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Bureaucrats should start listening to nurses

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Before her recent retirement, Sister Marks was tellling me about the ups and downs of her career. ‘Forty years in healthcare is a long time,’ I said. ‘Do you have any regrets?’

‘No, I can’t think of anything better than a career in nursing. But I’m impatient about the rigidities of the system,’ she said.

‘Today’s nurses are much better informed than in my day but they’re still not allowed to challenge existing practices.

Bureaucracy, you see,’ she added.

I laughed and said: ‘I don’t suppose there’s a nurse in the land who loves bureaucracy.’

‘No,’ she agreed. ‘But you have to distinguish between good bureaucracy and bad. It’s good when it promotes the cause of enlightened healthcare. But when it becomes an end in itself, it invents rules for absolutely everything – some of them bonkers. That’s what we’ve got at the moment. The whole thing is over-regulated.’

I thought about this and asked: ‘But how could you change it?’

‘Well,’ she replied, ‘you could start by accepting that rules are temporary mechanisms. You could review them regularly and, if they’re outdated, bin them.

‘Second, you could listen to the end users – the nurses. They could tell bureaucrats what rules work and what do not. Why not have suggestion boxes? Why not have nurses’ brainstorming sessions?

‘These would produce more hands-on efficiencies than most bureaucrats could ever think up, and make nursing an active profession rather than a passive, compliant one.’

She added: ‘The worst bureaucratic interventions come from central government. Like the initiative to measure nurse compassion and smilingness. How on earth will they manage that?’

‘Possibly they could invent a “smileometer” for nurses to wear on their faces,’ I suggested.

‘I wouldn’t put it past them,’ she said.

Lesley McHarg is a third-year nursing student in Scotland

Want to read more of Starting Out? Just click on the 'more by this author' link at the top of the page.

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