Friday, 18 December 2015

The Code

Earlier this year,  new changes were made to The Code for nurses and midwives. The Nursing and Midwifery Council (NMC) has set updated standards that all registered nurses and midwives must apply to their practice.
There has been mixed discussion today from healthcare professionals and from the public, some of whom are in favour of the updated code of conduct and revalidation process; others who believe it to be somewhat condescending towards nurses and midwives. After the Francis Report and the Keogh Report highlighting flaws, concerns, dangers and poor practice across poorly-performing trusts, I find it puzzling that there is so much variation in care delivery across what should be a well-performing, unified organisation, theNational Health Service. Will updating a code of conduct for some of its workforce be enough to drive up standards of care delivery, or is there Something Missing?
I’ve worked in several different trusts as a nurse – both in primary care and secondary care – as well as in the independent sector for a while. Wherever I have worked, there have always been various issues ranging from money shortages, poor standards of care, mistakes, anger and disenchantment, to job dissatisfaction and stress with burnout. I’ve seen the best and the worst of care; with some incredible, caring staff who will go the extra mile for their patients. I’ve heard people say that the NHS runs on the goodwill of those who work within it. I’ve always done my best as a nurse to work to the best of my ability, for the benefit of patients. And if you were to ask any other nurse or midwife or healthcare worker, they would almost always say the same.
I have always said that if I ever stopped caring about my job or my patient, it was either time to change job or leave nursing. I often wonder if standards of care delivered by the NHS workforce reflect the standards of care delivered by the trusts and by the government…if as healthcare professionals we are expected to uphold standards and codes; if NHS Trusts are expected to comply with statutory regulations, targets and standards; what targets, standards and compliance are in place for the top governing bodies and government which control the NHS from the top down? Where does this drive for improvement, delivering high standards of care, behave compassionately and respectfully to the patients begin – the individual, the government – or both? Where does it begin for the staff? Why are staff bullied? Why are there failures in care? Will a code of conduct be enough to ensure that dreadful things don’t happen in the NHS, any more, or is there Something Missing?
I believe there is: one of the fundamental elements of mindfulness practice is based on connection. Connection with the Self. This connection, in the form of reflection or a moment to sit still and contemplate a situation or event that has taken place allows a more meaningful experience. Regular mindfulness practice and other forms of meditation, such as Metta meditation has a positive impact on ourselves: it makes us “nicer”. This connection within, when practiced regularly, can enable us to connect, empathise and act with compassion towards others. I would like to see this connection embedded with everyone, including patients, staff, trust boards, local and national government. The connection works both ways, though – even I struggle with that bit – I find it difficult to have compassion for the current political mess the NHS is faced with, at the moment.
So, this new code…I hear (and connect with) all those who have positive and negative experiences in their care delivery or as a patient; I understand and agree with much of the revised code; but  I also see that mindfulness deserves a high profile space in clinical care, starting with training student healthcare professionals. Influencing our thoughts towards ourselves and how we relate to others begins within. If this happens, who knows: perhaps others will begin to be influenced positively, too – including the public having a greater sense of trust and empathy for what NHS staff face on a daily basis.

Nikki teaches mindfulness and meditation to adults and children, and works as a nurse in an acute NHS hospital.

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