Salt and Light after the Francis Report: What Does it Mean for Christian Nurses?

The horror stories that emerged from the evidence gathered in the series of enquiries into the failure of care at Mid Staffordshire NHS Trust have shaken the long held national belief and trust in the NHS. Horror stories of patients left in soiled bedclothes because nurses were too busy to take them to the toilet, people being triaged by A&E receptionists, others being left unable to reach food or drink and literally dehydrating and starving to death.  The catalogue of neglect makes for horrific reading.  Hundreds, if not thousands of patients, are thought to have died and suffered unnecessarily as a result of poor care at just one hospital.  At the time of writing, thirteen more NHS Trusts are under investigation after patients and staff raised
concerns about care standard.

The second Francis Report published in February sought to address the reasons for wider, systemic failure to police the care standards at Mid Staffs and across the NHS.  The Trust management are castigated for a blind focus on targets and cost savings at the expense of frontline staffing and quality of patient care. The professional bodies (most notably the Royal College of Nursing) are attacked for a failure to
support or take seriously whistle-blowers.  Other regulatory bodies, professional bodies, educational institutions, the NHS Executive and the Department of Health all come in for criticism.

Francis makes 290 recommendations – it is not a short or easy read, even for a public inquiry, which means, sadly, that few if any of them will ever be taken up.  Central to his recommendations is that transparency becomes a legal duty for NHS trusts and professional bodies – a ‘duty of candour’ should be legally enforced on all NHS staff, requiring honesty about mistakes.  Furthermore, gagging orders to stop disclosure of ‘unpleasant’ stories in the media should be made illegal, and professional bodies must be more
proactive in supporting whistle blowers reporting on failures of care.

The other central theme is that there needs to be an overall culture change in the NHS that puts patients and their needs at the centre of the system. This seems so fundamental that the inquiry’s need to state it explicitly and in detail suggests how far NHS structures and institutions have drifted away from their original purpose.
Significantly, while good leadership is vital to this, Francis makes it clear that the culture change is the responsibility of every NHS employee, from ‘porters and cleaners to the Secretary of State’.  It is a bottom up change, not further top down restructuring that the inquiry advocates.

Sadly, the government’s response seems to have missed the boat on this last theme, focusing instead on the exact opposite – more top down regulation with yet more new sets of quality targets, a new inspectorate for hospitals, and a proposal that nursing students be required to spend a year before training working as care assistants.  Legal measures to stop NHS managers responsible for failing trusts being re-employed in the health service and a legal duty of candour on health professionals and institutions finish off the main responses from government.

It is hard to be in nursing in the UK at the moment, as it seems everyone is blaming us for the systemic failure of the health service.  But it cannot be laid at the door of a single profession or single set of values or government policies.  It is institutional sin at its worst – a culture within institutions and professions that promotes the needs of the providers over the needs of patients.

Paul reminds us that ‘our struggle is not against flesh and blood, but against the rulers, against the authorities, against the powers of this dark world and against the spiritual forces of evil in the heavenly realms’ (Ephesians 6:12).  There is a spiritual side to this – something of the enemy that blinds even the best of us to the truth at times.  So first and foremost we need to pray – for our professions, our workplaces, our managers, and our political leaders.

But most of us go into nursing because we are compassionate people. As Christians we also have the strong motivation to do as Jesus taught us – to do for the least of those in need what we would do for Jesus himself.  So we also have a prophetic responsibility to speak truth, to be whistle-blowers, to care in a different spirit when those around us seem to have lost compassion, and to encourage, commend and work alongside those who are caring to the highest and most compassionate standards (Isaiah 1:17, Psalm 82:2-4 and Proverbs 31:8-9).

We need to be salt and light in the NHS more than ever, and to win back trust from the public.  It will take prayer, it will take faithfulness and courage and it will take leadership. Above all, it will take time. This may seem impossible, but with God, nothing is impossible (Matthew 19:26).

What can you do? Start with prayer. Start everything with prayer.  If you can, find one or two others who will pray with you—and pray for others who will also join you to pray, who will act with integrity and courage and compassion.  Pray for your workplace, your colleagues, your leaders, your patients.  Let God transform your workplace one person, one prayer at a time.  Ask God to show you the way—at whatever level you work, from student to Charge Nurse, from Director of Nursing to Staff Nurse.  It doesn't matter that you feel you cannot make a difference—God can, and he uses those who doubt their own influence and voice to speak, if they will just trust him to speak.

And, above all, do not despair, but trust God and seek to honour him wherever you work.  This is a golden moment for God to work in our health system.

Steve Fouch

A Nurses Prayer...

A prayer from Mother Teresa and used by her Sisters of Charity in their care for the sick, poor, and dying:

Dearest Lord, may I see you today and every day in the person of your sick, and, whilst nursing them, minister unto you.

