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'Consign outdated ideas of nursing to the past'

The health secretary has once again spoken out about what he intends to do to ensure nursing in this country remains respected and worthy of that respect. One of the things on his hit list is nurse leadership.

If he had eavesdropped on the conversations at last week’s Nursing Times Summit, which was taking place while he made his announcements, he’d have found food for thought.

The event, which brings together directors of nursing and chief nurses from around the UK and Ireland, is Chatham House rules, so I can’t divulge what was said. However, I can tell you that Graham Pink, the former charge nurse who blew the whistle on Stepping Hill over 20 years ago, was a speaker. As was the author Joan Woodcock, who has penned two books about her experiences of nursing from the 1960s to the 1980s - Matron Knows Best and Matron on Call.

Both these nurses’ books reveal their evident passion for their profession and for patients. But that isn’t all these nurse authors have in common. Their books also paint pictures of dictatorial managers - some of whom were bereft of compassion for the workforce and oppressive in imposing their will. Ms Woodcock and her peers accepted the strict regime with a forbearance and sense of humour while Mr Pink kicked back against it.

Nurses who have survived ritual punishment and fear at the hands of their seniors often turn those episodes into humorous anecdotes for their books. But in these days of positive reinforcement, praise and reward, can we really see an era in which many nurses faced abject misery or humiliation as halcyon days?

Other professions seem more able to consign such outmoded role models to the history books, but nurses and the public still seem to celebrate the old-fashioned strictness of matron, and cling to the belief that these figures made patients safer and nurses better.

Many of today’s managers are democratic, fair and sensitive. But as long as nurses hark back to a time when managers and matrons were dictatorial bullies, and recall it with fondness, are we allowing the media, the public and those still in the profession to believe these were better management role models? Are we suggesting that being tolerant, open to discussion and fair is somehow less?

In doing so, we imply that nurses are too weak to make their own decisions, or unable to make the right decisions, and need to be governed by an autocrat who disempowers them. Is that really what’s best for the patient and the profession? I think it’s time to take off the rose-tinted glasses when we look at the past.


Readers' comments (21)

  • Not all managers and senior nurses from the past were bullies or dictatorial. As a junior nurse one of the best ward sisters I ever worked with when training in the early 70's, was a super role model and I chose to work on her ward once I qualified. She always thanked staff at the end of a busy shift, never asked others to work late or forgo breaks without doing so herself and was very fair to all. An excellent teacher and manager who was a superb sensitive nurse.

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  • it appears to be nursing nature, or human nature in general, to stick to the familiarity and perceived security of the past and to demonstrate extreme resistance to change and an unknown future even though such change may bring significant improvements. This seems evident with the current government reforms which the government.

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  • above comment sent in error before it was edited. should end after reforms.

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  • Under the Chatham House rule you can divulge what was said, just not who said it.

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  • From my experience there are good and bad nurse leaders from 20 years ago and today.

    I was seconded as a manager and all the weekly meetings were just "Yes" meetings. Anyone who did disagree were challenged quite forcibly and left to feel isolated. Once the higher echelons left the room, then there was alot of moaning about what was being done.

    The fact that Chatham House Rule was used shows that nurse leaders are afraid of being identified as speaking out against their bosses.

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  • There are some really good managers, who tick all the right boxes. But they are in the minority. All too often managers are little better than yes men. Some are extremely aggressive to their staff. Slavishly following orders, no matter how detrimental to morale.

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  • The role of the ward sister has changed though hasn't it. When I was a student in the 90's, the ward sisters seemed to know everything and taught us a great deal. It was always the ward sister who looked after the final year students and helped prepare us for our Finals.

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  • Nurse/skill shortages. "Nurses have been saying this for a long time." but have they. I undertake medico legal work and I have rarely (only once) seen that this has been recorded in any patient's notes. I have seen it entered by physios, SALTs and OTs. In many cases it is clear that the nurses are very busy and incidents have often occurred at Bank holidays and week ends with a higher number of agency staff. The nurses have not been familiar with the ward, the hospital protocols or the patients and have said they di not know who to contact to ask for assistance or advice. There is no apparent leadership. Still in these cases the environment is not taken into account, the issue is, did that patient have an acceptable standard of nursing care to meet his or her needs. If the answer is no, then the case is proved. In a civil case, this means that the Trust is blamed and is liable, this also means that the managers are upset and look for someone else to blame for their system failure. There is a risk fior the nurse that if they did not make "the management" aware of their difficulties that the nurse could be referred to the NMC.
    If the nurse has recorded that they have notified the senior nurse manager on duty of the pressure, this should be noted with the name of the person informed and their response. It can be- sorry we can do nothing.
    In that case a nurse must show that they have and how they have prioritised their workload and have informed the nurse manager what can be done and more importantly, what cannot be done with the resources available.
    All of this must be recorded dated and signed.
    Without this both the patient and nurse are at risk.

