March 6, 2020, by Richard Bates
Dame Yvonne Moores Interview
Dame Yvonne Moores is Chair of the Florence Nightingale Foundation. She is the only person to have been the Chief Nursing Officer (CNO) for Wales (1982-1988), Scotland (1988-1992) and England (1992-1999), advising everyone from the Prime Minister to the Secretary of State for Health on nursing matters. She also chaired the World Committee on Nursing and advised the World Health Organisation on developing a nursing resolution for the World Health Assembly. Yvonne recently served as Pro-Chancellor of Bournemouth University and founded a healthcare charity, Poole Africa Link.
Dr Jonathan Memel, researcher on the Florence Nightingale Comes Home project, met Yvonne at the headquarters of the Florence Nightingale Foundation in London to find out more about Nightingale’s influence upon her approach to nursing, leadership style and belief in pursuing what’s right.
Image: Dame Yvonne Moores during a recent visit to Lea Hurst, the Derbyshire home of the Nightingales. Photo Courtesy of John Rivers CBE, DL
When do you think Nightingale first influenced you and your career as a nurse?
It was Florence’s association with compassion that struck me early in my clinical career as a nurse. I was very spiritual when I was a teenager and through my local church I delivered religious services in wards. That brought me my ‘I want to be a nurse’ moment: I thought, ‘this is was what I want to do’. Compassion is something that is often lost in the hurly-burly of delivering therapeutic interventions, where people are rushing in and out of hospital, or in and out of a home. But compassion is about actually spending time with people and taking the whole person, not just their illness, into account. In the fifty-odd years that I have been involved in nursing there has been an increasing focus on technical responsibilities, but the importance of compassion has never gone away. This is something that I have always associated with Nightingale and that has very much impacted my clinical practice and my development as a practicing nurse. I go to West Wellow Church [on the Nightingale family’s estate in Hampshire] each year and spend some time beneath the tree that she sat under and contemplated. No matter what religion, there is a spiritual aspect to everyone’s care. The nurse has to contribute to that dimension of the patient’s experience − hopefully supporting them to recover, but, if not, then easing their passing from this life.
Another obvious legacy of Florence to me is leadership. For me, leadership was the first call of the ward-sister: making sure that the totality of the patient’s environment – not just the therapeutic interventions − is taken care of. For a nurse today, leading in a clinical setting still includes taking charge of cleanliness and appropriate supplies in much the same way as it did in Florence’s day. Further into my career as CNO, and later working around the world, other aspects of Florence’s model of leadership became important. That included being a good role model, being clear about objectives and outcomes, and, most of all, enabling and developing others. If you don’t spend a third of your time developing others as leaders themselves − ensuring that they are supported, coached, mentored − you’re going to fail as an organisation and as a person.
Nightingale was a pioneer in her use of statistics and data. Do you see any influence in that respect?
It has always been my priority to ensure that we implement research findings, and that absolutely flows from Florence. An important legacy of her work today is infection control, but there are a lot of other areas of research in nursing that have not been implemented in nearly the same way. We know more and more about effective nursing practice thanks to both ‘soft’ and ‘hard’ research, but I’ve always pushed hard to make sure that knowledge is actually translated into practice.
You were involved in the ‘research agenda’ during your time as Chief Nursing Officer of England. Could you say a little more about that development and any challenges that it posed?
When the schools of nursing moved into universities we sought to include research within their remit, as well as education. The American model of nursing research was largely medical, emphasizing quantitative research and lots of control trials. In the UK there was quite a lot of debate within the nursing community about whether this move into universities would undermine those values of compassion that I mentioned before. The nursing community is large and varied and we often challenge, or indeed argue, with each other! Nonetheless, we always wanted nursing research in UK universities to find a balance, so that those values of care and of compassion were actually incorporated into the research process.
I was interested to read about your work on clinical supervision, which was all about providing leadership so that nurses followed protocol and met standards of care in the NHS.
Yes, this came to the fore when I was Director of Quality and I set up what is now called the Care Quality Commission − an overarching body that monitors standards. In the 1990s we also introduced the concept of clinical governance, which has now become central: it’s all about monitoring standards and learning from mistakes.
When implementing this work on quality you worked particularly effectively with the Chief Medical Officer (CMO) of the time. How unusual was that kind of collaboration?
It was unheard of. The expectation was that the CMO would call the shots. As a reflection of this, the work on clinical governance that I mentioned began its life in the 1980s as what was then called Medical Audit, with little involvement from nurses. Introducing nursing work into that was met with enormous opposition from the medical profession. I can still remember the meetings with the heads of the Royal Colleges, where they would say that the responsibility for quality was the doctor’s and insist that they didn’t want other people involved. So, it was not easy to bring that change throughout.
That’s a longstanding theme throughout the history of nursing: distinguishing the role of the nurse and the role of the doctor.
Yes, but what was interesting about our work on clinical governance in the mid- 1990s is that those two sides genuinely came together. With the CMO, [now Sir] Kenneth Calman, I set up the clinical outcomes group and brought all the leaders of the medical profession round a table with patients and other professionals in healthcare. In order to show that this was a shared endeavour, I would chair one meeting, and the CMO would chair the next. Well, that was very interesting! When one of the doctors round the table spoke, they would often not even look at me as the Chair, only at the CMO − it was that awful. There was no eye contact, no communication; it was almost as if to say, ‘you’re not really chairing this meeting Yvonne, this is a medical conversation’. We had to break that down, which took a number of years, but you now have a far more collegiate relationship. Kenneth and I brought about a shift in culture from our good working relationship. We visited and walked the wards together, so we visibly demonstrated that the top leaders of those two professions did things together, spoke at conferences and talked together as equals. Everyone has a vital contribution. And they are equal contributions.
That does resonate with Nightingale’s ability to bring about change. She has I think at times been unfairly characterised as manipulative, when in fact she provided a marvellous example of a leader who knew how to collaborate with people. Could you say a little more about on the importance of influencing others for you?
Yes, influence is certainly a quality from Florence. You use people, let’s be blunt! But you work together. You have to have a clear agenda: know what you would like to achieve and then go and achieve it. My agenda was such that I had to work closely with the CMO. It’s all about identifying your key people who will promote and support your agenda. That includes ensuring that you are at the top table − Florence showed that you can’t influence effectively unless you’re there, where the discussion is taking place, and where you can input and impact. Externally, as CNO I also had to influence vice-chancellors, heads of health policy organisations and the like. I would influence using data and statistics: you make sure that you are completely briefed and knowledgeable before launching into a topic or a conversation, and that comes from Florence.
Nightingale often worked closely with politicians. Could you explain how politics factored in your career?
Being political was undoubtedly another key influence from Florence. My first CNO role was in Wales and that was a very good starting point. Despite the relatively small size, you still got your own ministers and, through them, your own seat at the cabinet table. I learnt a lot about how to operate in the political arena from a top political operator. One thing that I quickly learnt was to choose my mentors very carefully. Mine was Roy Griffiths, who at that time was reviewing the whole of the health service and running Sainsbury’s. Well, gosh, what a role model! It builds your confidence, makes you believe and think: ‘Yes, I can do this!’. An equally formative experience was my later work with Malcom Rifkind as Secretary of State for Scotland.
What was it like to then come out of the spotlight in 1999? I wouldn’t be surprised if you wanted to take a break after your time as CNO in three different countries!
It took me pretty much a year to get my personal feelings, life, and stress levels back to normal again. You are on such a high: your adrenaline has to go all the time, you are up very early to go through all the press cuttings before meeting ministers; then you’re up late at night with them at conferences or dinners. After about a year out of the spotlight I became involved in higher education as the deputy chair of the committee of university chairs, a lobbying body for higher education. So that took be back onto the other side of the table and back into meetings with the secretaries of state.
Were there many other women around that table?
Interestingly, of about 110 universities represented I was one of six female representatives.
Global health has been a strong theme of your later career. Do you sense that Nightingale is known and well-regarded among nurses around the world?
I think so. When I meet and speak to nursing leaders around the world Florence is remembered and spoken about. At the Florence Nightingale Foundation we are interested in expanding our work to involve nurses in other countries. We are also thinking of developing a nursing policy think tank, based in the Foundation as a voice of nursing on policy issues and influence on government. As I said at my interview for this role: if Florence were here today, she would be walking the corridors of power, influencing and being a voice for nurses and nursing. There is something of a void at the moment, but I intend to develop this organisation to fill some of that space.
Has Florence influenced you in any other ways?
Yes, in one final way: courage. It is the one thing that she had and which I hope I’ve got, and which we all need. Because you’ve got to make the difficult decisions. You’ve got to seek solutions to difficult problems. And it really, really takes courage when it gets tough and you have to take stock and stand firm. As CNO I can remember occasions when I was in the secretaries of state office and I had to deliver a really difficult message, when politicians never want to hear bad news, they clearly want to hear solutions. So that is my final thought on what I have learnt from Florence. And it’s a message that I give to others. You have got to stand up for what you believe in. Sometimes it is right that you are on the fence and you have to balance and negotiate your way through, but, now and again, you have to absolutely stand firm in what you believe in and say it.
That’s an inspiring note on which to end. Our readers will I’m sure enjoy reading these reflections on your career and its links to Nightingale. Thank you, Yvonne.
As part of our upcoming exhibition at Lakeside Arts in Nottingham, Nightingale Comes Home, Dame Yvonne Moores will be delivering a lunchtime talk: ‘Reflections of a Modern-Day Nurse Leader: Following the Lady with the Lamp’. This will take place on Wednesday 15 July 2020: further details at https://www.lakesidearts.org.uk/special-collections/event/5323/following-the-lady-with-the-lamp.html