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EDITOR’S COMMENT

'Nurses aren’t immune to changes in etiquette'

It’s rare that I ever read anything in the papers about “a crisis in nursing” and actually agree with its sentiments.

Usually the columnist breaks my heart with the stories of poor care. But I know such incidents are rare (although always inexcusable), and I am confident in the profession’s ability because of the hundreds of nurses I meet every year, and hundreds more who write to me, telling me what they accomplish each time they go on shift.

I am usually left feeling saddened on behalf of those excellent nurses – whose abilities and motives have been called into question by the poor-performing few who are causing a haemorrhage of public confidence in the profession.

I feel differently about last week’s series on nursing in The Independent. There were some things that made my blood boil – the oft-repeated suggestion that student nurse education is getting worse because it’s moving to all-degree, for example. But, on the whole, many articles were measured. They acknowledged there were brilliant nurses, highlighted some of the extraordinary ways that they go out of their way to care, and reinforced the notion that we should not assume that all nurses are evil creatures, who enter the profession just so they can put drinks out of reach of frail, older patients.

What one of the articles, published last Thursday, also identified was that British culture is changing and that is influencing care.

It relayed the story of a lecturer who said it was not uncommon for student nurses to have to be told not to text friends while at the patient’s bedside.

In a week in which a coffee seller in Norwich banned customers from using mobile phones while ordering their cappucinos and americanos, it’s pretty clear to see that British etiquette is flexing. As a society we are losing some of the manners previous generations held dear.

Of course, a nurse’s focus should be entirely on the patient. Nothing else is good enough. But the public and the media should also recognise that nurses aren’t a special breed. That nurses exhibit some of these abbreviated manners is unforgiveable, yes, but it’s not a symptom that nurses are bad and uncaring – but that they are part of our modern society, and able to succumb to the pressures and distractions of the fast-paced world we inhabit.

This doesn’t mean we should not try to stop it. If a coffee seller won’t hand over a latte without gaining the full respect of a customer, nurses have every right to be the gatekeepers of good manners in their jobs – expecting and exhibiting full attention and focus.

Readers' comments (30)

  • Texting? from a patient's bedside?

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  • Still find it incredulous that student nurses need to be told that. Poor care is not as isolated as you think! As a nurse I am ashamed to say that some of the care and attidtudes expressed while my father was dying a couple of years ago, left much to be desired. The shining lights amongst the nursing staff were few. Professional standards are without doubt lacking and poor excuses for ignoring paients needs - "you can see I'm on the phone" -"I'm busy" - nurse stood around are not uncommon. If nurse recruits cannot be screended for their attitudes to those for whom they are likely to care then we are lost - or have we all got compassion fatigue?

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  • It is not acceptable to lose the manners that our older generations hold dear, and modern distractions should not be an excuse.

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  • I am a student nurse and find it unbelievable that someone would take their phone onto the ward in the first place. These students obviously havent learn't anything from their communication modules otherwise they would realise that using their mobile by the bedside portrays their disinterest in the patient.

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  • It struck me as very bad manners the other day watching the man in front of me having his goods checked without even acknowledging the cashier or making any eye contact with her because he was too busy talking on his mobile. He put his goods in his bag, put his plastic card in the machine, tapped in the numbers and took the receipt from the cashier, still chatting away and without as much as a smile or a thank you before walking away! Putting myself in the place of the cashier who may have several clients a day who do this must be quite disheartening and make one feel that one is being treated as a non-person and a robot just doing a job. I then thought of the difference it makes when one is greeted by a friendly cashier than by those who hardly bother at all.

    I then generalised this mobile phone behaviour to what one witnesses out on the street, in public transport, riding a bike, driving a car, crossing the road or on any other form of transport where there are pedestrians, including small children and the elderly, which can be downright dangerous. One has coffee with a friend or group of friends and invariably one or more are distracted by their phones. If you are in the middle of telling them something important which is interrupted by their preoccupation with their mobile phone or a call this can also be very distracting and disagreeable leaving one with the feeling that you are not receiving their full intention and even that they consider what you are relating to them is of less importance.