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  • Hi Jenni
    Nostalgia is a powerful drug. I am now a woman of a certain age having just celebrated my 'one before another big one' birthday. In many parts of my life I seem to have become addicted to looking back and I love nothing better than telling stories of the past with old nursing friends, preferably over a glass of wine or two, comparing funny and not so funny stories. It enriches our lives.

    There is a dark side to this, however, and it was a conversation with another nurse, James, who is approximately 15 years younger than me that pulled me up short....

    I told James at the time he made me feel humble and made me really reflect on what my inadvertant behaviour was doing as a leader.

    James challenged me by saying 'Can I just say, that all you older ('thanks' - I thought) nurses who keep harping on about the past are not helping.'

    I asked 'why?' and he explained in fairly straightforward terms how the conversation about the 'good old days', when everything was wonderful, made him feel and it wasn't good. He explained that it gave him a feeling of never being able to live up to that past and a sense of failure as a result.

    He is right and I am wrong. I applaud him for challenging me so directly. Thank you, James.

    Why am I so grateful? As I say nostalgia is a powerful drug but on wikepedia it says 'nostalgia describes a yearning for the past, often in idealized form'. I think the final part of the sentance says it all.

    Yes - it is good to look back. There were good things about the days when I was a ward sister (in the 1980s gulp!) but there were also not so good things. If I was to be a ward sister now would I do the same things I did then - of course not.

    The same is true of now, there are great things about nursing now, and, as we have witnessed on various occasions over the last couple of years also things we can improve.

    The fact is we need to be careful about this powerful nostalgia and not let it colour rational views about modern nursing. As previous comentators have said some things were good then but I would argue the nurse who challenged me demonstrated clearly that we have good leaders now too and we should all work together across the generations we have in the healthcare system to continue to work out what are the next best steps for nursing as a whole.

    I won't be harping back to the past in such a public way any more. I have also challenged myself to listen more and talk less and for anyone who knows me you will see how hard that will be :0)

    I will continue to reminisce with my peer group over a glass of wine because reminiscing about issues like the use of clinitest tablets to test urine (which was one of my favourite jobs) are fun to talk about and we are a profession that shares through oral narrative.

    But its time we changed our language. I want to have new, positive conversations about 'modern' nursing. We should be positive, we have a lot to be proud of.

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  • If the Secretary for Health is not a bully, terms that describe his recent behaviour are dictorial, undermining, not listenening and he has a 'hit list' generally a negative term for getting rid of people; for nurse leadership. Surely this is a paradox on his part, by 'hitting' nurse leadership is the same as 'hitting the NHS' and we all know what he has done to that.
    The man is a lunatic, and is making the this public service a psychotic environment. The morale of staff is low to say the least, view comments on other opinions/blogs. So looking back as I can, into the past in nursing, the one thing we did have in the 70's was good morale and a sense of belonging, that permutated into the patient care.

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  • Hello
    I enjoyed Annes' response. This is a tricky one for me !
    I am a modern nurse leader . For those of you who are perhaps not aware I remain on Part 2 of the NMC Register.
    Now, in accordance with our code I keep my skills and knowledge up to date.I have undertaken courses, clinical study and through, Social Media these days, find myself reading a huge range of articles etc related to Healthcare development generally and enjoy debate with many other healthcare peers from a variety of fields.
    Like Anne I enjoy nursing nostalgia and indeed value my early years in training which was mid 80's, when Sister, in some areas, was very much a person we feared !
    I am a big ambassador for the role of the second level RN as it was ! Some of you may have partaken in the webchat or read the #NurChat blog from March entitled " Should we bring back the EN ". It was prevalent that the participants who remembered and valued the true role were, indeed, nurses from a certain era and again nostalgia/ reminiscing was evident.The chat more or less concluded that many expressed that we could see the value in the role of such a nurse in current nursing and that perhaps the role of the AP was similar, although, of course there is no regulation, which has led to further recent debate.
    I find that I do, rather often, have to relate to nursing past when explaining my qualification, which by todays standards is no longer achievable !
    I am proud of my personal achievements and meet a variety of reactions . I have been told that it can be of an educational value to students I have met. They can be amazed, bemused and able to reflect on changes apparent now in their world of training !
    I truly am a product of nursing past but with current knowledge can chose how nostalgia can perhaps on occasion, be appropriate in my current, modern day practice !

