Reena Patel and Dr Rachel Morris discuss ways for nurses to navigate through a compliant while reducing the risk of burnout, based on their experience and reflections in primary care. This article intends to provide information and signposting to suitable resources and does not offer any legal advice in complaints management – always follow the process set out by your employer.
The current challenges within the NHS, and an increase in patient complaints since the Covid-19 pandemic, highlight the need for greater support to practice nurses and others in the multidisciplinary team (MDT).
There is a greater autonomous working set up in a GP practice compared to a secondary care, and practice nurses can be more vulnerable and susceptible to patient complaints than elsewhere in the NHS.
Complaints made towards us as individuals working in healthcare, or the organisations we work for, are inevitable, and dealing with complaints is part of our professional responsibility.
However, it should not be forgotten that the complaints process can have a huge impact on those involved and a negative effect on wellbeing.
A complaint can have a significant physical and psychological impact on those involved and can be felt as a personal threat.
Nurses may be worried that a complaint made against them might impact their professional reputation, and the fear and anxiety involved may even contribute to burnout for some individuals.
Ways to avoid stress because of a complaint
While complaints should be taken extremely seriously, there are ways to approach the situation that may be helpful in reducing the stress involved.
The following tips are aimed at helping practice nurses to learn from complaints and to help protect people from burnout that could result from repeated or prolonged complaints.
1. Stay calm
When you receive a complaint, don’t react or make decisions in haste. Emotions can often be heightened on hearing about a complaint, and things can seem worse when we are already stressed and under pressure. If we react when emotions are heightened, when we feel threatened or triggered, we’re likely to say or do something we may regret later. So, take a pause, give yourself time to get back into a calm frame of mind before you respond.
2. Adhere to protocol
Every organisation has a process on complaint handling procedures. Be familiar with this process, ensure you follow the correct procedures, and do not deviate from the protocols. Note that the systems and complaints function can vary between trust and organisation, and from primary care to secondary care.
3. Think safety first
Is the patient safe? If the answer is yes, then things can be resolved in most cases. If the patient has come to any harm, the escalation of the complaint will then depend on the nature of patient harm.
There is a fine line between a learning event and a significant event. Think: ‘Were there grounds to complain?’ If the compliant was justified, then action should include reflection on learning and future safety netting to avoid patient harm and mitigate the risk of future errors. Even if the complaint seems unjustified there may still be huge learning you can take from what happened.
4. Accept that we do all make mistakes
As clinicians, we should accept that we are humans, and that we can make mistakes. Some of these mistakes will be serious. Whilst your first reaction may be to beat yourself up about it, try to practice self-compassion and treat yourself with the same care you would treat a friend in the same situation.
Advice on the ‘duty of candour‘ must be followed and this also helps to avoid the chances of future disciplinary actions.
5. Share what’s happened with a trusted colleague
When we receive a complaint, we often feel a great deal of shame – even if it was a simple mistake or if it couldn’t have been avoided. Shame makes us feel that we are not good enough. Telling someone else about what has happened and how you’re feeling often makes shame disappear. Knowing that we’re all in the same boat and that it could have happened to anyone can be incredibly helpful.
6. Have good habits around documentation
Develop a habit today to ensure your documentation is clear, factual, concise, eligible, and up to date.
If you write something later, mark it as ‘written retrospectively’. Alternately, mark it as ‘error’ if appropriate.
Never try to hide, amend or manipulate documentation against protocol.
Avoid documentation which could cause misunderstanding and put another clinician in a compromising position unnecessary.
Always be professional and respectful, yet transparent in written notes. This includes any telephone consultations.
Where possible, use practice approved communication systems e.g. a system which allows clinical system integration, enhanced telephone and video consultation and facilitates accurate record keeping. If calls are recorded this can be useful to investigate and manage a complaint.
7. Get a different perspective
Seek advice and opinion from other healthcare professionals and peers, possibly those more experienced or senior in position. Seek out support, an unbiased view, and a friendly listening ear to help you to debrief.