    So many people now seem to live in their own world and even when not engaged in a phone conversation they are often occupied in frenzied action with their mobile which seems almost pathological instead of being in touch with their surroundings and making any sort of verbal or non verbal contact with those around them. At worst one can feel ignored which, apart from being bad manners, can be dangerous in traffic. So much time spent in, or thinking about their virtual world and lack of contact with their real surroundings and engagement with other people, both known to them and strangers, must contribute to the feelings of malaise which many people now experience and also add to their stress as they are always on alert for a call or message and often involved in making or receiving one or using the many other functions on their phones.

    For a patient, feeling unwell and uncertain and with heightened sensitivity, it must give them even more profound feelings of not receiving the respect and attention they need and deserve. Even a mobile in a pocket means that there is an expectancy of receiving calls or messages which may distract people from giving their full attention to another or to a task in hand.

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  • Lansley refused to be interviewed by the reporter of the Independent for the series of articles mentioned in the above article.

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  • I've had patients continue to talk on their mobiles or refuse to take their tv headphones off when I am trying to do their medication or obs. I find that extremely rude and disrespectful.

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  • Anonymous | 18-Apr-2012 9:17 am

    so do I. When a ticket inspector on the train comes or somebody talks to me I always remove my ear plugs.

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  • Hi Jenni
    This is part of the conversation we have with our nurse leaders in the Leadership programme. Its an interesting debate!

    We sometimes forget, I think, that we have around 4 generations working as nurses in our workforce. If each one of us thinks about our grandparents and or parents we will be able to recognise that between those generations there are differences in terms of culture, manners etc. I don't think we talk about it often enough but I know most nurses would respond and say we do think about it and take it into account when we care.
    I think that the thing that seems to be affecting this most dramatically is the evolution and impact of technology (Mobiles etc). What this has made happen is that the pace of change is so fast is that the differential between generations is much much wider. So, for example, I can see where my grandparents were in terms of their expectations and manners and indeed they were broadly similar to mine; my son, in contrast, sometimes gets frustrated with us, his parents, as he thinks that we don't understand how his generation communicates and so on. I think he might have a point.
    If we are seeing in the media, as you say, cafes refusing to serve people coffee if they are using their phones, perhaps this is the start of society starting to take a bit more ownership of this mass of complicated social change going on around us. I think nurses are not confused but I think society may be confused and nurses are obviously part of society. Has society cemented what the normal polite behaviours in the world look like in the connected mobile working world?
    I am an optomist. I value nurses and nursing and I think this is easily resolved if we have more conversations about it. At the end of the day its partly about communication which is at the heart of nursing (whether that be using technology or not :0) )
    Anne

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  • I think it rude not to give whoever is in front of you your undivided attention - cashier in Sainsburys, colleagues and friends, patients. Anyone really.
    I have reminded students that unless they have little children, ill family or are epecting a new child any day I don't want to see their phone in their hand whilst in the clinical area and amongst patients and staff. Gets me a few strange looks but then, they don't see me with my phone in my hand so try to lead by example. I suppose i don't view my phone as an accessory organ!

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  • Anne Cooper | 18-Apr-2012 12:48 pm

    you make a very valid point and one can easily forget the 'divide' between different generations. Some fascinating research has been carried out on this and on the different ways the younger generations think, relate to others and their working patterns, beliefs, values and expectations compared with older generations born before the IT boom. It is even questioned whether as a result of all this high tech. brains are becoming differently hard wired (The Shallows - Nicholas Carr, Atlantic Books - and a fascinating read).

    Even for a baby boomer it can be difficult sometimes to be non-judgemental about other peoples' manners and understand what in modern society is acceptable and what is not. It sometimes requires great flexibility, tolerance and acceptability. I try to adhere to my older basic good manners, some of which are still relevant today, and be less judgemental about others unless I consider them to be blatantly disrespectful and offensive towards others or to myself. Having lived most of my life in highly multi-culti societies I try and evaluate the expectations and values of others and then treat them accordingly.

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  • from Anonymous | 18-Apr-2012 1:22 pm

    I don't think it is good etiquette sticking chewing gum underneath the table top in a café - I just put my fingers on some!

    I wonder what Emily Post would have said about that if they had gum in her day. She would probably have been shocked to see people chewing it with their mouths open and blowing bubbles in other people's faces with it!

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  • Little One

    I take my phone onto the ward, specifically because our staff room is not safe and I use it to check my CVVH numbers and drug calculations as my phone has a calculator and the hospital is too cash strapped provide us with any. I always let patients know that is why I have my phone out so they don't think I'm being rude. I still have to concentrate though so may not be able to have a conversation with them until I've finished.

