Employers must have supportive structures that encourage nurses to be assertive, says Bill Whitehead
In recent months, nurses have, in some instances, been criticised for failing to challenge medical and managerial decisions where they knew them to be wrong. In a few high-profile cases this has led to patients dying or suffering to such an extent that they have been forced to pursue the healthcare providers through the courts.
Why is still happening? The universities and schools of nursing that preceded them have been advising their students that they are autonomous professionals for decades. That was certainly the case when I registered in the 1980s. Equally, nursing’s professional regulator has long made this clear in its code of conduct.
‘This stems from the long-standing position of nursing as an oppressed profession. Nurses are oppressed by forces that continue to permeate the whole of society, such as gender and economic class’
Something deeper than the educational and legislative process must be going on.
Let’s look at the facts. Nurses and doctors are part of the same multidisciplinary team, striving towards the same goals of providing excellent patient care, diagnosis, treatment and cure. They each seek to have therapeutic relationships with their clients. Both professions have a range of specialisms and roles that encompass the care of the whole person from cradle to grave. What is the difference?
Both professions gain their registered status with bachelor’s degree level academic achievement as a minimum. Nurses generally have one degree after a three-year course and doctors usually have two after a five years, but they are of
equal academic status. Both have a professional regulator with legal power to admit and remove the ability of people
Even if this professional equivalency were not the case, academic and professional achievement cannot make a person right when they are clearly wrong.
If we are focusing on the wellbeing of the people in our care, we must be prepared to accept the collective wisdom of the team, rather than rely on the ability of one member of it, no matter how prestigious their qualifications.
In the majority of cases (but not all), the doctor will have lead responsibility for the patient’s treatment. Similarly, the administrators of the organisation may often have a legitimate managerial responsibility to lead nurses. Neither of these positions of power negate the responsibility of nurses to raise their concerns. They are required to do so legally and ethically.
Why is it then that many nurses still feel that they are unable to question the word of medical professionals and corporate managers, even when this is to the detriment of their patients?
This stems from the long-standing position of nursing as an oppressed profession. Nurses are oppressed by forces that continue to permeate the whole of society, such as gender and economic class. Nurses are mainly women and from working-class backgrounds. Therefore, despite our achievement of legal and academic equality, nurses continue to be unfairly oppressed in the same way as other women and working-class people. This position is to the disadvantage of nurses and the people we care for.
To challenge this situation requires courage from us as individuals and collectively via our trade unions and nurse leaders. We also need supportive workplace organisations where we are encouraged to challenge decisions we believe to be wrong, even when they are made by doctors and managers. This requires employers to have supportive structures that encourage nurses to be assertive in their everyday professional lives. Only then will we have a safe environment for patients and a truly professional role for nurses.
Bill Whitehead is assistant subject head for nursing at the University of Derby