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Nursing seen as hard, nasty and menial


Leading nursing figures are establishing a not for profit body to attract recruits put off by the widely held opinion that nurses are “unambitious”, “put upon” and “passive”, Nursing Times can reveal.

The move follows concerns that, despite soaring numbers of applications to nursing courses, many strong candidates are being deterred by the profession’s poor image.

Nursing was seen as “hard, nasty, menial” work, with long hours, low pay and requiring empathy rather than expertise

Nurse directors at NHS London and NHS West Midlands are now setting up a social enterprise to inform the public, nurses and students about what nursing really involves.

The venture illustrates how urgent senior nurses regard the profession’s image problem.

NHS London chief nurse Trish Morris-Thompson said nursing’s image had been through a “very rocky period” following high profile failings involving nurses, such as those at Mid Staffordshire Foundation Trust.

She said: “We know if we can do something to improve the brand of nursing, it will start to restore the general public’s faith in healthcare by nurses.”

This would help to encourage more people to enter the profession, as well as reducing university attrition rates and improving care, she added.

The social enterprise will run a website, to be sponsored by private companies such as nursing agencies, providing information on nursing careers, research funding and universities.

In addition to demonstrating the range of nursing opportunities available, it will track nurses’ careers and eventually provide data such as patient surveys and nurse sensitive metrics.

The move, the final details of which are being signed off, is the strategic health authorities’ response to research they have carried out revealing nursing is not seen as an attractive career by the “vast majority” of the public.

Findings shared with Nursing Times reveal that members of the public, who were interviewed in 81 research sessions, commonly described nurses as overworked, underpaid, patient, stoic, put upon, unambitious and passive.

Nursing was seen as “hard, nasty, menial” work, with long hours, low pay and requiring empathy rather than expertise.

A record 108,000 people applied to nursing degree courses this year, with a further 86,000 applying for foundation degrees and other qualifications, suggesting there were around 10 applicants for each place.

This is around 75 per cent more than in the previous year, a rise attributed to the recession.

But Council of Deans chair Sue Bernhauser said the huge surge had not led to a rise in standards and had instead made it “harder to sort the wheat from the chaff”.

She did not agree the negative image was due to problems with the standards of newly qualified nurses, but welcomed the attempt to inform the public.

However, Central and North West London Mental Health Foundation Trust director of nursing and operations Andy Mattin said: “There’s a concern about people who have completed a [pre-registration nursing] programme and don’t meet the required standards.”

The trust has introduced an assessment centre for newly qualified nurses applying to posts, in an attempt to weed out the many unsuitable candidates.

On average, only 30 per cent of those attending assessment days passed basic literacy and numeracy tests equivalent to GCSE level.

Educating the public about nursing would attract a wider range of people into the profession who had the intellectual capacity and the necessary communication skills, Mr Mattin said.

The need to raise the calibre of students and newly qualified nurses has been identified in a series of reports in recent years.

The report of the Prime Minister’s Commission on the Future of Nursing and Midwifery in March said “a new story of nursing” was needed to “recruit suitable talent and demonstrate that nurses are not poorly educated handmaidens to doctors”.

Nursing and Midwifery Council chief executive and registrar Dickon Weir-Hughes has previously raised concerns that some students were too emotionally fragile for the job.

The Image of Nursing: Findings from NHS London and NHS West Midlands research

Image of nursing

  • Not an attractive or relevant career for the great majority
  • Hard, nasty, menial work
  • Low pay, long hours
  • Requiring empathy, not expertise

Image of the nurse

  • Overworked, underpaid
  • Patient, stoic, put upon
  • Passive, reactive, unamibitious

Reasons for misconceptions

  • Lack of knowledge of becoming and being a nurse
  • Absence of role models to help real understanding

Actions needed

  • Challenge vague, generalised perceptions
  • Stimulate new perceptions of the identity and role of nurses, as well as the benefits of being a nurse

Source: Quantitative research with 159 members of the public from target groups, across 81 research sessions


In numbers

  • 108,000 - number of applicants to nursing degree courses in 2010
  • 20-28% - estimated attrition rate for UK nursing courses
  • 37% - the amount of nurse mentors who told a Nursing Times survey they passed students in spite of question marks over their competence or attitude
  • 30% - the proportion of newly qualified nurses passing basic numeracy and literacy tests at Central and North West London Foundation Trust



Readers' comments (50)

  • About bloody time!

    Saying that though, there is a lot of truth in some of these perceptions (overworked, underpaid, passive!) and a lot of people within the profession need to change as well!

    I would like to see a greater emphasis made on the education/qualifications and skills modern nurses hold. Lets move away from the 'assistant' image?