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  • I too think manners and etiquette are to be desired in certain situations especially nursing, do not use your phone when with patients...........full stop put it your locker (or where ever) use in breaks and at end of shift.

    TAlikng about cashiers and ppl not getting of their phones. I find it annoying when the cashier chats away to a friend or another cashier when serving me

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  • Little one, were you not taught to do drug calculations the 'old fashioned' way - with a pen, paper and a bit of mental effort?

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  • Little One - sorry the I'm using my phone as a calculator doesn't wash! BTW, Hospitals have never bought nurses calculators - besides you can pick one up a lot cheaper than a mobile phone! If you need a calculator buy one. Mobile phones should not be allowed on the ward at all. They are a distraction. When any nurse enters the ward they should be totally focussed on the patients and the days work ahead. I am afraid I have seen too many people use the "I'm using it as calculator excuse" but often then have a quick check of their messages etc. because they can as they "just have it in their pocket". Time to get our priorities right and realise we are at work to care for patients and nothing else should get in the way of that.

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  • I wonder how many accidents, work related or any other type, or even a task carelessly executed (which might even include an unsatisfactory interpersonal encounter for the recipient of a communication, verbal or non-verbal) worldwide have been due to inattention caused by mobile phones. This may not necessarily mean using it at the time of the accident but even as the result of a message received or anticipation of a future message, or even just using the apps.

    If there is nowhere safe to leave a mobile outside the ward it should be left at home. It is possible to live without them during the working day and until one gets home.

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  • I find it very disrespectful when I am trying to handover and others are on their phones, no-one says anything as the senior staff are amongst the worst culprits.

    I have seen relatives come in and spend the entire time on the phone, I've had to ask patients to turn their phone onto silent mode or use it outside because they are on it day and night. They don't care that they are disturbing other patients or distracting the staff.

    Some people are just inconsiderate and rude, doesn't matter who they are, how old they are or what work they do, they are just rude.

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  • Anonymous | 22-Apr-2012 10:36 am

    on my old ward one or two nurses used to sit on each other's laps and groom each other during handover as there wasn't enough seating for all in our small office. These newer nurses were in league with the managers and were given free reign to 'run' the ward so the rest of us couldn't comment. We had an older night nurse and although very experienced everything that could go wrong on nights happened on her shifts even though most was beyond her control. Maybe it was because she did a few more nights than the rest of us. I did a fair amount of series of 5 to 7 nights and was always so relieved when they were over and nothing serious had happened where my integrity could have been put in doubt.

    Our night nurse was constantly interrupted by these young misses when all I am sure she wished to do was to hand over and go home to rest. They talked among themselves, interrupted her when she was speaking, did not always listen, criticised her in an offensive, aggressive manner and after she had left mocked and criticised her behind her back even though she was very good and experienced at her job. They were efficient, but sometimes over familiar with certain patients, and it is hard to know what went on below the surface as far as the quality of the work was concerned and taking short cuts. They were always the ones who got their work finished on time and showed up the 'deficiencies' of others who did not regardless of their workload, especially, their older colleagues who had been on the unit far longer and wished to spend more time with their patients!

    They were entrusted with the off-duty planning at their request as the person in charge of two wards who spent most of the time doing office work rather than on the wards, was hopeless at it. They would disappear together for half a shift after a break to an empty room no matter how short staffed we were or how urgent the work was. 'they were busy and it is up to you to organise your work properly'. They were never stressed or over stretched, they always managed so why couldn't the rest of us even if we were left with 20-25 patients on our own (the extra 5 being in bathroom, squeezed in between other beds, in the cubicle by the washbasin so nobody else could access it, and in the corridor!).

    Although there was an off-duty request book any changes or errors were non-negotiable. We did not know in advance when the plan would be done so it was sometimes difficult to put a request in on time. Any request for a change or an error was always met with hostility. The only hope then was to try and find a colleague willing to swap with you.

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  • Our pensions are being raided, our pay has been frozen for years, nurses are being made redundant daily, the NHS in England is being privatised and all we can talk about is texting??!!! FFS.

    If you see a nurse texting in the ward instead of doing his/her job.....tell him/her to stop it!! Simple.

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