Valuing staff

heather_lawrence-150x150Commissioner Heather Lawrence trained as a nurse before moving into nurse education, HR Management and running healthcare services. Since May 2000, she has been CEO at Chelsea and Westminster Healthcare NHS Trust, a London Teaching Hospital. The lessons learned during nurse training have influenced every aspect of her career:

Do your staff feel valued? As importantly, do you feel valued? We all want to feel valued and it is easy to achieve this if we remember some simple rules of personal behaviour and, of course, create an environment where this is possible.

For me, valuing staff starts with the recruitment process. Selection should be a two-way process – while we want to select the best candidates, the best candidates must also feel that they selected us. The next priority is induction and local orientation, followed by annual appraisal and PDPs. A question that I ask managers at interview is “how many of your staff know you?”

I am always asked how I know so many members of staff. It is quite simple. I believe it is important to be approachable, to say hello to people and to ask how they are. They nearly always tell you something interesting or useful. Effective two-way communication will also help staff feel valued.

A monthly team brief followed by a face-to-face cascade system, a daily news bulletin and a monthly newsletter all help. Individual staff members and teams can also be recognised through employee and team of the month awards.

When patients write to express their gratitude to a staff member, ward or department, I write to each member of staff to thank them – it is important to recognise the positive as well as the negative feedback.

In clinical areas where there is clear leadership, teamwork, good communication and face-to-face meetings – rather than relying on e-mail – staff feel more valued. Each of us can play our part by just asking people how they are and using those two simple words: ‘thank you’.

As we move into a period of less growth and higher cost improvement targets, it is essential that we have transparency with staff concerning the issues we face and that we work together to ensure all staff feel valued, even when we are asking for more productivity and more efficiency. If we do not, then patient care will suffer and staff will feel less valued.

8 Responses to “Valuing staff”

  1. Thank you for the practical wisdom of new leadership where managers engage more openly with the workforce. My recent evaluation of work-based learning of qualified nurses in the SW region identified some managers with similar qualities but others that need to develop the phronesis. As an academic running action learning sets for uni and interprofessional learning sets in local Trusts I have witnessed the ‘buzz’ and pride when I have invited managers (consented by the learners)into the learning sets to hear at first hand any barriers that may be perceived regarding change. Often the learners see a new window of opportunity opening up when they can see active listening and exchange of ideas and positive feedback. This is the new leadership.

  2. All staff would love to feel valued and should. If managers were not as pressurised by unrealistic targets and budgets there may well be a better communication with the staff on the ’shop floor’. At the end of the day if we are not continually bombarded with targets produced by people who have either a) never nursed or b)been away from the wards so long the have no idea what modern nursing involves maybe staff can be appreciated for what they do.

    As a nurse I try to give my best to every patient I am in contact with, the time I get with them is decreasing rapidly because of paperwork, audits and essential documentation. Value comes with being able to have the time to do our jobs something that we just don’t have.

    However you communicate 1 nurse to 30 patients is just not enough. Staff can be as efficient as you like but something will always suffer and without appropriate documentation our registration is on the line so, with deepest regret, patients suffer.

  3. I have read with interest the comments regarding valuing staff and for the first time I have given my opinion as a ’shop floor’ worker.

    I joined my community nursing team one year ago. My induction into the service has still not been completed. This is due to increased work load and reduced staff.

    Besides the increased work load and complexity of care being needed in the community. Due to earlier patient disharges to help meet government targets and reduce hospital acquired infections. We have also had ’system 1′ thrust upon us as a computerised record keeping tool. We were told that it was a ‘patient centered’ tool that would be of great advantage to the patients and the multi-disciplinary teams by providing a single point of reference for the patients care records. However, it has caused more problems than benefits. We have not been given time for this “essential” computer inputing. Nurses still need to keep full written notes in the patients home because the system one notes are being completed retrospectively, sometimes weeks after the event. Nurses routinely work through their lunches and stay over at the end of their shifts, without pay, to try and complete their documentation. We are told by our managers that we cannot claim overtime and time owing is impossible to get back because of the increaed work load and decreased staffing levels. This is both draining and demoralising.

    There is minimal face to face contact with management and e-mails we receive are usually to complain not praise. To give one example; instead of the above mentioned system 1 being used as a patient centered record of care tool it appears to be being used as a time and motion monitoring tool. Managers are expressing more interest in the number of visits done, and timing of the visits. But, they are not realising that the system 1 notes are not always up to date because we are out visiting patients. I understand that we need to prove our worth to GP’s, but when we speak to the GP’s they always say how much they value our service and tell us about the excellent feed back they get back from their patients and their relatives. Our management only send us e-mails complaining that we are not completing the system 1 visit timings correctly. There is no recognition for the unpaid extra duty we are doing to even complete this work. Again, enforcing the feelings of being under valued.

    Media reporting does not help the nurses cause. We are blamed for the increase in hospital acquired infections and there is a constant media call for more cleaners. But, since the move to contract cleaners in hospitals the cleaning they do has been reduced and does not include cleaning up human waste. Instead this has been added to the nurse and the health care assistant’s tasks. It is this ignorance about the demands on the nurses and health care assistants that reduces the publics awareness and repect for what we do.

    While junior doctors have had their hours reduced. Nurses have embrassed this as an opportunity to develop their professional status. But, as the nurses roles developed staffing levels have not increased to accommodate this increase in our responsibilities. Instead it just appears to have been a cost cutting scheme.