Though you hide yourself behind the unattractive disguise of the irritable, the exacting, the unreasonable, may I still recognize you, and say: "Jesus, my patient, how sweet it is to serve you."  

Lord, give me this seeing faith, then my work will never be monotonous. I will ever find joy in humoring the fancies and gratifying the wishes of all poor sufferers.

O beloved sick, how doubly dear you are to me, when you personify Christ; and what a privilege is mine to be allowed to tend you.

Sweetest Lord, make me appreciative of the dignity of my high vocation, and its many responsibilities. Never permit me to disgrace it by giving way to coldness, unkindness, or impatience.

And O God, while you are Jesus, my patient, deign also to be to me a patient Jesus, bearing with my faults, looking only to my intention, which is to love and serve you in the person of each of your sick.

Lord, increase my faith, bless my efforts and work, now and forevermore. Amen.

NCFI Cares

Rest in Faith

A boat is traveling across the sea when the wind and waves begin to knock the boat around. Most of the people on the boat are fearful as the waves bring water into the boat. Yet, one passenger is asleep on a soft cushion below the deck of the boat. The storm continues and the boat begins to fill with water. All the passengers are in a panic except for sleeping passenger (Mark 4:35-41).

Our nursing boat is often rocked by a storm. The storm can be a change in funding, challenges to patient care, or not enough staff. We can quickly feel overwhelmed by the winds of change and the rising water of uncertainty. In fact, nursing and health care are always experiencing some type of storm.
         
Just as Jesus rested in confidence on the storm-rocked boat, we can rest in him. Jesus cares about health care, nursing, and our patients. He will continue to guide us and provide for you, me and our patients. So, when we find ourselves in a health care storm, we can rest in faith and God’s promises to provide.

Carrie Dameron

NCF (USA)

Look for NCFI Cares every 2 weeks from Nurses Christian Fellowship International

Francis Report: Some thoughts for Christian Nurses & Midwives

Today’s long-awaited publication of the second Francis Report into Mid-Staffordshire NHS Trust is being hailed by many as a watershed in the National Health Service.  Whereas the four previous inquiries into the failure at Mid-Staffs focussed on the specific failures of the hospital staff and management, this second report from Robert Francis QC focusses on why the many checks and balances in the NHS regulatory system so completely failed to pick on the problems.

The report highlights a massive managerial, cultural and organisational failure not just at the trust, but in commissioning bodies, professional bodies, training institutions, the NHS Executive and the Department of Health.  Somehow or other, every part of the system had a vested interest in ignoring or marginalising reports from staff who were raising concerns about the failures at Mid-Staffs. 

Of particular concern to nurses are the failures highlighted in the Royal College of Nursing in its role as both a professional body and a trade union.  It failed to support whistle blowers, and failed to take seriously the issues its own members were bringing to its attention.

As Christians we are obviously concerned to show the love and compassion of God to our patients – it’s why we went into nursing. But as a report on the BBC Radio 4 Today Programme this morning highlighted, so many nurses and midwives across the NHS even now struggle with staff shortages, target culture and pointless bureaucracy which constantly put pressure on them to spend less time and energy actually caring for their patients’ needs.  One midwife sadly said that while she loved being a midwife, her advice to anyone training today would be to seek as soon as possible to practice anywhere other than within the NHS or the UK!   All those speaking in this report wanted to remain anonymous and had their words spoken by actors – such is the climate of fear many feel in the NHS.  To speak out is to jeopardise your career.

This sounds very dispiriting, and I hear other stories regularly of very good care, and of nurses and midwives loving their work and working environment.  But so many also report their struggles with a system that tries to stop them caring.  Francis challenges this, proposing that openness and a culture of transparency are vital for the professions and institutions in the NHS. Speaking out for the poor and the vulnerable is a core calling for all God’s people, and we should be the first in line to speak out appropriately when things are wrong. 

The report also challenges all NHS staff to change the workplace culture away from protecting the institution and its priorities and towards caring for the patient and their needs.  It seems shocking that this needs to be said in this day and age, but the evidence of the report suggests that too often it is the protection of organisational interests that trumps care for our patients.  

Christians are called to show compassion to all who are in need, and to be salt and light wherever we find ourselves.  How can we be agents for change in our places of work? How do we each day model to our students, our colleagues, our managers and our juniors how to truly care? What values and priorities do we bring to the workplace each day, and how much do they rub off on those with whom we work?  It goes both ways, of course, so we need to be regularly filled with the Spirit and fed on the Word if we are going to come in a different spirit.  For that we need not only our churches to support and pray for us in our work – we need to seek each other out and support and pray for one another.

We will be waiting until March to hear what the government is going to do – how many of the Francis Report’s 290 recommendations it will actually put into practice waits to be seen.  But the report makes one thing clear – it will be bottom up change from ordinary staff that will truly revolutionise our health service, not more top down reforms. That is a challenge to us, to be the hands and feet of Jesus in the NHS and be his agents for change.