Having an MDT approach to this in the fullness of time can be extremely beneficial, but don’t put off seeking support early.
8. Don’t take it personally
Complaints are usually not about you; they are about frustration with what the patient is going through, and you are in the firing line.
Having said that, when one is going through any complaint it can often feel very personal and trigger negative emotional responses. This can spiral downwards if not managed in time. So, it is vital to pause and do a pulse check on one’s own stress levels and wellbeing.
There is a range of factors that can contribute to complaints, or a series of events leading to a complaint, such as unconscious bias in healthcare, conflicts with colleagues, duty of candour, challenging consultations, poor record keeping, prescribing and medication errors. Try to focus on the facts of what have happened and avoid telling yourself unhelpful stories which can cause the downward spiral – for example rather than telling yourself ‘I mucked up, I’m not good enough’, a more helpful story would be ‘I made a mistake as I am only human – this is a helpful learning experience for me’.
9. Recognise burnout and use a support network
Complaints can cause a lot of upset and stress for healthcare professionals who are trying to do their best in a difficult environment. It is vital to recognise burnout early on and take action, rather than wait for an event to happen or worrying that you are weak because you ‘can’t cope’. Be proactive and not reactive.
Never underestimate the value of support from external help, eg seeking help from counselling or therapy. Talking to a therapist or a counsellor can help give clarity which you wouldn’t get from talking to people you know personally. This can also be an opportunity to reflect and manage stress, workload and avoid burnout, in both one’s personal and professional life.
It is also really important to ensure you have a good support network of friends, family and peers to help get you through this. If you are worried about your mental health or levels of stress and burnout, you can also go and see your own GP.
10. Identify learning outcomes
No matter what, we can always learn from a complaint – even if it’s just how to manage ourself through criticism. Insight improves outcomes for patients and learning for all clinicians. Hard as it may be, try not to think about complaints as obstacles but instead see them as opportunities.
There may be opportunities to show that you were following best practice, or learning opportunities, such as personal development in the following areas that are often the root cause of a complaint: competence, communication, consent, chaperones, confidentiality, clinical records and customer service.
And two further suggestions:
11. Seek medico-legal advice early
Contact your defence union as soon as possible. They can act as a very helpful ally and help you respond at every step of the way. They are also only too happy to help out when you are unsure or worried about a mistake, even if a complaint hasn’t yet been made.
Every clinician should have indemnity, and it is recommended that they are a member of a professional organisation such as the Royal College of Nursing (RCN) that provides them with support for their other legal issues like employment advice, Nursing and Midwifery Council referrals, inquests, and many other potential legal issues.
Especially if they are not a member of a medical defence organisations such as MDU and MPS. During a complaint such organisations can be extremely useful for providing advice and support, and if needed may provide a representative.
12. Prioritise self-care
While you are involved in a complaint, do make sure that you keep the three vital areas in life in balance: mental wellbeing, physical wellbeing and financial wellbeing – in fact, increasing your self-care will help you cope much better when you are going through stressful and difficult times. And do remember to seek help early.
Reena Patel is practice nurse specialising in diabetes in Leicester. Dr Rachel Morris is a former GP; host of the You Are Not A Frog Podcast; specialist in resilience at work; creator of the Shapes Toolkit Resilience Programme, Cambridge.
Resources
Royal College of Nursing. rcn.org.uk/get-help/indemnity-scheme
NHS Resolution. Complaints policy
NHSE. Feedback and complaints about NHS services
World Health Organization. who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases
NHS Resolution defines a complaint as ‘an expression of dissatisfaction that requires a response’, and this can be either written or verbal.
Burnout is described by the International Classification of Diseases (ICD-11) as ‘a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed,’ although this is not yet classified as a medical condition.
Podcasts: eg, You Are Not a Frog – a podcast to help healthcare professionals beat stress and work happier, Feel better live more
Courses: eg, RCGP, MDU, MPU, RCN, the Beat Stress and Thrive for Healthcare online course, The Shapes Toolkit Programme for Healthcare
