So…… it appears to have happened – Nursing is in its death throes.
“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.
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, spellbound and with increasing horror to her ordeal. It was told simply, without drama. With eloquence she made the point that nobody cared. She told of how reluctant she became to press her buzzer to summon a Nurse– and that if she used this method to receive assistance, none was forthcoming. She gave the distinct impression that if a patient asked for help, it made Nurses cross.
I would not have believed such a description of patient care possible in this country. Perhaps these standards would be tolerated in countries 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 explained how she had tried to find answers about what had happened to Nursing. She admitted that Nursing was challenging – but then, as she ably pointed out, there are many other challenging jobs. Nurses have a choice 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
Little did Christina know that the people who cannot do it have no insight into their lack of ability. That is at the heart of the problem. Their perception is that they know all the theory that there is to learn. They have had good grades at University. What they do not understand is that theory and learning does not equate to being an adequate nurse. Nursing is a vocation as well as a practical career. You require empathy and social intelligence as well as academic ability. A University Degree cannot, and will not, provide you with the requisite skills for Nursing.
Lack of Problem Identification.
Christina had investigated further – had tried to pinpoint where Nursing had gone wrong. She had received a huge number of helpful replies from Nurses, former Nurses and Tutors. Project 2000, targets and lack of supervision were all mentioned. A Matron, who would unexpectedly check on what was happening on the wards, could not compare with a CEO who wouldn’t.
But it goes 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. I wouldn’t know whether I was looking at a gifted player or a passable one. I would believe what I was told.
Lack of a Role Model
With the lack of the matron comes the lack of a role model. Having been involved in Nurse training, it is simplicity itself to identify those interested in their work and who engage well with the patients. This was the function of the Matron. Eagle-eyed, she would prowl her domain, looking for any slip in standards: mentally ticking those who were above average and noting those who were below par.
Lack of Immediate Action
The CEO merely manages: a Matron could identify a problem and act swiftly. There were no discussions or 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. Action was king. Her complete power and incisiveness and excellent judgement bred both respect and fear.
Lack of Patient Knowledge
This was demonstrated when I was sent to help a newly qualified University trained Nurse, as her junior. Although I had five years post registration experience, she had the Degree, and was therefore in charge. I observed that one of the patients looked particularly ill and, after checking his pulse and blood pressure, asked her to call a doctor. She refused. Disbelieving that there was a problem, she went to look at him herself. As I accompanied her, and we stood at the foot of the bed, I realised with horror that she was unable to recognise that this patient was ill.
Because she could see nothing wrong, she refused to phone a doctor. Ten minutes later the man was dead. Never again did I allow theory to claim it was superior to experience. I am sure it is an event that she will remember too – but it is not the best way to learn. In contrast, by the end of second year, I don’t think there was any of my class who could not recognise an ill patient.
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 – i.e. worked at through talking together – and 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 – but now Nurses view this exercise as data collection. We were trained to turn this into a real conversation – to be interested. We knew our patients quite well at the end of the procedure, but without the initial engagement, empathy cannot occur.
Lack of Loyalty
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 was. Your standards were very closely associated with your place of instruction, and low standards not only demeaned yourself, but your institution. No nurse would have wished this in my day. Loyalty was paramount – competition was essential. We all aimed to set standards superior to any other Nurse, trained anywhere else.
Every Nurse tried to demonstrate by her actions that her training had been the best in the country.
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 Discipline
Strict discipline has gone, along with the two hourly “back round”, which allowed you to engage and know your patient. The nurses no longer care and the patients go unwashed and unfed. Now there is minimal engagement with the patient. Nurses consume snacks and drinks in plain view. If a Matron had seen such a thing, your feet would not have touched the floor on the way to the permanent exit. You would have lost your job for such behaviour. Nurses were professionals – they should never to appear sloppy and careless.
Lack of Pride
Salaried hours are used atrociously. It is almost commonplace to see a cluster of nurses sitting round the Nurses station; I have witnessed them shouting instructions the length of the ward. They can be downright unpleasant to the public, and “how to answer a telephone” must no longer be incorporated in the training. Not only is pride in work and appearance missing– it appears that there is no shame.
Florence would be rotating in her grave if she knew what had happened to her beloved profession. She set standards that no one else even considered. But today, the Nurses appear to have regressed into the untidy, undisciplined band that she fought so hard to educate, in both standards and behaviour. These standards we no longer understand how to meet.
So many ingredients are now missing that all the protocols in the world won’t help.
© Linda Jane McLean R.G.N., O.N.C., Dip. Com.Care