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'We have allowed the nursing role to be denigrated'

Like many, I am concerned about nursing. In my view nurses have become too defensive which inhibits our capacity to care.

We are less generous in our nursing because we are on the defence, ready to avert complaints before we are willing to really care.

The nurse/patient relationship is in crisis. It is not enough to blame individuals, the problems are widespread. There is something amiss at the heart of the culture. I have been concerned, like many, by the indifference to suffering I have witnessed in nursing staff. I think this is symptomatic of a wider cultural problem within the health service and the independent sector.

Nurses have taken the blame for this lack of care for too long without stressing enough the destructive effects of litigation, enforced target-setting, complaints and cutbacks, and huge public expectations.  We have allowed the nursing role to be denigrated. Essential care is largely left to untrained staff who are underpaid, overworked and constantly criticised and become hardened and drained if they are not given the right support.  The fact that nursing staff get tired, stressed and emotionally drained is overlooked.  We continue to put enormous pressure on ourselves and each other to strive for unrealistic goals of tough “can do” perfection, which denigrate the very humanity so necessary to good nursing practice.

I once asked my university tutor if he thought nursing was undervalued as a profession because it was predominantly female; he said not undervalued so much as taken for granted, like mothers and wives. 

It is time to take a good hard look at where we have gone wrong. The mantra “if it isn’t written down it didn’t happen” is chanted in every university lecture and training session.  We need to examine what we are actually saying here. Is it saying first cover your back, look after yourself, defend yourself. Is this good soil in which a therapeutic positive relationship will flourish? 

Part of the culture of litigation and blame also comes from an unwillingness to accept the reality of death and old age. We can relieve symptoms, we can make people comfortable and we can maintain their dignity but we cannot always make them better. Sometimes this is understandably difficult for patients and relatives to accept but it isn’t usually anybody’s fault - death and old age are bigger than any of us.

The public and legal professions need to accept the consequences of litigation and adding fuel to the blame culture, understanding that it erodes trust and good will and ultimately breeds resentment, because unless we have a healthcare system run by robots there will always be mistakes.

I am fortunate enough to work in a home where people do matter, where there are living, active relationships between service users and nursing staff, where the drive for efficiency and meeting targets has not outweighed the time for real care. However in healthcare the pressures are mounting. The drive to super-efficiency is ever-increasing, as are the complaints from angry relatives and the criticism from other professionals and the threat of litigation. I wonder who will be left wanting to care? Nursing should be counted as one of the most privileged and important careers you could choose. The fact that it isn’t reveals a lot about our values.

Lucy Calcott is a staff nurse at The Chaseley Trust, Eastbourne

Readers' comments (18)

  • there's so much negative press written about nurses now that everyone seems to hate us, we can never do anything right and are constantly put down. I don't know how it all started but I wish people would understand that we know there are some people who do not deserve to be in nursing but we are not all like that, most of us really love our jobs and the work we do. I wish the newspapers would leave us alone.

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  • Agreed. Our reputation is being destroyed while those who 'run' the trusts are laughing all the way to the bank.
    Get rid of the chief execs and all their cronies and let consultants and senior nurses/PAMs run trusts.

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  • Anonymous | 6-Feb-2013 10:18 am

    Agreed.

    The NHS is not in the manufacturing business and should never have been allowed to be run as such.

    a new model specific to health care and possibly unique to the NHS needs to be rapidly developed with more clinical management and authority by clinicians with appropriate supporting administrative services. This is something all staff should be involved in to achieve an organisation of excellence from the point of view of patient care and staff development and somewhere everybody can work with pride in the knowledge that their patients feel safe, secure and well cared for in a fitting environment.

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  • I think it is a very scary time to be a nurse at the moment and I can only think of one reason why I still do it.. if I dont, who will look after these vulnerable in-need patients?
    From a nurse branded recently as lazy by some work colleagues because I don't rush through my obs and drugs, I do them properly, and I stop if necarsary and deal with individual patient needs such as toileting. Just because it delays me doing the washes doesn't mean I dont want to wash, it means I only have one pair of hands and I care about nursing properly!!!!!!

