OPINION

'Why did the chicken cross the road? To escape the cannibal'

12 July, 2011 | By Mark Radcliffe

Have you heard about Flossie the cannibal chicken? If not, you have come to the right place.

Flossie was one of a group of four chickens in a chicken coop. One morning, when the keepers went to feed the chickens, only Flossie was left.

I’m guessing that they quickly reasoned that one of three things had happened.

Three of the chickens had tunnelled to freedom.
Evolution had kicked in overnight and three of the chickens had flown the coop.
Flossie had killed and eaten the other chickens.

A search for clues found no tunnels or discarded chicken-sized mining tools nor any swooping chickens overhead. Flossie, however, lay against a shed wall burping over a pointless toothpick with a bloodstained beak and a drumstick on her lap.

Something went wrong for Flossie and she turned on her own. There is no way back from eating a chicken, unless of course you aren’t a chicken yourself - if you were a fox or a person, it wouldn’t make the news.

Just goes to show that chickens are like every other species - OK I’m guessing about a lot of species - some of them are not very nice. This seems particularly clear when reflecting on our own species.

We can, if we are feeling miserable or touched by self-loathing, notice that in the words of the inimitable and splendid musician Nick Cave: “People they ain’t no good.” The case for the prosecution calls hundreds of witnesses ranging from war, genocide and man-made famine to street violence, the stoning of ambulances and fraud.

I know that for every act of terror or unkindness, there is a rationale or excuse, from “we are carpet bombing people to free them from oppression” to “he was drunk/upset/not himself because he was drunk/unloved/lacking in self awareness” - but the truth is some people are not very nice.

Indeed, some people are difficult. They can be aggressive, confrontational, self-serving and manipulative. They can believe ridiculous things about other people’s rights, religions or haircuts and maraud through life being hateful. If we are lucky, they don’t touch us too much or too often.

But all people are potential patients. Even the nasty ones. While we know

that all patients need to be treated the same - with unconditional positive regard

and empathy, and non-judgementally - constructing that regard and that equanimity takes energy, skill and sometimes our full attention.

Nurses face managing difficult people in difficult situations every day. Some patients can be wearing, spiteful, vicious, unhelpful and even vile. And it is a given that they require the same considered management as “easier” patients. The emotional energy, skill, consistency and awareness required to attend to difficult patients is wholly and unquestioningly assumed.

I wonder if, as nursing continues to come under scrutiny from so many quarters, the consequences of emotional labour should not come under the scrutiny of nursing itself? Do we even acknowledge the need to re-nourish? To articulate the continuing professional development needs of nurses in this area?

The emotional labour of nursing remains all but overlooked, perhaps because it does not fit into the construction of the idea of nursing as a quasi-medical profession. If so, what a strange oversight. A progressive idea of nursing requires more than a focus on knowledge and skills. It requires a professional and educational focus on protecting and rearming nursing values and qualities as well. It requires a collective willingness to re-nourish nurses.

Readers' comments (36)

mike | 12-Jul-2011 12:53 pm
Very well said, I think that the emotional labour of Nursing isn't as much overlooked as ignored completely.
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Anonymous | 12-Jul-2011 1:31 pm
"....that all patients need to be treated the same - with unconditional positive regard"

I would rephrase that

"...that all patients need to be treated" with the same "unconditional positive regard"

my patients and everyone else i encounter individuals with differences and i treat them accordingly but with the same positive regard

please excuse my nit picking but I find this important as I do the topic of your article.

I am still desperately but unsuccessfully seeking the title and further information on the book you wrote which I saw referred to in the comments here and which sounds like a must have, must read!

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mark radcliffe | 12-Jul-2011 4:49 pm
Hello both; We are a long way from prioritising the less tangible but core issues like emotional labour because of the political climate in my view. All the more reason to bang on about it perhaps.
Anon; yes your phrasing is more accurate than mine.
The book is fiction and is called 'Gabriel's Angel'. Thanks for asking.
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Adrian Bolt | 13-Jul-2011 1:00 pm
"I know that for every act of terror or unkindness, there is a rationale or excuse, from “we are carpet bombing people to free them from oppression” to........"

I can't help noticing that you are equating "carpet bombing people" with "acts of terror". Very lazy thinking Mark. The countries who engaged in carpet bombing (i.e. the allies during the war and the US air force in Vietnam) were all representatives of liberal democracies which for all their faults were fighting unelected regimes or in the case of the Second World War an elected fascist regime.

Carpet bombing was the only form of bombing available at the time and while it might sound nit picking it was the factories and housing that were being bombed not the people themselves. Or in the case of Vietnam large swathes on largely uninhabited jungle.

