Nursing is a Sentinel, Not a Silo - Busting the Myth


Published: 07 March 2017

You know that you’re getting old when you see the same wheels being re-invented and often the same mistakes being repeated.

One that I still see to this day is the attempt to homogenise healthcare and render nursing invisible by using the ‘multi-disciplinary team’ as a kind of Trojan Horse.

Here’s how it works.

First, you need to control language and terminology. Create a ‘dark side’ so that everyone understands that ‘silos’ in healthcare are bad, bad things created and sustained by, among other things, naked professional self-interest, crude patch protection and simple unwillingness to collaborate or communicate with others.

On the sweetness and light side, ‘breaking down silos’ becomes synonymous with greater integration, improved multi-disciplinary teamwork, stronger horizontal communication, improved inter-professional education and more.

What’s not to love about becoming a ‘Silo-Buster’?

From here it doesn’t take a quantum leap to work out that one way to ‘bust’ health silos is to dismantle anything that might look like one.

A case in point – Nursing.

Surely having a Nursing Service, nursing education, a Director of Nursing or a Nurse Executive at your Executive Leadership Team table is simply pandering to this discipline-privileging, silo mentality.

After all, aren’t safety, quality, great patient experience, low infection rates, reduced unnecessary re-admissions, and all of the other key indicators, “everyone’s business”?

Game, set and match to the silo dismantlers.

Except that nursing is not and has never been a ‘silo’. Nursing is a sentinel that needs boosting, not busting.

Like many, I remember the days when managerialism (Klikauer 2013) as an approach was in the ascent (not great managers, I stress) and the prevailing wisdom was that anything in the organisation that retained the word ‘nursing’ was an example of ‘silo thinking’.

It thus made perfect sense that there would no longer be a ‘Director of Nursing’ responsible for the largest and most vital element of any health service. Instead, we could have a Director of Quality and Patient Services or something equally diffuse and anodyne. Even better if this person could be in charge of car parking, risk management and anything else that looked organisationally homeless.

The results of this nadir were truly painful to watch: hospitals and health services that were to all extents and purposes, leaderless and directionless. Nurses worked in huge organisations where they had no idea who was ‘in charge’.

Back in his (in)famous report of 1983, Sir Roy Griffiths observed that :

‘If Florence Nightingale was carrying her lamp through the corridors of the NHS today, she would almost certainly be searching for the people in charge.’

(cited by The Mid Staffordshire NHS Foundation Trust 2013)

Many nurses like myself agreed but wanted to add that, Florence wouldn’t be ‘looking for someone else who was in charge’, SHE or another powerful, inspiring nurse leader would BE in charge.

They’d be in charge and they’d be driving safety and quality standards as if mediocrity were just a bad dream.

They’d be creating a workplace where nurses were queuing round the block to prove that they were good enough to work there.

They’d be connecting and joining internal and external places and services so that ‘seamless care’ wasn’t just a vapid cliché because that’s what nursing ‘whole people’ means.

They’d be developing and using data as if lives depended on it, because they do.

They’d be proving daily that care and caring aren’t some low-level ‘soft-skills’ but part of the transformative power of nursing.

They’d be running a sentinel service called ‘nursing’ that is where the rubber of patient experience, safety, and quality care hit the road.

They’d know that nurses are the frogs in the healthcare ecosystem and that when we stop croaking or start disappearing then health services are in all kinds of trouble.

They would recoil at the idea that nursing needs some linguistic ‘qualifiers’ to make it sound more important and heaven help anyone who wanted to dismantle or homogenise this service because they thought it was a ‘silo’.

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