Nursing - Unchanging Values in a Changing World

A couple of months ago, a number of nurses met together at our regular London Refreshment Dinner where a retired nurse shared her experiences of nursing in the UK during the years of 1971 – 1996.

What was it like nursing in the 1970’s?

 I vividly remember my first day! On arrival a porter took my bags to my bedroom, where I found my uniform laid out on the bed. That first evening all ‘fresher nurses’  donned their uniforms and learnt how to make beds,  something that epitomized the apprentice training that we were about to undertake.

Another memory. The ward layout was different.  Most patients were nursed on Nightingale Wards. These wards had about 15 beds on either side, with the nurses’ station situated somewhere in the middle. Because of this layout, it was rare for a nurse not to be in the ward at all times. Added to this, there were no buzzers and so nurses were dependent on patients calling out for help or assessing a patient’s condition as they passed by.

Looking back – What ethos helped you care for patients in the 1970’s

Teamwork – Nurses worked closely together to get their work done. There was a camaraderie that said ‘that we could cope with anything as long as the team worked well together’!  On some wards, nurses were not able to go home at the end of their shift until all their colleagues had finished their work too. 

Authority and discipline. Sister was the person who took responsibility for overall patient care. This meant that as long as a student/nurse followed her instructions, they were free from fear of being disciplined.

Kindness and honouring patients. We were taught to treat patients as honoured guests. That somehow, the ward was seen as a place where nurses were ‘practicing hospitality’ and where kindness was practiced and encouraged.

Were there special moments?

There was a patient who had been unresponsive and unable to speak for many months due to a cerebral haemorrhage. On the day of Prince Charles's wedding to Diana, the ward was celebrating the occasion. The day-room had been decorated and patients and staff were all watching the event unfold on the television. This lady too had been wheeled into the day room. As she watched the television she was fairly unresponsive. Then she suddenly said ‘look there are the horses’. For me, that was one of my most precious moments.

Do you think it was easier to share your faith during your time nursing?

Yes, because people were more accepting of the Christian faith. In fact, in the hospital where I worked, prayers were said on the ward at 08:00 every morning.  I also had a time when I prayed with another Christian nurse who worked on the same ward. I believe that this led to opportunities to share faith with staff, patients and relatives.

Is there a specific example of you sharing your faith with a patient?   Yes. One patient came back from Easter day, and asked what it meant that Jesus had risen from the dead. I sat down and explained what the resurrection meant, and she wonderfully became a Christian! I do want to say, that opportunities like that were very rare.

  

What advice would you give to Christian nurses today?

Well, Nursing today is very different but God’s timeless truths are relevant for all Christian nurses at any time, any place! And so I want to leave you with two thoughts.

The first thought comes from 2 Thessalonians1:11 & 12.

In these verses Paul is praying for the Thessalonians who are going through a tough time because of their faith. And so he prays that they will continue to live Jesus’ way in hard times so that -  God would count Christians worthy of his calling.  This sounds like an impossibly high call to achieve doesn't it? But the truth is that we are not alone.

Paul continues teaching us that God is the one who will enable us to do this. It will be God who will give us the power to fulfil every good purpose and every act, as we are prompted by our faith. In a nursing context, this means that our faith in Jesus will prompt us to care for our patients and others (both in the little things and the big things) with Jesus in mind.  It might even mean going against the flow of popular opinion at times.  But whatever situation we find ourselves in, we can rely that God will give us all we need. 

Amazing!

As this happens, something will happen to us. The name of the Lord Jesus will be glorified in us and us in him.  In other words, what is at the very heart of Jesus, the beautiful, sacrificial heart of Jesus will shine in us, and furthermore we will know more and more that we are in Jesus. It is like a two way traffic. You see as Jesus shines in us so we know more and more that we are safe in Jesus.

What is more, Christians will know that they can take no credit for what happens, but that it is all due to the gift of on-going grace from God the Father and the Lord Jesus Christ. When Paul’s prayer is answered in our lives, we as Christians can’t lose, and many others will gain!

Second thought. Your smile goes a long way!

Our Willing Hands

While Jesus was in one of the towns, a man came along who was covered with leprosy. When he saw Jesus, he fell with his face to the ground and begged him, “Lord, if you are willing, you can make me clean.” Jesus reached out his hand and touched the man, “I am willing,” he said. “Be clean!” And immediately the leprosy left him.” (Luke 5:12-13, NIV 1984)

The nurse will find it easy to apply this short story from Luke’s gospel to him- or herself. We have made it our daily duty to be willing to clean, serve and heal the sick and the dispirited. The committed Christian nurse will find it easy to use this account as a sharp rebuke, “I must be more like Christ as I work! I must show the compassion that Jesus shows here!”

