a way of showing respect and helping that person to retain their dignity and self respect as an adult. Of course if the incontinent person offers to allow you to call them by their first name you are entirely free to do so.
I would suspect
Well I'm with John Hunter on this: in August 1775 he wrote to Edward Jenner "I think your solution is just, but why think? Why not try the experiment"? Don't suspect, do the research.
I think it is interesting that so many people have commented saying they found the use of a first name patronising. I my self tended to find the use of "Love", "Darling" and god forbid "a good girl" by relative strangers far more patronising and although I dont like to draw comparisions found that this mainly came from the Drs while Nurses tended to ask me personaly what Id like to be called or in some cases reverted to my first name which I had no problem with as long as I was addressing them on the same level! Perhaps in some cases "love" etc are acceptable but as a person with sound state of mind I would far rather the presumption of first name basis than the somehow more intimate and condescending "Love & good girl" (especially from people younger than my self!). There is no way to please everyone but perhaps asking is as close as it gets!
I dont know but perhaps it is more of a gender related issue than a Dr/Nurse issue? unfair as it maybe I think I would probably be less affended by another woman calling me love, honey or darling than I would a man? Im not sure why and would definately not appreciate it in any context but somehow I think it would upset me more???
I think that we have been here before - I'm sure I have previously commented that my GP calls me by my first name (without having asked whether I mind), so I decided quite quickly to call him by his (no Dr before it) and he hasn't raised any objections. Quite honestly, how could he?
One more comment. It has just occured to me that maybe the reason that midwives started calling patients by their first names was because there aren't that many 'Mrs Jones' out there any more and maybe the old school midwives felt a little uncomfortable saying 'Push now, Miss Jones' when they were of the generation that beleived you had to be married to make babies, (especially the spinsters amongst them).
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