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Queen's Professor appeals for end to professional hierarchies in clinical practice

In a British Medical Journal cover story, Professor David Thompson from Queen's School of Nursing and Midwifery has appealed for the end of the Doctor – Nurse Game.

Queen's Day 8

A nurse who has held leadership roles for more than 30 years, Professor Thompson cites the recent report into deaths at Gosport War Memorial Hospital, where around 600 people received fatal doses of opioids and where there appeared to be a culture of uncritical deference to doctors by nurses and a fear of raising concerns with managers.

Professor Thompson writes: "Professional hierarchies appear to be endemic in health systems, but we have now got strong evidence that they harm patients and contribute to an organisational culture of fear in healthcare".

Thompson also asserts that, "Subservience and deference are not benign traits or signs of a good nurse, in fact we can see that they contribute to a culture that is killing patients, with professionals fearing dire consequences if they question or challenge colleagues in terms of their practice or behaviour".

There are good ways to challenge that culture, and Thompson suggests that an environment of interprofessional education builds the team approach that could demolish these hierarchies.

Professor Pascal McKeown, Head of the School of Medicine, Dentistry and Biomedical Sciences at Queen's, is very supportive of this approach to the delivery of healthcare education:

"Cognisant that healthcare is delivered by multi-professional teams, we now ensure that professional practice, leadership and teamwork are embedded as core elements in our undergraduate and postgraduate programmes."

The BMJ paper by Thompson suggests that strong leadership is required to create a safe, open, questioning healthcare organisations. Professor Donna Fitzsimons, Head of Queen's School of Nursing and Midwifery, added:

"The new Simulation Centre being developed at Queen's will help to embed such a culture at a formative stage of development between doctors, nurses, and allied professionals. It gives us the opportunity to cultivate far more than clinical skills in our students. By learning together in a realistic clinical environment they will develop the leadership and autonomy that characterises professional practice. This BMJ paper demonstrates that healthcare needs nurses and doctors willing to challenge poor practice and stand up for patients to ensure these scandals are a thing of the past. At Queen's we take that responsibility seriously".