Comparing the indiscriminate injury caused by the terrorist bomb with the sort of military action currently being carried out in Libya and Afghanistan, involving precision bombing where every possible care is taken to avoid civilian loss of life, is frankly absurd.
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Anonymous | 13-Jul-2011 3:07 pm
@Lard Wheel Inn | 13-Jul-2011 1:00 pm

we should of course be talking of nursing and this is a little off thread but are you absolutely convinced that the half million or so casualties of dresden and hiroshima were collateral damage of legitimate industrial/military targets? or, just maybe, terrorising the civilian population to pressure their governments to capitulate?

and the "oops, we did it again!" precision targeting of al jazeera is not an attack on free speech?

wake up and smell the napalm!
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mark radcliffe | 13-Jul-2011 4:42 pm
Lard Wheel Inn: Well loathe as I am to ever defend anything I write (it feels like bad form) whilst you may dispute that carpet bombing people may not induce terror can we agree - as my sentence says - that it is unkind?
Nice pic :-)
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Anonymous | 13-Jul-2011 6:29 pm
I agree Mark, emotional input is entirely in keeping with the principle of service. I a business and product orientated economy unseen essentials such as emotional labour or kindness are at best hard to fathom and less easy to measure and make a profit from. How do measure the worth or a kind but economically unnecessary kind word to someone in distress? How do you challenge this in a manager who is 'time is money and waiting time targets' orientated?
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Adrian Bolt | 14-Jul-2011 12:32 pm
Neatly dodging the issue there anon @ 3:07pm. You are right to a point of course the carpet bombing of Dresden was a terrible thing as “Bomber Harris” freely acknowledged at the time, when you are fighting a total war you can bomb the factories or the people who work in them (or more accurately the homes where they live) which is why of all the war generals, admirals and air chief marshals he was the only one not to be recognized with a peerage or title after the war. But don’t forget the axis powers employed their own terror weapons V1, V2 rockets and in the case of Japan nerve and chemical weapons.

But all of this misses the point that was then this is now. Now we are fighting an enemy who is implacably dedicated to the destruction of the West and every thing it stands for, an enemy that would make the wearing of beards compulsory and who would stone to death any woman thought to be having an affair, an enemy who sends suicide bombers into crowded market places, puts remotely detonated bombs beside roads and flies fully laden passenger aircraft into tower blocks or had you forgotten what we are dealing with here. Compared with that what is the killing of a few innocent civilians when the odd smart bomb goes astray although regrettable is pretty insignificant. We spend more on NOT bombing innocent civilians in one raid than the Taliban spends on health care in an entire year.
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Anonymous | 14-Jul-2011 10:29 pm
Edwin...there you are - I was beginning to think you weren't bothering to drop in!
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DH Agent - as if ! | 15-Jul-2011 2:36 pm
Mark, are you actually saying, to put this very simply, that awkward and challenging patients can sometimes provoke inappropriately 'well sod you, then' 'influenced' behaviour from their nurses ?
And that you feel nurses, and their employers, do not adequately examine and address this problem ?
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mark radcliffe | 15-Jul-2011 6:45 pm
Michael: No I am suggesting that emotional labour is a key element of nursing work -and working with difficult people may make that clearer sometimes - but the way we support, educate, manage and value that part of the work seems to me lost in the plethora of skills and knowledge that underpins nurse education.
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DH Agent - as if ! | 16-Jul-2011 11:32 am
mark radcliffe | 15-Jul-2011 6:45 pm

'Nurses face managing difficult people in difficult situations every day. Some patients can be wearing, spiteful, vicious, unhelpful and even vile. And it is a given that they require the same considered management as “easier” patients. The emotional energy, skill, consistency and awareness required to attend to difficult patients is wholly and unquestioningly assumed.'

