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OPINION

'Finding nurses who will speak out is like hunting for Easter eggs'

My daughter stops me: “Dad, Easter is about Jesus dying and being resurrected right?”

“Yes” I said confidently.

“And Passover is totally different but happens around the same time.”

“Uh huh”. I now look around for her mum who definitely drew religion when we divided up areas of parental responsibility.

“Last week it was Buddha’s birthday.”

“Was it?”

“Yep. Bit of a coincidence don’t you think? All the different religions having special days at the same time. Do you think all the religious people got together and decided to have their festivals at the same time so everyone would be off work?”

I like her thinking – the bigger picture, interfaith collaboration. And I like the idea of loads of religious people sitting round in a cafe saying “April? Do you have anything on in April?” But I also notice how unknowing I felt in the face of religious questions, how I wanted her to stray back to something a bit like sociology, to organising things so everyone gets a few days off work every four months.

We often make sense of the world on our own terms don’t we? It reassures us, helps us feel close to being in control? But I wonder if it also draws us away from areas of thinking or acting where we might feel less able? Politics for example. Because it seems that so often when the discussion strays toward the political, nursing feels ill at ease and retreats or at least reframes the political into something more homely, like standards or professionalism.

I think it’s telling that while the National Union of Teachers has moved quickly to oppose the suggestion of regionalising pay and doctors have been vocal and consistent in their opposition to the Health and Social Care Act and their defence of the NHS, nurses have been relatively quiet. It was also telling that an article on nursingtimes.net revealing that Health Secretary Andrew Lansley would address the Royal College of Nursing Congress was greeted as an opportunity to express anger – a vicarious anger given the small numbers who will be there. We know there are strong feelings but we don’t know how to express them, so nursing’s political expression will undoubtedly consist of some pursed lips and maybe a slow handclap.

I have always thought it was a lack of political confidence that quietened the largest profession in the public services. A lack of confidence borne of a history of deferring to medicine, men or managers has meant that even engaging with the political world feels like a step too far. But it isn’t just confidence is it? 

I know there are many nurses who are politically astute, engaged, intelligent and able – but they do not find themselves speaking or acting on behalf of nurses or nursing. It seems to me the very structure of the profession prevents the politically articulate from ever finding themselves in a position to act.

The RCN tends toward professional rather than political voices – perhaps because it primarily sees itself as a professional organisation – and Unison tends toward generic rather than specialist campaigning. We do not have a tradition of, or a clear training ground for, political activity, for dissent, for engagement.

Nurses have a capacity for creativity, moral clarity and personal courage. In theory they could thrive politically in a progressive and constructive way but something about nursing prevents that expression. Given the government assault on health services, wouldn’t now be a very good time to do something about that?

Mark Radcliffe is a senior lecturer and author of Gabriel’s Angel.

Readers' comments (16)

  • It's somewhat odd that Mark talks about nurses not speaking out, and then in the latter part of his article suggests a Government 'assault' on Health Services. Well pardon me Mark, but I don't see it as an assault - rather an attempt to trim the NHS and its bureaucracy to a more manageable beast - and they should be lauded for doing so.
    Sure it will never be perfect - these types of changes seldom are, but at least this time it is not change for change sake, and actually looks to have a meaningful outcome.
    As a nurse, I get a little annoyed at people like Mark - who are instilling this mindset into our nurses of the future presumably - who just want us to speak up to have a go at the Government (particularly, it would appear, if it is not a Left wing one!) when the Government actually deserves praise for some of its initiatives. Not all of us are angry with the Government - more the mismanagement that occurs at a local and regional level - over which the Government despairs of too!

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  • I wish I had the confidence to speak out in the work place but the power of management can make life uncomfortable by moving your wards, even your hospitals within the same trust and according to my contract they can do just that.
    I think that is a major factor in nurses not speaking out.
    Also now the response is if you don't like it leave as there are many nurses looking for a post at the moment.

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  • How true My daughters had her hours changed She works 20 hours a week over 31/2 days Shes now been told she cant have her half day anymore and hours will be adjusted over the month All the staff now cant finish at 3pm they have to have a 1.2 hour break so finish at 3.30 making it impossible to collect children from school They still dont get their full half hour break as there isnt enough staff to do the work.They are just told if they dont like it look elsewhere for a job Your hands are completely tied and you have to put up with this bullying until you are lucky enough to find another job!!!

