“Nurses aren’t kind,’ declared the journalist Christina Patterson in a shocking exposé of her experience of NHS treatment for breast cancer. She was speaking at the Royal Society of Arts.” “Care to be a Nurse?” Radio 4, January 9th, 2013.[i]
The profession, into which Florence Nightingale injected such dignity and prestige, has become unrecognisable from Christina Patterson’s vivid account of the in-patient care she received. I listened to the Radio 4 programme spellbound, and with increasing horror, by her description of her ordeal. It was told simply, without drama. With exquisite eloquence she made the point that nobody cared. She told of how she lay in distress and pain, yet too fearful to press her buzzer to call a Nurse: that, if she had once believed that this was a method of summoning support and assistance, she was wrong. She learned that if a patient asked for help, it made Nurses cross.
I would not have believed such a description possible of patient care in this country. Perhaps these standards would be tolerated elsewhere, where they had not benefited from such a shining example: but not in Britain. British Nurses were sought world wide for their standards, empathy and care. So, when I heard her moving broadcast, I was ashamed of my profession – ashamed to admit to being one of “them”.
Christina’s horrific experience – which she described without any anger – had caused her to research what had happened to Nursing. She admitted that Nursing was challenging; but then, as she ably pointed out there are many other challenging jobs. She observed that Nurses have a choice about how they respond to a patient: whether they are kind and gentle or sullen and bad-tempered. She concluded by saying: ‘if you’re employed to do it, and can’t do it, do something else.’ There was sustained applause. Christina made me consider deeply the factors that are missing today – and those listed are by no manner of means all, but rank fairly highly.
Lack of Insight
The people who cannot “do it” have no insight into their lack of ability. In fact, the less able they are, the more insight they lack. Their perception is that they know all the theory, and have good grades from University. When you try to explain that theory and knowledge does not equate to being an adequate nurse, there is lack of comprehension.
Nursing is a vocation as well as a practical career. You require empathy and emotional intelligence as well as academic ability. A University Degree cannot and will not provide you with the requisite skills for Nursing. It requires not only a raising of awareness, but a level of behaviour, which is difficult to learn behind a desk. The advanced level of learning is important, but that aspect could be addressed later: when we have assessed the person attributes of the trainee. That was Florence’s method: make sure that you are working with the right material.
Lack of Ability to Identify the Problem.
Through Christina’s further investigations, she had received a huge number of helpful replies from Nurses, former Nurses and Tutors. The culprits identified through her many replies were: Project 2000, the introduction of targets, and lack of supervision. It was pointed out that a Matron, who would unexpectedly check on what was happening on the wards, could not compare with a CEO who wouldn’t.
But the essence of the problem is deeper than that: a CEO cannot fulfil the function of a Matron because he/she does not know what they are looking at. They rely on being told. It is akin to appointing me to the position of Manager of Manchester United, just because I have managed a Ward. It does not translate. It would not work. I would not know whether I was looking at a gifted player or a passable one. (Moreover, in football, nobody would try it: it’s too important.)
Lack of a Role Model
With the lack of the Matron is the obvious lack of a role model.
Having trained Nurses, I can testify that identifying those interested in their work and who engage well with the patients is simple. This was the function of the Matron. Eagle-eyed, she would prowl her domain, looking for any slip in standards. Where the CEO manages, a Matron could identify a problem and act swiftly, without any discussions and duplicate copies to explain to everyone what she had done and why, and, of course, what the outcomes would be. No problem was allowed to fester.[ii] Action was king. In every area of your professional conduct, the Matron could and would comment.
And, after a recent conversation, I realise that our precarious standards are being made ever more difficult to maintain. I failed a student Nurse on her placement, as she had shown no interest, appeared to learn nothing, and was never willing to assist a patient. I was told that as I had not given her notice of my intention, she would take me to the Union if I failed her.
It was too much hassle to fight: much to my shame, I passed her. I have heard of others who have responded similarly. This situation does not drive up standards.
Lack of Empathy.
The importance of empathy needs to be recognised. Empathy stands on three legs – it is a triad, and can be defined as an automatic neural response to others. It can be deliberate and deliberative – and worked at through talking together. The talking is important as it:
1. Allows connection with the other person.
2. Enters another person’s world through active imagining.
3. Shifts perceptions of the other person and how you relate to them.
The conversation and getting to know patients is a vital factor. The opportunity arises when you have to go through their information with them, and it is unfortunate that now Nurses view this exercise as data collection. When this could be turned into a genuine conversation, the patients became real people with real problems. At the end of the procedure, engagement had taken place and the first steps to empathy had been taken.
Lack of Loyalty and Standards
All Nurses had a real loyalty to their teaching hospital – it was home. You were identified as a product of a particular establishment by your Hospital Badge.
You wore this with pride, although it was a mandatory part of your uniform.
Your mission was to demonstrate to others what an excellent training ground that Institution was.
Your standards were very closely associated with your place of instruction: low standards not only demeaned yourself, but your institution.
With loyalty paramount, and competition essential, performance was driven upwards. All trained Nurses aimed to set standards superior to any other Nurse- trained anywhere else.
We all attempted to demonstrate by our actions that we had been trained at a superior institution,( and frequently went to some extra miles to prove it!)
Coming across an excellent Nurse, drove us even harder.
Lack of Security
Many patients leaving my care said: “I felt so safe in your hands”.
Again and again, I heard this statement – first, as a senior student, then as a Qualified Nurse and later as Ward Sister.
Encompassed in these words was the reward for delivering high quality care: your patients thought you were an angel, told you so daily, and had complete security and confidence in your ability. If someone had reported any incident on my ward, which caused such distress as Christina suffered, I would have moved to other employment.
Lack of Self-Discipline
The systems have gone: the discipline has gone.
The Nurses no longer care, the patients go unwashed and unfed. Now, Nurses do not engage with the patient, but consume snacks and drinks in plain view.
If Matron had seen such a thing, their feet would not have touched the floor on the way to the permanent exit. To the onlooker, it appears casual, shoddy and careless. These are salaried hours, spent munching, and ignoring patient need. Not only is pride in work and appearance missing– it appears that there is no shame.
It is unfortunate that they seem unaware of the fact that, when they behave in this way, the public do not take them seriously.
Florence would be rotating in her grave if she knew what had happened to her beloved profession. She knew the importance of behaviour and developed her trademark –the “Nightingale Nurse”: that was the pinnacle to which one aspired.
She set standards – in Nursing, in hospital design, and the Army- that no one else even considered: standards we no longer understand how to meet. Inertia has set in[iii]. The basic standard of behaviour is missing, and the cornerstone of the profession has been removed.
FROM LACK TO HAVE
The conundrum of how to teach people to recognise need;[iv] to overcome the careless and abusive way in which the patients are treated; to instil a semblance of pride in the profession is a challenge for us all.
The task is clear. We are lacking in so many areas.
What we have gained in technology and education has adversely impacted on so many relationships. What should be better, is obviously not. Patient engagement no longer occurs at the same level, mainly because the routines of washing, turning and feeding no longer exist. Contact has been lost
The standards that Florence set lasted 100 years. She took great care about whom she accepted, about who would bear her name. Start with the attributes of the individual, and build!
Grow Nurses – then we can go Forward without Fear.
© Linda Jane McLean R.G.N., O.N.C.,