    I entered nursing with a strong devotion to provide the best patient centered care that I could. I worked hard as a student because I was proud to be entering this profession. However, with the continued increased work load, reduced funding, the endless battle to just get the resources that are needed to provide the care that the patients both need and deserve is draining.

    Moreover, our salaries do not reflect our professional status. A fire fighters salary is; fire fighter trainee – £20,396, fire fighter development – £21,245, fire fighter competent £27,185.
    Police salaries on commencing service is £22,680 and increases to £25,317 after just one years service, then increases annualy to far more than a nurse will earn without moving into management. Unqualified teachers can earn £24,453, there main pay can be £30,842. Also, teaching benefits include more days’ holiday than in most other professions, a final salary teachers’ pension and housing help.

    Immagine the increase in nursing recruitment, feeling of being valued and staff retention. If only we could offer salaries and benefits like those given to other public services professionals.

    I could continue all day and give reasons why nurses feel under valued and demoralised. But, I will resist. After everything I have said I love my job, I care deeply about my patients and I have kept my committment to provide the best patient centred care that I can. I just wish that the people with power would come down to the ’shop floor’ more often and hold a forum where nurses can speak without direct management being present therefore facilitating open an honest discussion. And that salaries refelcted our professional role.

  4. Do we feel valued? We are entering into a further period of cost restraints and target driven value for money spent, on our patients on staff investment in training and most of all our ability to further enhance the patient experience.I am now entering into my fourth decade in nursing.I am at this time a Matron working in servcices for older persons in Mental Health.We need to balance all the drivers within areas of education, workforce planning and service delivery.
    I have trained and retrained over the years I have seen all types of educational rethinks and ways of working.I recently asked a group of seniors like myself, what brought you into nursing and what makes you stay with all the frustrations we encounter?
    The general response was.
    I have always wanted to nurse.
    I want to make a diffrence.
    I want to teach and pass on my skills.
    I want my community to be as healthy as possible.
    I want the knowledge to do thinks correctly.
    I want to make a diffrnce to my community.
    I need to earn a living and support my family.
    I belive by training I can do my Job safely and with expertize.
    Patients will always need a nurse to take care of them to support them through illness to recovery,or in there final hours when no one else is there, to be present in the final moments of life and to enable that person to be unafraid.
    I had the oppertunity to ask a group of new nurse recruits the same question.
    The interesting thing is with an almost 30 plus years in the diffrence of experience,the new nurses stated almost exactly the same group of values and reasons for wanting to nurse.
    Managers who are also part of the team they want to understand the challenges and assist the delivery of safe and effective services.When things go wrong we need to answer things in an honest and open way, part of a managers job is to ask the difficult questions and walk the patch,staff on the shop floor need to see senior personel as part of the team.Not so removed that they are unaware of the daily struggles of all clinical and non-clinical staff.In saying this nurses need to use the oppertunity to feed back the positive aspects and not just whats wrong, a balance is called for.As to the value of our staff teams, nurses particularily in mental health don’t often hear to many positives back from the patient group.It is and will always remain I believe one of the most challenging branches of nursing but one were the delivery of care has moved so far in the last few decades.I value all the varienies of this service including medicine,therapists,social care and all the support sevices that deliver the levels of care to diffrent groups.We need to ackowledge that the commissioning of such diversity in services to mental health, has enabled great changes for our patient group’s.So as a final thought managers are and need to be in the position to do what they need to to support and assist clinicians to carry on delivering services sometimes in a changed way but always with the patient at the center.

  5. I am a health visitor with more than 3 decades of experience. I can chart the critical differences health visitors make to the lives of the client groups we care for and work in partnership with. Each time I have read the blogs I feel excluded, actually I do not feel valued – why – because my profession and the voice of health visitors is not represented on the Commission; the blogs make no reference to the profession – we seem to have dropped off the horizon! What are the reasons for their exclusion from the Commission’s membership? Were any health visitors invited to serve on it? What does the exclusion signify for the future of the profession?

  6. Similarly, it seems that way for school health nurses who are key in providing care in collaboration with health visitors, GPs etc and work across the boundaries of agencies and disciplines. When
    cases such as baby P happen, there is an outcry. However, there is good research evidence that interprofessional working cannot happen unless supported by and espoused by those in leadership and management positions -T.Pettigrew (1998) ‘Intergroup contact theory’ in Annual Review of Psychology 49. 65-85. However, if those in leadership and management neither support IP working explicity, jealously (and counterproductively) guard the uniprofessional status of professions (as does the NMC) or do not even acknowledge the value, contribution and existence of staff, such as HVs and SHNs then baby P will happen again.

  7. Reading through the comments here its clear that the systems and controls in place to manage quality, delivery and budget become such a burden that people do not get the recognition they deserve for what they do actually achieve. All too often the emphasis on what hasn’t been done, what isn’t in place yet, what needs to improve. This approach which could be called “contiunuous improvement” has to recognise progress made in smaller ways on a daily basis.

  8. I can only echo everything that you have said in your article Heather. I think that valuing staff is a crucial element in the success of any organisation – and comes into particular focus in the healthcare sector where often peoples lives are a stake. Sadly, i have heard many negative stories from friends in the health service who continue to be treated unfairly – it seems like there is a long way to go until the situation is remedied.