Linda Nazarko: 'Ivory towers jeopardise holistic nursing care'

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I once worked in a hospital in the US. Nurses in the UK were adopting lots of  ideas from the US such as primary nursing and I was keen to see how these worked.

I was astonished to find that the system impeded my efforts to deliver holistic care. Despite the rhetoric, I wasn't the primary nurse. Everyone wanted a bit of my patient.

Certain parts of a person's body were off limits to me because they were the preserve of specialist nurses. I was supposed to wait for a specialist nurse to give nebulisers. I was supposed to observe my patient becoming dyspnoeic if the respiratory specialist was delayed. If I observed peristomal complications I was not to use my knowledge and skills to address the problem, I was to consult a specialist.

It was made clear to us non-specialist nurses that we lacked the skills to provide holistic care. In the evenings, at weekends and at night we miraculously regained our skills and were expected to use them.

The specialist nurses used a model that disempowered non-specialist nurses. This model discouraged nurses from using their initiative and developing their skills. Ultimately, it damaged patient care and nurse morale. The patient was viewed as a series of systems instead of a unique person needing support and comfort.

Now, I am the specialist. People ask my advice. They look to me for guidance. They say: 'I'm sorry to bother you.'

It would be so easy to adopt the ideas of those specialist nurses. I could make myself feel big by making others feel small. But that would be a terrible thing to do. My role is to educate, enable and empower nurses. This improves staff skills and morale and makes a huge difference to patients.

When we're busy I'm more than happy to pitch in. Walking in the shoes of the nurse or the care assistant is good for the soul. Ivory towers can be isolating.

The more expert a nurse becomes, the further they move from day-to-day practice. Nursing needs to return to its roots. Expert nurses can lead by working on the wards and in the community. We have to influence practice at the bedside – that means shedding the suits and pitching in.

In some trusts this is happening – my director of nursing wears a uniform with pride, as do others.

Specialists need to remember they are still nurses and return to join the nursing team at the patient's side.

Linda Nazarko is a nurse consultant at Ealing PCT

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