I'm afraid that I don't use the same terminology as nurses (I suspect you pick a lot of it up because you are nurses - for example nurses seem to use 'patient autonomy' when I tend to say 'Informed Consent') but I'm struggling with emotional labour.
If by emotional labour, you mean the 'problems within your head arising from the combination of your own emotions and your professional duty' then I can see that this is likely to be so 'tricky to address' that employers will tend to keep out of it. But, as usual, thinking like a patient, all that matters is how nurses behave towards the patient: whatever is happening inside your head, is only relevant in so far as the patient experiences its consequences.
One nurse did say he could after years of experience 'cope with angry patients much better now, but when newly qualified 'no chance' !' (I'm paraphrasing, but that was his point) but a decent nurse will learn that type of thing, by experience. But some of these things are not like purely 'clinical' skills - some of these things, are very difficult to 'properly deal with' without the experience, so training or support in those areas is trickier.
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tinkerbell | 16-Jul-2011 11:52 am
in my nursing i have worked mostly with difficult patients and not to mention some staff along the way. It has focused my attention on the fact that sometimes i dislike most in others that which i dislike most in myself and vice versa. It has promoted my own self awareness. It is easy to nice to someone who is loveable but more of a test to be nice to someone who is objectionable, but i do believe that we should practice unconditional positive regard regardless. My job has been emotionally draining and there is a need to regroup and refresh yourself emotionally as well as physically. We are all of the same species whether we like it or not and we all inhabit planet earth. Society is 'you and me'. I ain't no saint yet and i still have a mountain to climb but i feel that in helping others i have helped myself and it has led to me become a better person hopefully. I think the work we need to do on ourselves is a lifes labour and untimately, hopefully, we come out better and not bitter. For all the innocents who have lost their lives in wars is important to demonstrate how far we can go towards anihilating one another whether on one scale or another. We have to be aware of our motives. It is all very draining but rewarding to be self aware and we need to take time out for ourselves to recharge and find some peace within ourselves to be able to go back into the work place so that we don't end up burnt out, stressed out and completely knackered. We are all mirrors to one another and whilst it is an uphill struggle should try as best we can to be kind to one another even on a bad day. This is your mission should you chose to accept it.
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tinkerbell | 16-Jul-2011 11:56 am
p.s. Mark thank you for the article by the way. Much food for thought.
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mark radcliffe | 16-Jul-2011 5:49 pm
tinkerbell: thank you
michael: Emotional Labour is a term that goes back to some research in the early 80's and was developed by Pam Smith in the early 90's. It is about the work involved in constructing and presenting the most congruent, considerate and useful set of emotions for each particular patient.
It is, most nurses I know suggest and tinkerbell seems to be saying, the draining bit and I would suggest that marks out the most skilled and most appreciated nurses.
If you are interested you might want to look at Hotschild (82ish I think) or Smith (91 ish I think) or the unmanaged heart by Theodosius about 2008 I think.
I suppose in truth I am simply trying to keep such things on the agenda because I think they are very important.
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Sarah Stanley | 17-Jul-2011 3:12 pm
last year i went on the "Advanced Communication Skills" training course.
I was looking forward to it, thought it might provide some useful tips for dealing with the sort of patients mark is talking about.
NO! All it was about was trying to make us believe that those patients had a God given right to behave how they like and it's probably all our fault anyway. I was feeling fine when i went in the room on the first morning, by the end of the course i felt like punching the trainer. Hmmm...something wrong somewhere!!!
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tinkerbell | 17-Jul-2011 11:44 pm
Sarah what a shame the 'Advanced Communication Skills training' was put forward in such a way as to take all your enthusiasm away. These training courses are so souless and lifeless sometimes, they miss the point that we are human too so that we end up coming away feeling like some kind of failure that needs reprimanding. I was not aware of the works that Mark mentioned before i wrote my above post and so went to have a look. I was only speaking from my own personal experience having worked within mental health with young adults, drug and alcohol detox, community psychiatric nursing, a mother and baby unit, anorexia, locked wards & most recently the elderly. I understand the concept of what is being said in the writings that Mark refers to but also found it dry and dispassionate as if i am selling myself as some kind of 'product', so i am not surprised that you came away feeling annoyed even angry and frustrated. Why or why can't they find facilitators that can also relate to us with some kind of 'emotional labour'. I think if i had not come across it myself through my own experience then i too would find it all rather off putting but i do believe that the concept is right even if it is put across in such a dry way and if you can see through the wood for the trees then it is the right way to go. You can fake it until you make it. Good luck with that one.
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DH Agent - as if ! | 18-Jul-2011 3:16 pm
mark radcliffe | 16-Jul-2011 5:49 pm

Mark, I am probably still being too thick here:

'It is about the work involved in constructing and presenting the most congruent, considerate and useful set of emotions for each particular patient.'

So, if I have got this right, it is basically what I said - emotional labour is 'getting my own head right, when I am dealing with this aprticular patient' ? So, it is NOT anything which can be OBSERVED - it is the feelings the nurse experiences, and the challenge when these are difficult to handle?

There is a lot 'inside peoples heads' which interests me - basically I see a lot of validity in Dr Who's comment 'Don't insult me by telling me you are the last of your species - I am the last of my species, and you aren't'. Some things, only start to be 'understandable' when you are deeply involved in the situation, in the role yuo are considering, personally - in fact, too much of the 'wrong type' of experience, can make it harder to understand other perspectives.
There are many things which drop off agendas, but should stay on, because they are important. And it is also true, some some of the omportant things are very hard to easily measure: I sometimes wonder if too much emphasis is given, to improving things which can easily be 'scored', at the expense of things which are harder to 'assess' ?
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DH Agent - as if ! | 18-Jul-2011 3:21 pm
mark radcliffe | 16-Jul-2011 5:49 pm

Just discovered I can't read any more - very annoying !

You said 'constructing and presenting' - so this CAN be seen ! But showing a set of appropriate emotions to a patient (whether real or faked) would, I have thought, take more time than most posts suggest nurses have ? You can show anger very quickly, but showing 'empathy, understanding or compassion' does, I think, take much longer in some cases: do you always have the time ?
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DH Agent - as if ! | 19-Jul-2011 10:21 am
It is the presentation of a constructed emotion to a patient, which bothers me here.
Humans are very good at 'picking up on' false emotions - and if you can tell that a nurse is presenting a 'front', this can be somewhere between confusing and annoying, and if that happens, it does nothing to foster 'open communciations'.
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