Preliminary findings of the Virtuous Practice in Nursing research project conducted by the Jubilee Centre for Character and Virtues point to concerns among early-career nurses who are on the verge of completing their initial three-year training. Many final year students who were about to qualify feel inadequately equipped to deal with the complex ethical dilemmas they may face on busy NHS wards, according to the initial findings.
Interviews conducted with several final-year students (early & mid 2016), many of whom will now be practising staff nurses, suggest they are concerned about the pressures of balancing the needs of patients with the demands of hospital management.
In contrast, some nurses told researchers they have received good training regarding the holistic side of patient care, but the findings point to an apparently mixed picture of professional training in relation to character and role-specific moral virtues.
Despite a series of high-profile scandals, including appalling levels of care uncovered by a public inquiry at Stafford Hospital, public perceptions of nurses are good. The recently published 2016 Ipsos Mori Veracity Index concluded nurses are the most trustworthy professionals, higher placed than doctors. (There are no prizes for guessing politicians are bottom of the league table.)
However, interviews conducted with nurses as part of the Jubilee Centre project suggest there are deep-seated anxieties when it comes to fulfilling the role of moral exemplars and satisfying the ethical demands expected of nursing professionals.
The research data is still in the process of being gathered and the views of hundreds of trainee and qualified nurses will have been sought by the end of January. The final report will provide a unique snapshot of the place of virtues and values in the modern-day NHS and shed new light on the practical application of ward-based ethics and how this might enhance good nursing practice.
Three cohorts are being questioned as part of the project: first-year undergraduates; final-year undergraduates; and nurses with at least five years’ experience.
All of the anonymous participants answer a questionnaire that requires them to reflect on their own character strengths. They have to select six attributes from a list of 24 and put them in rank order. They are also asked to pick six character strengths from the same list that they think apply to the ‘ideal’ nurse.
As part of the questionnaire, nurses are also asked to respond to a series of practical and topical dilemmas, one of which relates to a nurse/patient relationship on social media.
Ten per cent of the participants in each cohort also take part in interviews touching on the importance of character strengths, their views on being a good nurse and the barriers, if any, to being a good nurse. The nurses are also asked to comment on professional guidelines and the Nursing & Midwifery Council code of conduct. Do the codes, for example, capture what it means to be a good nurse today? Could the guidelines be improved? And what conflicts have nurses identified between personal values and professional guidance?
Participants are also asked how professional education and training could be improved.
It is clear that some nurses feel well prepared following university-based training, but some feel overwhelmed by the prospect of facing their first day at work. They are concerned about decision-making on behalf of patients and acting as patients’ advocates. Nurses get theory-based teaching but they feel there is not enough scenario-based teaching. All the nurses spoken to as part of the study commented on this.
The concerns are summed up by a third-year student who said: ‘… they teach us to be very professional, which I completely understand because being a nurse is a profession. But also on the other side they should show us that you’re working with people and you are a human as well. So sometimes you should open up… not breaking the rules but putting your values into practice.’
These issues go to the heart of the nurse-patient relationship and they reflect the tremendous pressure practitioners face, whether they are newly-qualified or established in their careers. Nurses are expected to conform to extremely high standards when it comes to patient care, trust and clinical efficiency. As soon as a nurse puts on a uniform, they are expected to conform to the Florence Nightingale ideal, being compassionate, virtuous and looking at patients in terms of holistic care.
It is hoped that the Jubilee Centre’s report will lead to a better understanding of the conflicts between a rule-and-code approach to moral practice and the application of phronesis, or practical moral wisdom, in our hospitals – and that can only help the training of nurses and the delivery of high standards of patient care.
Jinu Varghese, Research Fellow, Jubilee Centre for Character and Virtues
If you are interested in participating in this national study please click on the link below which will take you directly to the survey: