Creative Commons

Vicarious now that is an interesting word which is frequently followed by the word “liability”.  Is that just because we live in what in seems to be an ever increasing litigious environment?  Or is it because health and social care professionals continue to develop their knowledge and roles and responsibilities in relation to raising concerns?

There have been many significant reports following inquiries;  such as The Mid Staffordshire NHS Foundation Trust Public Inquiry, The Report of the Morecambe Bay Investigation and more recently The Gosport Independent Panel, which have reflected upon situations where patients and clients have not received a high standard of care.  Often the crux of what had gone wrong in the organisations, which were the subject of investigation, was a failure to ensure the protection of the very people the organisation existed to serve.  Students and practitioners are frequently encouraged to read and reflect on these reports as reminder of how not to care for patients and their families.  Several of such reports when reported in the media were accompanied by a phrase that went something like “these matters have been explored in great detail so that we might reflect and learn from what this situation has shown and so ensure that it will never be repeated in the future”. Sadly we all know that not to be true, otherwise there would be no need for any such further reports.

Many such reports have been influential in shaping the delivery of high quality care and improving the manner in which organisations manage situations which raise concerns. You might also argue that eventually there should be no need for disciplinary and fitness to practise processes and procedures within a health and social care environment if all health and social care practitioners consistently demonstrated the standards of conduct and behaviour that their various professional preparation programmes have carefully explained to them.   Whilst we still rely upon human beings for the delivery of health and social care there will always be the possibility of errors and mistakes.  In the wake of the Mid Staffordshire Inquiry Report 2013 chaired by Robert Francis, into the breakdown of client care, Professor Don Berwick, an international expert in patient safety, was asked in 2013 to advise about how to improve patient safety in the NHS. His report made a raft of recommendations including moving away from blaming an individual to looking to learn from errors. The report was subtitled “A promise to learn  – a commitment to act”. Individuals working within organisations such as the NHS should not fear raising concerns or speaking up when they make a mistakes or something goes wrong.  Merely dismissing or punishing people is insufficient if no attention is paid to helping people understand what happened in an open and transparent manner and apologising when things have gone wrong. The Freedom to Speak Up Report 2015 further emphasized the need to foster a culture of learning and safety in all organisations so staff feel safe when raising concerns. Organisations must cease to foster a blame culture which fuels fear and move to a culture “which celebrates openness and commitment to safety and improvement”. Several of these issues have been explored in previous posts within this blog such as Duty of Candour, Honesty, Integrity, Professional and Trustworthy.

There is a company in the United States of America called Vicarious which is concerned with developing artificial general intelligence for robots.  Human level intelligent robots may be a long way from completely replacing Health Care practitioners but they are certainly making a significant contribution to Health Care. Artificial intelligence permeates our lives. We travel in planes flown by auto pilots and driver less cars are becoming a reality on our streets.  There is conceivably a place for increasing artificial intelligence in the delivery of Healthcare but we should also possibly be cautious in giving vicarious authority to robots in place of human practitioners. You may be interested to view a video from the Chief Executive Officer of Vicarious talking about future data applications.

The NHS as the largest employer in the United Kingdom is the likely destination for the first post of the majority of neophyte practitioners. It is important to remember that the vast majority of professionals adhere to their professional Codes and are safe, competent and caring practitioners who consistently make a valuable contribution to ensuring the health, safety and well-being of patients, clients and service users. In so doing they also help to maintain the integrity of the NHS. The number of individuals who have their conduct and behaviour scrutinised by the regulators is tiny in comparison to the number of registered practitioners. The number of individuals who it is deemed necessary that they receive a sanction in order to protect the public is even smaller.

Professionally qualified staff within the NHS have the security of knowing that the NHS takes vicarious liability very seriously. The NHS accepts full financial responsibility where negligent harm has occurred as a result of the actions and omissions of its employees provided they were working within the sphere of their competence. All employees must exercise a duty of care and registered healthcare practitioners are accountable to their regulatory body for the standards of their practice and patient care. The Royal College of Nursing published their latest guidance on Accountability and delegation in September 2017.  It is a useful document to review, particularly for those for whom delegating tasks to others will be their experience in their new post rather than having tasks delegated to them as has been during their experience during their education.

The NMC (2015)

Appropriate Indemnity Insurance has been a legal requirement for all healthcare professionals since 17 July 2014.  It is a mandatory requirement of the Code that all nurses and midwives have an appropriate indemnity arrangement in place. The Nursing & Midwifery Council publish guidance on its website about professional indemnity arrangements.  It is important that healthcare professionals appreciate that whilst they may not need to individually hold an indemnity arrangement it is their responsibility to make sure that appropriate to cover for their practice is in place and confirmation of this is required from all registrants on re-validation.

Maybe over the coming month there will be many academics across the UK experiencing vicarious enjoyment as the students they have taught and supported conclude their Pre-Registration studies and embark on their professional careers. Personally it is a joy to read positive feedback from students confirming their knowledge and understanding of the demands of their future professional lives. These neophyte practitioners will be moving into their new posts acting under vicarious authority performing clinical care that is being delegated to them.  It is important that these, and all, practitioners remember their responsibilities under the NMC Code 2015 with regard to practising effectively when undertaking delegated tasks. Many of those practitioners will be meeting family members and carers who express the view that they wish they could vicariously suffer for their loved ones.  Countless times in a paediatric environment practitioners will listen to parents expressing the view that they wish they could endure on their child’s behalf or act as a substitute in their place.  It is hoped to that these neophyte practitioners will always deliver the highest possible standards of care, mindful of all they have learnt about professional conduct and behaviour, always putting the client first, treating them as individuals with dignity and respect. If the clients’ care and safety is paramount and enhances their health, practitioners may just have a vicarious experience of well-being themselves and feelings of joy and celebration rather than fear in their working lives. Make every experience count,

19 thoughts on “Vicarious

  1. Personally, I think it’s sad we have got to a time and age where we think it necessary to have robot care givers as they are able to provide the ‘best care’ instead of working on ourselves to become the best care givers we can possibly be.


  2. It is extremely important to review where things went wrong in care, as upon reflection we can work out how to improve and learn how to prevent these situations from happening again.
    The thought of artificial intelligence working within the healthcare profession is strange to me, as it is hard to believe that a robot could provide the same level of compassion that a human can, something that is crucial to the nursing role. Is it wise for AI to be working within a setting that holds so much confidential information, where it could then be easily hacked?


  3. As I have seen on placements, it is extremely important for all healthcare professionals to raise concerns, but I am aware that it may be seen as passing blame or judegement, and I agree with this post that we should be moving towards encouraging staff to promote safety. I also find it extremely hard to imagine that one day robots may be introduced to healthcare and could potentially take over our roles in delivering a high standard of care so focused on compassion and empathy.


  4. I found this post very interesting and agree that it is important for professionals and student to read and reflect on reports and cases of when care has gone wrong to remind us how care should not be provided such as in the Francis enquiry. One thing which particularly stood out to me is about rather than just punishing someone when something goes wrong we should take the time to understand what happened and make the correct steps to prevent it from happening again. I think that robots and artificial intelligence do play an obvious important role in society but we must be wary of this idea in health care, can a robot really provide the same level of care and compassion as a human? I find it hard to believe, and really care is about having a human interaction with someone who wants to help.


    1. Reflecting on our and others’ mistakes is essential to our work as future nurses. This gives us a chance to realise what went wrong and why. Furthermore, it is an opportunity to learn and not repeat errors in the future.
      When it comes about artificial intelligence, it is clear that soon we will see them more around us taking different roles in the society, however it is hard for me to imagine them taking over nurse’s role.
      Remember, nurses must use their personality to get close to the patient (get know the patient) in order to complete nursing interventions effectively. Would artificial intelligence be able to do that, or understand and empathise patient’s problems?


  5. As student nurses, we are encouraged to read and reflect on reports that disclose the quality of care delivered. In today’s nursing society, nurses are learning from errors instead of placing the blame on one individual. This is helping with the raising of concerns and speaking up for patients and families when a mistake is made or something goes wrong. Changes are made to improve patient safety. AS student nurses, we need to be confident and we need to be able to speak up when necessary. Hence, reflecting on our own mistakes, even when they are small, minor mistakes, helps us and shows professional accountability.


  6. This post was interesting to read. I agree, that it is very important for professionals and students alike to read up on what has gone wrong in the healthcare industry to ensure we don’t make the same mistakes. I still find it hard to swallow, that there are people out there who do not treat their clients with the respect and dignity that they would demand staff gave to their own family. From my personal experience on placement, I have learnt how important it is to raise any concerns, especially those regarding safeguarding. Which should be done so without fear. Artificial intelligence is something I am personally against to bringing into the health care sector, due to the fact they will not be able to provide the same amount of care and empathy required of nurses in the same manner. It does frighten me, that robots may be the next generation of health care providers one day.


  7. Very interesting reading about artificial intelligence but it can never replace the human touch to me. When we care for our patients we listen and respond. We use our body language. How can a robot care like a human? Also interesting comment about newly qualified need to feel joy and celebration at work and not fear.


  8. I found his post very interesting. I think that reflection is of he utmost importance as it is only through reflection that we can learn from our errors and then provide the best person centred care. I also think that raising concerns is important, even if it means reporting your colleagues and friends for misconduct, as improving quality of care is the top priority. We would want to be treated with dignity and respect, so our clients have the right to expect the same. In addition,although robots and artificial healthcare may relieve some of the pressures of the NHS, I am unsure of the concept as I think that human emotion, compassion and kindness is, first and foremost, the epitome of nursing.


    1. I found the blog interesting to read however I find it quite unrealistic that future technology could become replacement nurses. This is due to a few reasons but mainly because of the emotions that a person can deliver such as compassion/empathy. Emotions such as these a major part of nursing in order for patients so that they are able to feel comfortable with the care that’s delivered.


  9. It is important for every nurse/ professional to reflect and learn from where things have gone wrong. This can improve the care provided in future and prevent mistakes from happening again.
    As student nurses and throughout being qualified a professional will never stop learning or reflecting on practice. It is a vital part of nursing and providing care so that it can be improved and to the best quality.
    Reflection can prevent mistakes from happening so even reflecting on something good thinking about what could have gone better if a similar situation happened again.


  10. I believe that there is a time and a place for technological advances and in my opinion, this is not it. A contributing factor for my reasons for wanting to become a nurse was my ability to show genuine empathy and compassion to my patients and their families. I just don’t think you can achieve the same results with a robot! I would also be concerned about confidential and sensitive information and the risk of hacking which has happened in the past. Lets not lose the heart of nursing to AI.


  11. I agree with the last comment by Gemma that there is defiantly the right time for advances in technology. Some trusts are still struggling to move from paper to electronic systems, how implementing artificial intelligence would I do not know.

    “promise to learn and commitment to act” this is so important in implementing what the third-year student thought was the most important part of the code Promoting professionalism and trust.

    Great blog!


  12. Very interesting read. I can’t imagine a time which robots will replace healthcare practitioners, important skills such as empathy, communication and critical thinking cannot be easily performed.


  13. Vicarious – experiencing the imagination through the feelings or actions of another person.
    Liability – being legally responsible.

    After finding the definition of these two words, it has made me ponder on ethical principles and the law of tort. As long as we have human beings, there will always be mistakes; not always intentional. Organisational cultures have a huge effect on how services are managed. Abuse and neglect can be prevented if professionals have “a commitment to act” and are not afraid to whistle blow.
    Developing artificial intelligent of robots may reduce mistakes but replacing with robots who are unable to feel and understand the patient may develop further anxiety for the one in hospital.
    For the neophyte professional, one may need time to be invested in them to become competent and learn the culture of that team in order to reduce mistakes and be more confident, thus hopefully reducing the need for the legal department to become involved.


  14. This is a very interesting blog which fascinated me especially to see how the world is changing in regards to robots and becoming more medical advance though technology.


  15. Having experienced working where some assistive technology was in place I feel it is important to remember that part of healing is often connected with how a person is made to feel, treated and related to. Technological advance is a wonderful addition to nursing care, however, this cannot provide the same level of care a nurse can provide. working with and learning from past incidents and actions enables us to advance in our practice and maintain a professional approach. It is important to reflect on our practice and update our skills keeping in line with updated guidelines and working practice.


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