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  • "Hell is other people"
    J-P. Sartre

    Indirectly related to the topic under discussion here,but always related to nursing, I just read in a German magazine in an article on the secrets of long life that it is not the job which causes stress but the 'psycho-theatre'! It goes on to say that the psycho-rigmarole at work should not be taken too seriously!

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  • Tim Wood

    You are taling out of your backside. 'Assault' doesn't begin to describe what the unelected dictatorship is doing to OUR NHS.

    Those managers and their bureaucracy will have their pay protected to attract the right 'calibre' of individual.

    Unless you work in a city centre you probably have you pay reduced. Again.

    Let's not pretend that the gvt is doing anything as noble as improving the NHS - it is being prepared for sale. We have to reduce costs to make it more attractive. Many are finding that they are being moved to Private provider contracts.

    Everything that makes the NHS great is being flushed down the toilet for the sake of political ideology.

    The NHS will be the equivalent of Railtrack overarching a plethora of providers which do not, however you look at it, work to a common goal other than profit.

    You say it is not change for changes sake. Who are you trying to kid? These changes are lining the pocket of their friends in businesses that commonly contribute to the tory party coffers. No where in these changes is the patient at the centre of what will be the outcome.

    As a nurse i get more than a little annoyed, i get furious at idiots like you who allow these changes to be made with little of no thought for the people who you are meant to serve.

    Mark is right of course, it really is a shame that potentially the most powerful workforce in the nhs is silent except for a minority.

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  • Anonymous | 22-Apr-2012 6:00 pm

    well said.

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  • It is very difficult to speak out. I complained about the behaviour of my ward manager. I went to our matron. I told her about the low morale, bullying and poor leadership. The matrons response was to hold a ward meeting. At the meeting she asked those staff dissatisfied to identify themselves. Needless to say there were no takers, even though most agreed with me.

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  • Annoymous - 22/4 6pm
    I find it somewhat disappointing that you won't put your name so a proper discussion can be held. But whatever - I can still answer your points!
    The NHS is NOT great - and hasn't been for over 30yrs - if ever - the principle is good, but effectively flawed and unless radical changes are made will become more flawed due to the increased demands of society.
    'Being prepared for sale' - I think your socialist dogma gets the better of you here - there may well be a greater degree of private involement - public/private partnership - enabling more needs to be met, quicker, and more efficiently.
    As for personal abuse - well that is surely the dying argument of someone that has lost the debate (and the plot!) and who is determined that WHATEVER this Government (Democratically elected by the way!) does is wrong.
    Personally I do think the NHS needs to be radically overhauled - sadly I don't think that any Government has the bottle to do it - what is needed is a semi insured, semi public funded system that can provide high quality, timeous care - sadly that is not what we have due to mismanagement over the lifetime of the NHS, and no one having the courage to admit that that it is broken, and needs fixing

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  • Juggling Dog

    Tim Wood | 24-Apr-2012 11:40 am

    I want the NHS to remain publically funded, not partly by insurance as you do, but that isn't quite the same thing as whether or not nurses 'speak up enough'. That argument does tend to be political, because insurance would perhaps lead to a 'better' service, but not for those too poor to pay for it. It would also take the 'National' out of 'NHS', in my opinion.

    I do think, it is easiest to speak up if you are in a position of relative power or immunity, and whatever people say about nurses no longer being doctors handmaidens, I suspect that nurses do often lack the confidence to forcefully push their point of view; see Anonymous | 23-Apr-2012 5:04 pm

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  • Tim Wood, my name is not a requirement for a discussion. I may, or may not, have reason for posting my name. Have you ever considered that by posting as anonymous it can actually stimulate debate, not limited by fears of reprocussion!

    I'm intereested how you measure 'great'? I believe that the NHS is great, btter than any other health system in the world. It's just as efficient as any other system in the world. Not a popular idea in the Tory rags of course - wouldn't suit the Tory argument for tearing it up and starting again.