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  • Nursing lost its direction when nursing began to be governed by managers who knew nothing about nursing nor did they give a damn about nursing or patients. All these people cared about was a market driven NHS and everyone knows deep down that health care, no matter how hard we try cannot be ruled by a market economy. It needs to be consumer driven and not market driven. Put the patient first and we might get somewhere

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  • I just feel so very sad. I think the government have been looking for an excuse for to undermine our profession and now they have it. I am seriously worried about the future of nursing. We will be scape goated for just about everything that is wrong in the NHS and in the meantime the real culprits - the ones who put targets before care, will get off scott free.

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  • Carol Cleeton | 6-Feb-2013 7:19 pm

    totally agree with you.

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  • Anonymous | 8-Feb-2013 9:20 am

    Carol Cleeton | 6-Feb-2013 7:19 pm

    totally agree with you.

    Furthermore I fail to understand why this 'social experiment' has been allowed to continue for so long when it is so clearly demonstrated that it does not work.

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  • There are some food ideas that have been drawn from the manufacturing industry, such as looking at how ward management processes, routines and clinical environments can be changed in order to benefit both staff and patients. The model I'm thinking of improves culture in several ways. However, unfortunately instead of these concepts being built upon, nurtured and embedded at service level, I have experience of support for their input being stripped away by senior leaders in the name of target setting/budget meeting/financial crisis/ SHORT TERM STUPIDITY whilst also expecting to reap the rewards of assuming responsibility for a 'job well done' when presenting reports to the Board demonstrating pretty pictures of run charts highlighting how efficient their Divisions have been during a particular quarter (without proper explanation of how they got to those figures I might add!).

    The 'real' scenario shows staff at burn-out level covering neighbouring areas with low staff numbers leaving their own area poorly equipped to cope and patients relying on the goodwill of staff flexibility and helpful visiting families. Wonder why the Board reports don't include these details?...

    Whatever is implemented next as an outcome of the Francis Recommendations, there needs to be assurances that Senior Managers cannot strip away front line services, undoing the good work they strive to implement, whilst also still expecting them to meet Govt targets.
    This will work towards re-building a safer and more open culture within the NHS, but there's a long, long, way to go.

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  • Firstly, I really value and respect nurses.

    Secondly This must be one of the toughest times to be a nurse in the modern NHS.

    Every single nurse working in the NHS at the moment fighting target setting, management and cuts to give the best care they can while being attacked by almost everybody are brilliant

    I am soo proud of you Lucy andTrudy and Carol and everybody else here. Nursing has got tougher, must harder.

    Yet you are all still here, contstantly giving patients the best care and love and attention you can.

    When you have had enough, when you are about to give up, when you are crying always, always remember there are thousands of nurses out there, always remember you are healing patients, making life better for them. They know deep down that "someone cares for me and this someone is a nurse"

    You are not dirt
    You are not to be walked over
    You are not to be trodden on

    Why?

    You are strong
    You are tough
    You have compassion
    YOU ARE NURSES
    YOU ARE ALL, EVERY SINGLE ONE OF YOU.
    H E R O E S

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  • Firstly i totally agree with Carol Cleeton. Hospitals should be run by people who care about patients and their needs , not the target driven needs of government We need a complete culture shift back to the days when patients where the centre of our caring. However , I do not believe its all doom and gloom. there is some excellent nursing going on on a daily basis . My brother recently had a coronary scare and he said the nursing was exemplary....... in St Georges if you want to know ! My husband has just started chemotherapy at Guys and the whole experience was one of efficient sympathetic nursing and with a smile ! So dont despair , there is lots in nursing that is good, we do need however to look at what it is that makes nurses lose their compassion and stop caring

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  • judy mewburn | 10-Feb-2013 7:14 pm

    Ah, Guys is the very best and the rival St. George's not far behind!

    I was born at Guy's and have a long family history of doctors and nurses who trained there as well as a large circle of Guy's friends. It used to be like one big family. I still have a one-eared, one-eyed green bunny sitting on my dressing table called Guy who was given to me by the nurses when I was born in 1946! As it was just after the war the nurses apparently smuggled a whole batch of nappies into my Mum's suitcase when she left, although I can't remember this myself!

