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'Ask nurses the right questions so the profession can progress'


OK, mini quiz.

Get yourself a biscuit, gather as many nurses as you can without people thinking you’re starting a choir and answer the following questions:

  • When was the last time your line manager asked you if there was a course you would like to go on?
  • When was the last time someone checked with you that your clinical supervision was satisfactory and you were getting what you needed from it?
  • How often in the last three months did someone tell you as an individual you had done something particularly well?
  • When were you last asked what you felt was needed to enable you and your colleagues to do your job better?

I’m not asking because I think I know the answers. I’m asking because I think political agendas are set by the questions people ask and of whom they are asked.

The world seems to be full of people making pronouncements on the death of compassion and the failure of nursing - and it is not a coincidence that such things are expressed when the government needs people to collaborate with public service wage cuts - but we are not asking the right questions of the nurses very often, are we? Indeed, it seems lots of people (politicians, bureaucrats, journalists and so on) ask questions about nursing but do it in a way that imagines nursing isn’t listening or treating it like a child sitting in on a parent-teacher discussion at parents’ evening:

“I don’t think Jenny likes biology,” offers the teacher.

“Oh she enjoys playing ‘Operation’ and tried to dismantle the cat once,” says dad.

“No, I think she’s more an arts boy,” argues the teacher.

“Really?” says dad. “We’ve always felt she’ll disembowel someone at some point. We’d rather hoped she’d get paid to do it.”

And silenced Jenny sits there, waiting for someone to ask her about her.

And, of course, the questions tend to be quite loaded and implicitly judgmental. Questions such as: “Why don’t nurses care any more?” Let’s face it, it doesn’t matter what the answer to that question is, the damage is done by the condemnation that sits within it.

“Are nurses too clever to care?” Well, no, but if I answer that stupid question I enter a world where being intelligent and being kind are not allowed to exist in the same body and I don’t want to go there.

Or is there any question that refers to the nurse as “modern”: “What has happened to the modern nurse?” Sounds neutral and invites the answer: “She demanded a better education, a qualification that carries an appropriate amount of social value rather than a badge and a hat, and has navigated more power in the clinical environment in order to offer more to the patient.” But instead, you’d probably get: “She stopped being lovely like those unmodern nurses were.”

In essence, the world is asking questions about nursing that seek to condemn it, judge it, belittle it and not value it. Maybe we can’t do much about that; we can’t rewrite the social commentary of the decade, we can only wait for it to pass, which it will - although it will have greatly damaged the morale, sense of purpose and working conditions of nurses everywhere.

In the meantime let’s seek out the nursing voice and ask more interesting and progressive questions about what might help. And by help I mean help the act, quality, progress and sustenance of nursing. Let’s not talk about it, let’s talk to it. And maybe let nursing set its own agenda.

Mark Radcliffe is senior lecturer, and author of Stranger than Kindness. Follow him on twitter @markacradcliffe


Readers' comments (4)

  • Mark , you of course correct in your observations but for change to occur the profession requires leaders who care about nurses and patients.

    Those who sit in ivory towers dreaming about mythical "C's" are just fueling the fires of cynicism and providing encouragement to the media.

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  • Oh Mark, how right you are. However the problem is not so much about intelligence as ambition. For some strange reason ambition is not perceived to be compatible with kindness and compassion, so todays nurse who is highly intelligent and ambitious must be unkind and uncaring. There is nothing wrong with wanting to progress, it is what nurse education is directed to; personal and professional development, but I am not convinced that the profession is quite ready to accept this as yet. If colleagues are not supportive, how can we expect the media to be so.

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  • I may have been that manager. First they took the budget away and then they took my job away.

    It's not really about ambition so much as realising that if you stop learning, the world moves on without you. If you don't keep up with developments in health care, you're more likely to be delivering poor care in a setting which doesn't attract interesting and dynamic recruits. Nobody will want to work long in such a backwater.

    The teams which get real encouragement to grow professionally, even if it's on a tiny budget, are the ones delivering the best care for patients. Which is the point of all this education stuff, really!

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  • michael stone

    Mark, 'controlling the question' is something people like politicians spend a lot of time on: control the question, control the debate. I pointed out almost immediately post-Francis, that the Goverment had to be prevented from trumpeting the 'do nurses care' (inexpensive) question to the exclusion of the 'do nurses have enough time to care' (expensive) question.

    Something which tends to leave a lot of 'good questions' without any significant airtime.

    Another handy trick - recently seemingly employed by Justin Welby - is to set up 'a logic chain' you know is flawed, attribute it to the opposition, and then refute it.

    Welby claimed that supporters of the Assisted Dying Bill, were 'failing 'O'-level logic' because they 'wished to be compassionate', with Welby then DEFINING 'compassion' as 'suffering with someone else'. Well, I'm basically in the 'pro' camp, and I don't want to 'suffer with a dying patient who is suffering intolerably' - my version of 'compassion' would be 'to find some [legal] method of relieving his intolerable suffering'.

    Although it is very difficult, to express the concept in words: other than saying that 'I don't see why a terminal patient whose own judgement of his situation is that it is intolerable, should not be allowed to end his own life, with some help if necessary - because it is the patient who is suffering, and the patient who is experiencing his own life', it is hard to unambiguously express the 'why'.

    Because it has got to be the patient's decision - if a doctor or nurse decides 'to kill a patient to relieve his suffering' that change in the decision-maker, would clearly [to me] make that murder.

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