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  • Nurse managers are accountable for their actions and omissions as per the NMC Code. It's about time those who "slack" re-read the Code and act accordingly. It doesn't say anywhere that managers have to be "yes" people. In fact the Code gives clear direction to speak out if needed, not to just go along out of fear. It disgusts me to be honest that most (not all) managers cannot stick up for what they know to be right.

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  • Me again. According to the NMC Code " are personally accountable for actions and omissions in your practice and must always be able to justify your decisions". AND "be open and honest, act with integrity and uphold the reputation of your profession".
    Being a "yes" person obviously does not fulfil these requirements in any way, shape or form.

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  • our new ward manager is nothing but a bully Shes changed everyones hours some nurses working 50 hours a week with hours regulated over 3 months No negotiation if you dont like it look for another job.She made a drug error within 2 weeks of arriving on ward which was covered up. Noone can use mobile phones but she can. Noone can have any holidays between xmas and new year but she can have 1 week.To make matters worse shes made a friend of the only Auxilliary on the ward thats a tell tale and also a bully to the patients particularly if they are frail.The sooner i get another job the better

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  • the EN is still trained and valued in Aus, link to information re same , re my comment .

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  • How on earth can you get a job as a ward manager when you cant even do venepuncture???? The APs do all the bloods most of the time as most of the staff nurses on the ward also cant take blood.Why are they not made to go for training Its just another excuse to put on the poor APs who are not getting the wages the RGNs are getting but do most of thr work It stinks !!!

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  • Is it really the case that the nostalgia is about bringing back bullies? When there is a bully others form a bond in adversity and that feeling may be what people remember. But most of all what people want when they say 'bring back matron' or similar is that they want one person who is identifiable as being in charge and who has the authority to make a decision. The current climate of committees and sub committees before anything can be decided - even the colour of the folder to put the notes in - is enough to make anyone hark back to a simpler time - its not a call for a bully to take charge its just a desire to have someone take responsibility.

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  • Anonymous | 30-Apr-2012 12:54 pm

    On reading your comment I just wonder whether there were in fact less bullies before than there are now.

    One of the many different reasons that bullying might arise could be out of uncertainty and more responsibility than people are adequately prepared for or responsibility without the appropriate authority, which is often the case in employment and especially nursing, which may have been dumped upon them by someone else who didn't want it. Instead of being able to express or admit to any shortcomings bullying may be used to disguise a sense of insecurity, lack of confidence or a lack of ability or skills in some area.

    Bullying is often a defence mechanism and strategy to hide some deficit or other and can be intentional or with a lack of insight from the perpetrator into their overt or covert negative behaviour.

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  • Anyone can be a manager, not everyone can be a leader. Managers can be taught to manage. Historically the famous leaders in the world became so because they had something special, the ability to inspire others - whether positively like Churchill, Ghandi, or bad like Hitler.

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  • I am amazed that someone who is not a nurse feels she can use such emotive language when writing on a subject of which she has only hearsay experience.

    "Dictatorial", bereft of compassion", "oppressive in imposing their will" - I for one don't recognise these as characteristics of the majority of Matrons and Ward Sisters I worked with in the 1970s. Some were fierce disciplinarians it's true but it was for the benefit of the patients and instilled a self discipline into us, the students. We knew which Sisters didn't suffer fools gladly and who were the softies, with whom we could get away with cutting corners. Looking back, who did we learn from most, not the softies. Large organisations need rules to function well and someone has to enforce those rules.

    We did not suffer "ritual punishment and fear" nor did we face"abject misery or humiliation" in the Good Old Days. When we older nurses get together and recollect our training it is invariably with a good deal of laughter. I have yet to hear a modern nurse, trained by a university say that she had fun during her training. We are not being disingenuous by "accepting the strict regime with forbearance and a sense of humour" nor are we damaged survivors turning tales of terror into "humorous anecdotes" (Did you really read Joan's books at all?)

    In my long experience I have yet to come across a modern nurse manager who is democratic, fair and sensitive let alone one who knows how to dish out positive reinforcement, praise and reward.

    There are too many of them, occupying offices, going to meetings, kow-towing to Trust administrators to actually manage or lead the nurses doing the actual clinical work. In my last post before retiring I did not see one nurse above my grade in my department in 5 years! So much for leadership.

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