individual known and respected by his or her peers. Regrettably, the review I team’s terms of reference,

the above would help to dispel the rumours and misinformation surrounding these two important pieces of work. Jim Mclntegert RMN Elected member English National Board

which Mrs Bottomlcy set out, have become somewhat j clouded by the announcement [ that the Junior Health Minister, Baroness Cumberlege, will also be reviewing community nursing. The first Cumberlege I report on community nursing did not deal with community psychiatric nursing, so mental

The cost of moving into the community On behalf of the Charge Nurse Support Group at Prudoe Hospital, we would like to make the following points. As a group of professional* trained in the provision of care for people with learning difficulties, we fully support the concept of care in the community.


health nurses will be surprised and disappointed if CPN services are included within the community nursing | review’s remit. An announcement . confirming a commitment to

Points of view I laving difficulties trying to get your act together with a 1 constantly changing script? Barry Clifton considers the options.






| j

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Downie and Caiman identify two areas where a ‘personal moral outlook of a professional worker’ may not 'blend harmoniously with the performance of official duties’ (1). The first is when, for example, the nurse has a moral objection to being involved in treatment such as the termination of pregnancy or ECT. The second is when, for example, a doctor urges a patient into a private course of treatment which they can ill afford, or where it is unnecessary or of dubious effectiveness, because the doctor’s personal morality places financial gain ahead of





the patient’s best interests. But there is a third area where personal moralicy and official duty may conflict, which the authors do not mention. This problem may arise when a particular political outlook has temporary dominance. It is an area where government policy, supported by government-appointed managers, imposes financial limits on the resources provided for care in such a way that professional workers daily confront moral dilemmas that place them in a situation like that of a juggler spinning plates on the ends of six-foot-long canes. If the juggler can choose the number of plates used in the trick, he or she will be able to perform this impressive stunt. But the theatre manager, a non-juggler who has never watched the act, may one day decide how many plates should be used on the basis of the number of plates in the

It currently appears that the qualifications and experience of nursing staff are not fully recognised by the providers of care in the community, who appear to prefer the cheaper option of employing inexperienced carers. The providers of care would do people with learning difficulties a great injustice if they ignored the fact that many, if not all, the nurses involved would be prepared to take further training in order to move into the community with the residents. But staff at the hospital are faced with redundancies as a result of clients moving to community care. And the I traditionally inadequate

recompense of skilled nurses is reflected in the redundancy packages being offered to them. Certain staff members who have worked in the NHS for many years would like to step aside for their younger colleagues, but are unable to do so because of the financial costs of early retirement. So staff who are beginning or are in the middle of their careers are facing the prospect of redundancy, with little chance of finding employment of similar status or reward. P Stockley RNMH Chairperson J Callender RNMH Secretary/ Charge Nurse Support Group Prudhoe Hospital Northumberland

theatre’s cupboard. If the manager habitually insists on the juggler spinning more plates than is feasible, the juggler faces a dilemma knowing that defying the manager means redundancy, and that continuing will result in a terrible crash. The nurse is in a terrible predicament. The show may go on without the juggler, but it will be less of a joking matter if there are no nurses. The UKCC Code of Conduct says that if nurses are asked to do anything beyond their competence as a result of lack of time, skill or resources, they should assert themselves in order to be removed from the situation and should report the matter to all concerned. Until the UKCC has the teeth to get something done about such reports, however, their directive remains dangerous to nurses who act upon it - witness Graham Pink’s case. Until there is automatic and guaranteed protection for nurses from the kind of victimisation meted out to those who speak out, nurses have four options.

The first is to stick out their necks, in expectation of the axe, and the second to run | around trying to do everything at the same time until they explode or expire The third is to try to be i morally thick-skinned — | prioritising and performing what can be done while ignoring what cannot The nurse’s fourth and final option is to give up the | struggle and look for alternative employment, perhaps behind the till at a supermarket checkout. This may marginally j improve the quality of their life, but it will also contribute j to the worsening situation in health care. But it seems this is the type of situation where none of the currently available compromise solutions can possibly work. Barry Clifton RGN, BSc Hons, Dip PSN, is a charge nurse at a Kent general Hospital. Reference 1. Downie R, Calnan K. Healthy respect: Ethics in Health Care. London, Faber and Faber. 1987.

August yvolumc 6/Number *16/1992 Nursing Standard 43

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Trying to get your act together with a constantly changing script.

individual known and respected by his or her peers. Regrettably, the review I team’s terms of reference, the above would help to dispel the rumours a...
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