A need for nurses to have a stronger say in steering fundamental care

The COVID-19 pandemic signalled that our health system needs revision and greater resources to prevent it from buckling when crisis strikes. Most importantly, the pandemic showed that the fundamentals of care are not being adequately addressed – and the nursing profession is demanding a seat at the negotiating table to ensure this critical problem is rectified.

This call to action has been outlined in a statement from the International Learning Collaborative (ILC) titled “No more heroes: The ILC Oxford Statement on fundamental care in times of crises”. It underlines the role and value of nurses, especially in delivering care that brings kindness and empathy, and highlights the need for nurses to be at the centre of discussions that determine the provision of care.

Professor Tiffany Conroy, Deputy Dean for Nursing Leadership and Innovation and the Academic Lead for Nursing in the College of Nursing and Health Sciences at Flinders University, is also a steering group member of the ILC and was part of the team that wrote the “No More Heroes” document, along with Flinders University’s Vice-President and Executive Dean of the College of Nursing and Health Sciences, Professor Alison Kitson.

“This is such an important issue because care has been neglected and it doesn’t have a strong enough profile. It’s seen as something nice, rather than necessary,” says Professor Conroy.

“We know that good fundamental care which addresses people’s core needs actually improves their experiences and outcomes within the health care system. Nurses are experts at care provision. That’s why most of us went into nursing. We want to claim this responsibility back, to take ownership of care and make sure that it happens properly.”

Professor Tiffany Conroy

Professor Conroy says the necessity to say this now has been underlined due to the COVID-19 pandemic and the critical role that nurses played in serving the community. “Nurses were cannon fodder during the COVID pandemic, and it shows such a lack of respect for the profession that they were thought of as expendable, that they could do 18-hour shifts and be expected to survive it all. Those that did are paying the price for it now.

“So many decisions were made without nurses being a part of them, yet the nurses were the ones with the patients 24/7, providing most of the care. Their thoughts about what needed to happen were not heard, and they weren’t invited to be a part of those crucial conversations. I think that’s wrong.

“Nurses are being asked to do so much more within the health care system, and we have to make sure that fundamental care is once again prioritised by nurses.

“This is not about hero worship of nurses. It is about recognising their expertise in these jobs, and valuing the outcomes of the fundamental care they provide.”

Professor Conroy says the International Learning Collaborative was established 13 years ago to make fundamental care a priority, because its members could see that health services were focused on through-put and clinical outcomes, rather than the care of people.

She points to important crisis events that identified shocking breakdowns and failures of adequate care within health systems – including at the Oakden aged care facility in South Australia that led to a Royal Commission in 2019, and at the Mid Staffordshire Hospital in England which prompted a fulsome inquiry during 2013.

“These situations highlighted humiliating, degrading circumstances that occurred because there was a focus only on the medical model and the management of people rather than caring for people,” says Professor Conroy.

“There is a crisis in health, and there’s no way it is going to get fixed unless nurses have a seat at the discussion table, rather than just being on the menu.

“If we place greater value and prioritise fundamental care, we can fix a lot of the problems, but we also know that if nurses are not given the capacity to deliver that care, they leave the profession – which only compounds existing problems.

“We know that care from nurses is what patients value. They don’t remember what medication they got; they remember the people who made sure they were clean and fed, who were kind to them, and who made them feel safe.”

Professor Conroy believes the ILC statement can prompt a louder voice from nurses, to confidently assert they can help fix the ongoing health crisis.

“It’s a sobering fact that we now know there will never be enough nurses to deliver the amount of care that people require, but that doesn’t mean we are abdicating responsibility for that care,” she says. “By identifying what is needed in fundamental care, we will come up with solutions on how that care is delivered.

“We do have the answers, but now we must be included in the decision making.”

The paper – ‘No more heroes’: The ILC Oxford Statement on fundamental care in times of crises, by Alison Kitson, Tiffany Conroy, Lianne Jeffs, Devin Carr, Getty Huisman-Dewaal, Asa Muntlin, Eva Jangland, Mette Grønkjær and Jenny Parr – has been published in the Journal of Advanced Nursing.

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Fundamentals of Care