    I worked there in the medical school for five years for the lovely prof. of physiology and all the fab. but shy young medics before training myself as a nurse. I also lived in there some of the time first in the nurses' home and then in the staff wing after I qualified as well as in a very nice hotel the hospital had hired for nurses in Queensway which served a silver service breakfast with the full works of a traditional English cooked breakfast.

    Oh, happy days. I do hope they carry on in the true Guy's tradition and give your husband the best possible care and I wish you both well.

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  • Wow! Lucy has put the essence of the problems with healthcare culture in words I've never been able to find. I 100% agree. I see many other problems as well but do not want to detract from this point.

    I still believe if the care is delivered when it is needed and we give open and honest information to patients and relatives (and do this above all documentation) we can avoid most complaints. However I no longer blame nurses who act defensively as I can see how the culture and the system influences them to prioritise documentation and 'talking the talk' above direct care.

    There are often cues from managers that indicate as long as targeted paperwork is completed other things are overlooked. This for me is the essence of 'corporate nursing', it's form over function, head in the clouds stuff.

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  • I'm quite sure that this discussion started out as nurses now being too defensive to care.. how many of you have heard the follpowing phrases recently?
    I wasn't here yesterday, I've been off for 3 days, I;m not lpooking afte5r her today, you will have to speak to the doctor. .. and so on and on. Is it ay wonder that we get complaints and branded as not caring?

    If you don't know, find out!! how about using the following term?
    I'm not looking after her today, but I will find the nurse that is and she wil be ale to help you.... not

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  • Anonymous | 11-Feb-2013 8:36 am

    that is more like it. the patient then feels reassured they are in capable professional hands which can help reduce the stress, doubt and potential anger and there can be no dispute as long as these positive words are acted upon and somebody can help provide the answers.

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  • I don't know which emotion is more powerful after reading this article and the comments.

    One of those emotions is overwhelming sadness.

    PDave Angel | 10-Feb-2013 3:01 pm - I don't know who you are, but your words made me cry.

    It is so clear to me that nurses are still so compassionate, the real issue is the culture within which we now work. The bottom line is we can't afford the social welfare model any more but none of the alternatives sit comfortably with those of us who's values are closely aligned to the original values behind the NHS.

    Until this tension is resolved, I don't know how we can resolve this problem, as so many have correctly stated, this defensive, target, consumer driven culture is underminiing our ability to demonstrate our compassion. When we try to defend and advocate for our patients, we are browbeaten with management targets above the needs of the human being.

    Perhaps it would be a start to say that compassionate care is the responsibility of everyone, not just nurses and yes, I do mean managers too.


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  • Anonymous | 12-Feb-2013 1:47 pm

    "The bottom line is we can't afford the social welfare model any more"

    I need far more proof that this is true as I am not convinced. Maybe it has more to do with identifying what we really need and want for our society at all levels, prioritising these needs and wishes and then finding ways of achieving them and putting the money where it is most needed. We need people with an excellent grasp of the economy and others with expert skills in investing our financial resources and budgeting. we need people who are not caught up in the constant dishonest wrangle of party politics and who can provide us with a sustainable plan which can is flexible enough to adapt to evolving demographic needs over several generations.

    It can't possibly be right that we leave people to suffer and live in misery, pain or fear or die simply because we have set other priorities and cannot afford to look after them.

    Each one of us, from the very top down or very bottom right to the top, needs to take a long and hard look at ourselves and see where these priorities really lie and how we can work together to do something about it. It is a community and societal effort and not just a question of waiting for a certain, who we consider 'elite' to act otherwise we will be waiting a very long time before seeing any change and without carrying any guarantees of improvement.

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  • This says it as it is - my own thoughts exactly, particularly about precise documentation due to fear of litigation - I'm sure I could see another 2 patients in the time it takes to do one set of notes - and as I am not a trained typist, computer records don't help! Yes Nurses are on the defensive but is it any wonder when we seem to be the scapegoat for a lot of things that are wrong within the NHS? I totally respect my hard working colleagues and my line managers but we are all feeling the pressures which come from above and there is no denying the targets, budgets etc affect the quality of care given. I really don't think the public have any insight into how we are affected by policies and it saddens me when I hear another example of nurse bashing. I try to stay positive but it is hard.

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