We quote in ferocious and exasperated tones to ourselves the poem by St Teresa of Avila:

Christ has no body but yours,
no hands, no feet on earth but yours,
yours are the eyes with which he looks compassion on this world,
yours are the feet with which he walks to do good,
yours are the hands with which he blesses all the world. 

 As we grow in our love for Jesus, we grow in a deep desire to serve him as we minister to the frail elderly in the nursing home, the dying young man for whom older parents keep a worried vigil at home, the shocked family around the ITU bed, the labouring mother. And so this story of Christ and the leper becomes our model, our duty, and sometimes, our burden.

This is not wrong. Christ is our model; to serve him, our duty; to share in the suffering of others, our burden. But, the problem in applying this story in that way is this: we are not intended, at least not first, to see ourselves as Jesus. We are not first, the compassionate healer. We are not first, the source of cleansing, reconciliation, hope and peace. We are first, ourselves, the lepers. We are wounded, broken, outcast, unclean. We are those who need to hear the concern in his voice, feel the tenderness of his touch, and receive the spiritual cleansing that he willingly provided as he laid his life down for us at Calvary.

Before we aim to be like Jesus in our work, we must first model ourselves on the leper. We must see Jesus, and do so as the leper does. When the Nazarene carpenter walks by, the leper does not simply look upon the good teacher or the wise man. He sees his Lord and his only hope for restoration. He does not fear to cast himself in humility at the feet of God, seeking a kindness he knows he does not deserve. And, (what sweet relief!) he does not find Jesus lacking in compassion, mercy, willingness or healing power.

Before we use our willing hands, we must first receive the willing touch of his. Easter affords us the opportunity to remember that out of his love for those who were far away from God, Jesus resolutely faced the horrors of death on a cross, so that we, the damaged, the sinful and the needy might be healed and reconciled to the Father. Let’s worship the Lord of compassion with the humble manners of the leper, and marvel at the response of Jesus, “I am willing.”

Nothing short of an encounter with Jesus like this one will be able to sustain us to do His work.

Dimity Grant-Frost

CNM Student Staff Worker

Living Counter-Culturally for Christ in Nursing & Midwifery

As I write this I am uncomfortably awaiting the arrival of my second son in 2 days’ time and regard with fondness – and rose-tinted glasses – those days when at the end of an exhausting shift I could flop into bed, snuggle down and sleep soundly until the alarm woke me next morning / afternoon / evening!

When Christian Nurses & Midwives was launched I was working for the Universities and Colleges Christian Fellowship (UCCF) as their Staff Worker for student nurses and midwives (Christian Student Nurses & Midwives, or CSNM). Since then I have worked in a central London church as their women’s worker; got married; seen a little of missionary work in Latin America; been privileged to study theology for a couple of years at Oak Hill Theological College alongside my husband, and have spent the last three years getting to grips with being a mother to a lively little boy.

During this time I think the question that has been looming ever larger in my mind is what does it really mean to say 'Whatever you do, work at it with all your heart, as working for the Lord, not for men', (Colossians 3:23). What difference does the gospel really make to the way we live and think, to our priorities and values on a day to day basis?

When I took up the post of Staff worker for CSNM I inherited the organisation of a conference entitled Counter-Cultural Living. I don’t think I realised then the enormity of this phrase, or the astute diagnostics behind its selection as a conference theme; In particular in my three years as a women’s worker I saw on a daily basis the way in which the gospel had become something we added to our lives instead of the thing that transforms every bit of our lives.

It is all too easy to begin with the situation we find ourselves in and then ask how does the gospel apply? How do I act as a Christian faced with these set of circumstances?  But in truth Jesus says to us seek first his [God’s] kingdom and his righteousness (Matthew 6:33). Instead of saying “I am Christian in a place where I cannot talk to my patients about Jesus, so how then should I conduct myself?” we should be saying “Can I be a Christian in a place where I cannot talk to my patients about Jesus?” This will inevitably mean making the kind of sacrifices that we’re unused to making (for example are there jobs that Christians ought not to be doing?), and trusting God in a way we’re unused to trusting Him (how will people in those places come to faith without us there to witness to them?).

CNM has tried to support and encourage its members in this task of counter-cultural living within the workplace. I pray that it has been of help to its members over the past ten years, but sadly we have always struggled to increase our membership and so our impact on the profession has been minimal. Given the current anti-Christian enviroment, the need for CNM has never been greater because it has never been harder to be a distinctively Christian nurse or midwife.

One thing I think CNM can do is to encourage our churches to help us more specifically in this task of approaching our work Christianly and then to be ready to support us when we face serious trouble at work as a result. This will help CNM members lead the way in restoring the gospel to the heart of healthcare and should encourage other Christian nurses and midwives to join the vision of CNM and count the cost of discipleship.