Emma Legge, Head of Leadership Programmes at The Queen’s Nursing Institute Scotland and a former community nurse, brings a unique perspective as she reflects on an insightful lecture and awards ceremony she attended. In this blog, Emma encapsulates the essence of Professor Alison Leary MBE’s presentation discussing the concealed intricacies of the nursing profession and the urgent need to reshape healthcare safety paradigms.
Last month, I had the pleasure of attending the William Rathbone X annual lecture and awards, hosted by QNI in London. The lecture, given by Professor Alison Leary MBE, QNI Fellow and International Community Nursing Observatory Director, was titled ‘Thinking differently about nursing workforce challenges.’ It lived up to its name, encouraging us to challenge our understanding of complex healthcare systems, delve beneath the surface, and consider the hidden complexities of nursing, including the importance of safety.
Professor Leary has a background in workplace safety and applies mathematical models and data science to her experiences in nursing and healthcare, which offers intriguing insights. She argues that we need to reimagine healthcare, as its current safety structure is no longer fit for purpose. Safety systems in organisations are usually tailored to the risks and complexities of the services they provide. Surprisingly, nursing, despite being the largest safety-critical workforce in healthcare, is organised in a way that resembles a large retail organisation, overlooking the intricacies of the nursing profession. Professor Leary makes the stark point that this may be because ‘Safety in healthcare is not income generating.’
One aspect that struck me was the vast range of skills that nurses possess and employ. Professor Leary emphasises that much of their work goes unnoticed. Nurses are akin to icebergs; you only see a fraction of what they do when they are on duty. Their roles encompass vigilance, organisation, intuition, and various types of labour (physical, cognitive, emotional, and logistic) as part of their standard service. They are the backbone of safety within the healthcare system. Despite their immense contributions, nurses tend to define themselves by who they are rather than what they do.
Comparing healthcare to other safety-critical industries, Professor Leary draws attention to the airline industry’s focus on safety. In healthcare, the failure to adequately consider risks may harm patients, but it won’t lead to a catastrophic event like an airplane crash. Nonetheless, the harm experienced by nurses when they cannot provide the care they want to due to external factors is significant. The structure of the healthcare system, with experienced staff at the top and inexperienced personnel at the bottom, often results in over-delegation, lack of support on the floor, and increased stress, becoming a major reason for nurses leaving the profession. Frontline expertise is vital in any safety-critical organisation, and healthcare should be no exception.
Professor Leary’s words deeply moved me as she shed light on the true essence of nursing, how nurses navigate complex systems, and yet, modestly claim, “it’s just what we do.”