I used to struggle with the idea of clinical governance, until I came across this definition by the RCN, which says that clinical governance can be considered as a
“..framework which helps all clinicians – including nurses – to continually improve quality and safeguard standards of care. It aims to integrate all the activities that impact on patient care into one strategy”.
Basically put, clinical governance sets the rules by which we as nurses have to work. If you don't want to work according to the principles of clinical governance, you won't get a job as a nurse (or won't last for long as a maverick). It reminds me of the time my daughter phoned me up in tears about her mother. “Well, it's where you live,” I said unhelpfully. “If you want to carry on living there you have to play by her rules.”
However I have great reservations about clinical governance. About things like the emphasis on ‘evidence’ as a basis for knowledge and practice etc. Dale (2005, 2006) I think rightly questions the origins of evidence-based practice, and tracks it back to Medicine. So that even now the awful paternalism of Medicine continues to exert its influence over nursing, but in a far more subtle and insidious way.
I think that most nurses (and most Chief Executives too, for all i know) would say that the Department of Health [DH] is full of bollocks for most of the time, and never puts its money where its mouth is, and instead expect us as nurses to implement these grand initiatives as if by magic. There is a plethora of DH documents coming down from the Centre all the time, an endless rain of bureaucracy that cannot stop, and intended to harrass all areas of nursing practice. In mental health, documents may have CSIP and NIMHE imprints but look at the end of the document – who publishes it? Does anyone really think that the DH would publish something it didn't agree with?
And what’s with the Chief Nursing Officer's Review of Mental Health Nursing and the DH's pious Ten Essential Shared Capabilities for all mental health workers? What more blatant evidence is needed that the government is telling us how to practice?
And as i tell students: if you don't do it, you haven't got a job – that's the bottom line. To paraphrase Jean Jacques Rousseau: “Mental health nurses are free – but everywhere they are in chains.”
Other references:
Dale A.E. (2005) Evidence-based practice: compatibility with nursing. Nursing Standard 19 (40): 48-53;
Dale AE (2006) Determining guiding principles for evidence-based practice. Nursing Standard 20 (25): 41-46.