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  • Why are they surprised? It has been the attitude for hundreds of years and in many cultures, nursing is regarded as one of the menial jobs so difficult to change attitudes. In the UK in the 70's and 80's we had a much better profile and people would readily apply for nursing with aYes, a good idea to get the profile looked at BUT until our present and next young generations becomes less materialistic and selfish we are going to find it hard to attract people. There are still altruistic, kind and intelligent people out there and they still apply as they can see past the money. We need dedicated and truly motivated people in nursing not just any old bottoms sitting in university lecture halls. The middle 1990's and early 2000's were a disaster for nursing as for some people, nursing bursaries were regarded as a good way to get education and be paid while doing it, (all be it a pittance) and then disappear to other well paid jobs. We need to look at the way we train our nurses. Degree level no problem, but we need our training to be practice based, a medico-nursing model of health and illness, integral to the NHS and working towards managing workload and care and not so vague and woolly. How will we attract new blood if the public perception and EXERIENCE of nurses is viewed as uncaring and incompetent? Work on that and prove our worth not just spend huge amounts on propaganda which people will not believe.

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  • For me its not nursing that has the bad image but nurses!! The old adage 'nurse eat their young' still applies and the attitude of 'you don't need a degree, its all rubbish, I've been doing it for years and that's all you need' still sadly applies in a lot of areas.

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  • I am a nurse who is sick of hearing nurses whinging about low morale, low pay, being disrespected, DO SOMETHING ABOUT IT, YOU ARE ALL PROFESSIONALS!

    The reason poor nurses get through to be qualified nurses is because nurses let them pass placements when we all know they should be thrown out. Then when the NMC attempt to address the problem, we complain!

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  • In my CFP year of training in a class of 50 diploma and degree nurses, only two of us, (both dip nurses), scored 100% in a basic numeracy test. What does that say for medication safety?

    Maybe we need to train students in numeracy, rather than just test them.

    As a newly qualified nurse I will certainly make this a part of any mentoring I do.

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  • I think we need to do more than make sure that prospective nurses are well educated. The current perception is that nurses are bogged down with paperwork and are 'too posh to wash'. Nurses need compassion for our clients and should care for them as they would wish to be cared for. This is not being a handmaiden. This is one of the higher actions that difine our humanity.
    I would make prospective nurses work as carers for 6 months before training, to sort out the men from the boys!

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  • Are we all so quick to jump on the bandwaggon and make judgements based solely on hearsay? Some of us jump to conclusions that all nurses at the moment are none degree, if they provide poor care or lack skills, or indeed that the system of learning is to blame for allowing so called 'poor' nurses to qualify. Nurse training is hard 24/7 working coupled with education, Bursaries are topped up with extra shifts in the healthcare environment to strengthen understanding and learning. Or indeed to make ends meet. As nurses we are professionals who have an ever increasing workload, a harsh critical climate and constantly insufficient funding to provide truly excellent evidence based care. We are tested on a daily basis in our ability to make decisions about appropriate evidence based care, whilst fullfilling our obligations to our patients, relatives, employers, colleagues, ourselves and of course the laws, policies and proceedures that govern us. No amount of maths, english or degree can make a good positive nurse, the way we are looked upon and regarded is governed by the media response to failings, coupled with the governments who constantly place decisions regarding care, firmly out of reach of the nursing profession. I firmly believe that nurses are the backbone of the health service. The skill required to be a nurse cannot be soley based on either education or practice. Everyone learning new skills, will enhance those skills with support, additional learning and encouragement. Carry on arguing amongst yourselves though, but I think we are better off united as a workforce.

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  • In the US, we require about 13 years of study for physicians, 8 years for a pharmacist, six years for a physical therapist, five years for teachers, and only two years (and in the past, some had less) for a nurse. How can we expect to be taken seriously unless we raise the standard?

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  • Blah, blah, blah.......same old arguments going round in circles 'til we disappear up our own behinds and are entirely replaced by HCAs. All that will remain will be a 'rump' consisting of some specialist nurses; 'Queen Bees' directing the workers-the HCAs. Mark my words, it is already happening and we are sleep walking our way into virtual extinction.
    All of the comments in the article about how nursing and nurses are seen are our own fault; we ARE passive, underpaid, overworked etc. and sad to say, sometimes not very literate. Check out some of the comments on the article about the nurse switching off the patient's ventilator. It just does not look professional if we cannot even spell or punctuate. Sorry, but yes, these things DO matter... we are in positions of huge responsibility with people's lives in our hands. It reflects on our credibility.
    My daughter is one of the young ones about to start university life. When I asked her a few years ago if she would want to be a nurse she laughed and said no way! The public image of nursing is not good. Look at how we are portrayed in the media. Wicked and lazy (Daily Mail) silly, poorly educated, promiscuous, doctors' handmaidens (the ghastly 'Holby').
    It's also about the money. We are not paid enough but we are too expensive. We are not respected as professionals. We need to get a grip, get some backbone.......and maybe some good leadership and representation.

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  • It is poorly paid and we are passive.

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