‘Competence, like truth, beauty and contact lenses is in the eye of the beholder’ – Lawrence J. Peter
There’s significant debate at the moment between those who would assert that there is an influx of ‘too posh to wash’ degree trained nursing staff coming into the profession, and those who say that academic qualification links to better outcomes and wider knowledge. Who is right?
My son Isaac has spent over 150 days of his 3 years in hospital ; NICU, PICU, PHDU, general Paeds, ENT wards, Gastro wards, and if you then added to that all the clinic appointments with Paeds, Neurology, Orthopeadics, Orthotics, Audiology, Cardiology, Opthamology, Genetics, Dieticians, OT’s, Physio’s and so on he’s had a lot, and I mean a LOT of contact with the various healthcare professions – it’s 160 appointments if you calculate at 1 a week and a week with only 1 appt is a quiet one for us. Within that there must be over a hundred nurses in various roles ; right from the 1-2-1 nursing on NICU (who exhibited, for me, the best examples of staff who live and breathe the 6C’s aside from the odd one but i’ll save those for the ‘communication’ blog!) to ones that weight him at paeds clinic to the outreach nurses who help with our trachy maintainance etc.
You know what? Out of all of those nurses not ONCE have I sat there and thought ‘jees, check out how she understands how Isaac’s posture changes when he’s uncomfortable…you can tell he/she did a degree in nursing’ or ‘aww look at him/her struggling to suction his trachy – if only he/she had done a degree’. I’ve never thought ‘Ooh, you can tell they went to a Russell Group university as opposed to an ex-polytechnic’. I’ve met the odd few where i’ve pondered which planet they are from but that’s nothing to do with qualification route, more about ability to empathise..
Doctors though? Wow they love their letters. I’ve had correspondence from people with so many letters after their name that there’s a page break been inserted halfway through. In some way’s the prefix ‘Dr’ will suffice to show me that they passed medical school. As to whether they’re competent, ask me when i’ve seen them in action.
See, for me, competence frameworks are about being signed off that at one point in time you met the criteria of that measurement. Academically i’m sure plenty of readers will have met people who have admirable intelligence and capacity but poor personal communication, a lack of ‘common sense’ or both. Clinical competence or ‘on the job’ measurements of the 6C’s are more important to me as a patient ; but something else is crucial. For me, the person assessing has to be someone who lives, breathes and exhibits the 6c’s and can cite examples of where they themselves have got it right and got it wrong and learned. I dont care if that person is a Band 2 or a Band 8, I want them to be what they are measuring. Im sure you’ve heard someone say at some point ‘I wish I could bottle what they have’ – well this for me is what 6C’s competence is about and teaching it ; it needs to be coached by the great nurses we’ve met. The one’s who showed they ‘care about’ Isaac, who showed compassion by usefully using their understanding what the effect of having a child with complex needs may have on parents and the ones, who showed great communication and who modelled courage and committment. Did they show competence? Well I think so, in spades. Does their appraisal reflect my view?
Thats the other thing you see ; how do leaders include ON AN INDIVIDUAL basis feedback. There’s CCGs with PCP’s and all sorts of other constructs but where is personal interlinking in there? I’ve learnt more in my profession over 15 years from clients I work with that managers that is the brutal truth. And how have I learnt it? From their experience and mine and reflection. Not gathered through processes, but on an individual level. Sometimes having a family who would like to feedback in my yearly appraisal would have meant some hard messages and areas of improvement but I know it would have resonated more than a manager telling me survey results.
Also, if you’re competent, and you know you’re competent from other patients telling you you are, show it in your confidence. Note, that’s not arrogance (and if you ever hear me speak I can give you a gold bar anecdote about my own experience with a hugely arrogant, low emotional intelligence but also very skills ‘competent’ orthopaedic surgeon) ; confidence is about you expecting me to question and maybe put you out of a comfort zone but having the professional resilience to handle it. I’ve had 3 occasions where Drs have said to me ‘we’ve changed Isaac’s medication’ as if thats the end of the discussion without saying why or what their thinking was. Course, don’t get the science books out, i’m not bright, but at least explain why you’ve needed to change it. The ‘why’ makes me feel slightly closer to you ‘doing with’ than ‘doing to’. Nurses with confidence to be challenged have been great ; when we’ve asked ‘why this and not that?’ they can explain rather than either a) taking the hump and getting narky b) patronising or c) running off!
Sometimes you can be competent and not see the effect there and then, equally you can be incompetent and never realise you’ve created a legacy unless you stop, take stock, realise you’re never as good as you’re capable of being tomorrow and reflect.
So, competence to me means professionals oozing the other 5C’s towards Isaac, as to how competent you are he’ll either give you a big grin or he’ll tell you when he’s older…as to whether i’m a competent dad I think so but dont ask my kids…!