Care is our business
Joan Pons Laplana, RGN - Proud Nurse, NHS Change Day Care Maker
Why the 6Cs?
The roles of nurses, midwives and care staff have significantly changed in recent years. We have learned new skills and our responsibilities have increased accordingly. These changes are set in a broader social and economic context of greater demand for health, care and support, and the need to make the most of every penny available for people’s care.
Unfortunately, the 2013 Francis Report told a story of appalling patient care within a culture of secrecy and defensiveness [1]. The inquiry focused on one organisation, but highlighted a whole system failure, making 290 recommendations to address this.
One of the key recommendations is that NHS staff should be tested to show how their values and behaviors meet those of the NHS Constitution. These have been encapsulated in the ‘6Cs’ (Box 1), and are not new.
The 6Cs define a vision for nursing which reinforces the values and beliefs that underpin care, wherever it takes place. It provides an easy-to-understand way of defining nursing values and holds nursing and other staff to account.
Why are they important?
I understand why people can be initially very sceptical about the 6Cs. But let me tell you a story to show you why they are so important.
I started my career as a nurse for the wrong reasons; I wanted to be a physiotherapist but I didn’t have the required grades. As a young male nurse, I loved action and technology, so I fitted quite well into the accident and emergency (A&E) environment. After gaining my Nursing Diploma, I undertook a degree in Management of the Critical Care Patient and then worked in various very busy A&E’s around Barcelona. Work was intermittent, so I decided to pursue my career in England. I landed in Sheffield on Bonfire night in 2000 and I was quite impressed by the reception and all the fireworks illuminating the sky!
Unfortunately, my English was not good enough to be working in A&E, primarily because, in my opinion, they speak another language in Yorkshire! I therefore worked in the intensive therapy unit (ITU), where the ventilators, pumps and gadgets played to my interests. However, my primary focus was technology; I became very ‘Competent’ but Care, Compassion, Communication, Courage and Commitment were not my priority.
All that changed one weekend when I was allocated to take care of a young lad who had been in a car accident. He was being nursed in a cubicle; his body was battered red, with multiple fractures. He was ventilated and had various drains and pumps in situ. At the time, he was the ideal patient for me as my nurse vision was primarily performing tasks. But towards the end of the shift he asked me what was outside the little window at the end of the cubicle. The following day he again asked me what I could see from the window, and if I could move his bed close to it. Initially I thought he was joking, but he was dead serious. I told him it would be physically impossible.
That night I went home and I couldn’t stop thinking about his request. The next day I asked to nurse him again, and I asked him if he wanted to see the view. I still remember his face; it lit up with a big smile from ear to ear. It took me nearly two hours to manoeuvre all the equipment safely around the room, but I was determined! We finally made it, and like a miracle, a ray of sunshine came through the window and illuminated his face. He asked me to sit on his bed next to him, and for the next half an hour we were sat in silence holding hands. It was a powerful moment and we both ended up with tears rolling down our cheeks.
For the first time I understood what Care and Compassion meant. On that day I fell in love with nursing; my job became my passion. I still remember that immense feeling inside me that on that day - I made a difference to somebody. For the first time I was proud of being a nurse.
Unfortunately, it didn’t last - the following day I was called to the Matron’s office and reprimanded for ‘breaking all health and safety rules’ and ‘putting my patient at risk’. I went back to my safe mode of performing tasks, but I was not the same; something inside me was different. I was constantly looking for ways to experience the same feeling again but I became frustrated. I went home at the end of every shift demoralised, deflated and sad. My nursing career began to drift and I ended up working on the nurse bank, where I became even more detached and unappreciated. I was feeling undervalued and unable to make the difference. Because of that, I felt emotionally drained and I started to develop negative attitudes and feelings towards patients, and a growing devaluation of my own competence. I could say that my care was compromised.
It was like a marriage going sour. Nursing was not for me anymore, but I decided to give it one last chance before filing for divorce. I took a deep breath, and like a boy with new shoes, I went to my first day at work in my new role as a community nurse. In the induction package was a copy of the Compassion in Practice document. That day, for the first time in years, I went home smiling. Suddenly there were a change in culture and I fell in love with the vision and the idea of person centered care. The 6Cs for reminded me of my marriage vows, and from that day I try to live and breathe the 6Cs.
I was so inspired by the 6Cs I decided to join the Care Makers programme and I am now an ambassador for the 6Cs, spreading the word, enthusing others and embedding the 6Cs in my daily role.
It’s a privilege and an honour being a nurse, but with that privilege comes professional responsibility. The 6Cs can renew our professionalism and public confidence in our professions. The 6Cs are not just the business of nurses, midwives and care staff. They are the business of all health and care staff: from doctors, to porters, to physiotherapists, to care workers and managers.
Let’s renew our vows and fall in love with our profession again.