    I'm not sure what you mean by socialist dogma, but to pretend that the gvt is doing anything as noble as in the public interest is laughable. Consider what has happened with the banks - those socialists bailed out the banks, now the tories are ringfencing the toxic debts and selling off the profitable bits back to the markets. The potentially profitable bits of the nhs are being contracted out to companies like Virgin Healthcare (who are not, I can assure you, in the game for anything other than the bottom line).

    You need to try using Google occasionally regarding complex words like 'democratic' and 'elected'. Yes, we have a government, but they were not elected - the Lib Dems are Making up the numbers in something called a coalition. This means that the votes were split between the eligible political partys, none of which had enough seats to to form a democratically elected government. I'm ashamed to say that my vote for the lib dems went towards making the current political setup.

    I believe that the the idea of spending £3billion to change the nhs from a provider to a comissioner of care is idiocy, you happened to articulate your support for that position. You are wrong in assuming that I believe that whatever this government does is wrong.

    I agree with you that the NHS needs better management. I also believe that there needs to be a rethink on values - if you pay peanuts you get monkees.

    Do not be fooled into thinking that a semi-insured semi state-funding route is the way forward either, the vulnerable will lose out (i pay so i demand better), and profit becomes an overwhelming focus, rather than quality.

    I'll leave you with an example. I have a friend who has recently had cancer. Her pathway was badly managed. She was treated after her breach date. No one warned her of the potential long term side effects of treatment (which has meant the closure of her previously profitable business), health professionals thought that she was just whinging when she complained of a bit of pain in her arm when having chemo and ignored her (a year post treatment she will shortly undergo surgery for full thickness extravasation burns). She loves in a neighbouring euro country that has the system you advocate. Her insurance will not pay for the rehab treatment she needs, and the state does not provide it. Yet for many years she liked to tell me how we were fools in this country putting up with such terrible service. Contrast that with the private provision in this country of the care in privately run nursing homes - you may have seen the news in the last 24 hours. I could quote more if you like.

    We do not have a perfect NHS - of course we don't, but a considerable majority of us are in it for altuistic, not socialist reasons. Just don't believe it's as bad as the unelected dictatorship ("...no top down reorganisation of the NHS...") will have you believe!

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  • Just to add, one or two spelling errors on my post - typing on an ipad on the move!

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  • Tim Wood | 24-Apr-2012 11:40 am

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  • Tim Wood | 24-Apr-2012 11:40 am

    you appear to be pushing your own 'dogma'.

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  • Juggling Dog

    Tim Wood has the right to his express his own position - this seems to be developing an air of nastiness !

    Anonymous | 24-Apr-2012 9:59 pm

    I have considered anonymous posting, and I personally think it leads to more confused debates, and not to the promotion of better discussion - I do, however, accept that posting under your real name can be a deterrent to engagement. But I am only a dog !

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  • Tim Wood
    If it ain't broke don't fix it. Yet politicians, not clinicians, have damaged the NHS, From Thatcher onwards the idea of the NHS was profit, not service. When you have a London-centric government ( and all of them are) then things are done that quite rightly are a boon to that population ( I'm thinking mainly about 'competition') but have no relevance to anywhere else in the country.
    The Conservatives have sold everything in this country that was once owned by everyone, did everyone gain? Not at all. Instead communities have been ravaged for generations with lack of opportunity, and their choice has reduced.
    Now they have the chance to sell the last of the family jewels, under the guise of a world-wide recession ( were all in this shit together, but some of us are up to our ankles, whilst the rest of us are standing on our heads), the profits will go to the same people it always has, syphoned offshore to some Cayman Island account.
    It is terrible that people have to make a profit out of a kiddie wanting a glass of water on a hot day, or a pensioner turning on the heating when it's cold, now we'll see them make profit from people being ill and dying. For the future, just read what Professor Lord Winston has to say about the IVF rip- off in this country, extrapolate that to the rest of the NHS, and ask who ultimately gains from it. You, Tim?

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  • I agree with Mark.
    Nurses we need to speak up , we seem to be still in an era that is long gone.
    Our NHS is not perfect and never was but surely we can all see it is now falling apart too quickly before our eyes.
    I have seen Senior Sisters and Nurse Managers at work preventing debates and meetings where nurses voice opinions on political issues while reassuring us that we are good people who should keep the mouth shut and carrying on working.

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