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‘It’s too easy, a lot of the time, to blame policy, the ward environment, the fact that the trust is short of funds or whatever it is – that doesn’t mean you can have a conversation over the patient, that doesn’t mean you can walk by a dirty commode without doing anything about it,’ she said.

Pippa Gough, a nurse and assistant director of clinical quality at the Health Foundation, said that feedback and communication between colleagues – both nursing and medical – was key to acting as a good role model. For example, if a colleague began talking over a patient, you should not only discontinue the conversation but take them aside afterwards and explain why you had done so.

‘That sort of minute by minute, small, timely feedback is really important in terms of developing role modelling,’ said Ms Gough. ‘If everyone is able to give that very clear feedback, everyone – doesn’t matter if you are doctors, nurses or a multi-disciplinary team – is going to start behaving differently.’

Ms Cook acknowledged that acting as a good role model in the modern NHS was not always an easy task. ‘The pressures that are on nurses in the working environment will make them more or less easily able to do this role modelling. And, yes, it does get damned difficult. I think it is much harder than it ever was when I was working on the wards.’

Howard Catton, RCN head of policy, development and implementation, also noted how hard it was working under the pressures that frontline nurses often had to cope with. Most of the time, the right people with the right values were being recruited into nursing, he said, despite suggestions that some presumed tenets of nursing, such as compassion, had been watered down.

Referring to the introduction of compassion testing for nurse recruits at some trusts, as previously reported by Nursing Times in April, Mr Catton said: ‘By and large we do get the right people in with the right values and the right ambition, and wanting to do well and all the rest of it, but they get ground down by “compassion fatigue”.

Speakers suggested that with the right support good role models, if they wanted to, could go on to become good nurse leaders as well. ‘Part of being a role model is imparting confidence, which is hugely important again for leadership,’ said Ms Gough.

One initiative that has also helped promote nursing leadership by giving nurses at ward level more control over their service environment has been the Releasing Time to Care: Productive Ward programme. Launched in January 2008 by the NHS Institute for Innovation and Improvement, the ‘Productive’ tools and techniques are now being expanded into a range of healthcare settings.

‘There has been a huge amount of enthusiasm and a change for a lot of people in their feelings about going into work – the control they have over their environment, understanding how they are performing, having access to improvement tools and meaningful real time information which allows them to increase the quality of patient care.’

‘We are now at the stage where, against the economic climate as it is the moment, SHAs will inevitably start wanting more for less,’ she said. ‘How do we engage and ensure that organisations continue with the programme and do not see ‘Releasing Time to Care’ as a project that they invest in for a limited amount of time, but as a vehicle for long term quality improvement and cultural change?’

Mr Catton said the commission had to recognised as a ‘huge political opportunity’ but said he wanted to see ‘bigger ambition’ from its remit – such as looking at how nursing would be affected by the wider NHS quality agenda and the current economic downturn.

Ms Cook also questioned another part of the commission’s remit, which deals with the development of nurse-led services – and in particular the increased use of the social enterprise model, which was also highlighted in the NHS Next Stage Review.

She said there were several questions to be answered around nurse-led services. For example, there needed to be a distinction made in the importance between innovation within the NHS and more risky independent ventures such as social enterprise schemes.

‘Although it’s the minority and not the majority that will end up working outside of the NHS, the vision that this government has for lots of nurse-led services and social enterprises, that’s where you will get “naked professionalism”,’ she said. ‘They are not surrounded necessarily by the sort of team you would get in a hospital or NHS service, so there’s nothing between them and being struck off but their own professionalism.’

Ms Gough questioned the use of the term ‘nurse-led’ itself. ‘The problem for me with nurse-led models of care is this thing about autonomy – are they truly nurse-led or who else do they need to get in on the act to enable nurses to make decisions?’

Ms Gough added: ‘The “real politic” is that not many nurses have total decision-making power in terms of the way care is organised – the reality is you need to be able to negotiate really skilfully and influence really skilfully to push through the ideas that you think are important and place those in the context of other people’s ideas.’

However, Ms Cook disagreed on this point. ‘I think nurses know that and do that – nurse-led practices are a good example,’ she said. ‘They employ the GPs, they employ other people. There is real pragmatism about that. I think the danger is when nurse-led is used as a slap in the face for doctors, and sometimes that is what it’s about. All this promotion that nurses can do everything is basically unhelpful.’