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‘The important symbols of nursing have not been eradicated – they have changed’

We may no longer have the rigid nursing culture of the past but Jane Wright argues that despite being more informal, the profession still has a strong sense of identity.

Who are you? How do you define yourself? Is it by a name, a job, a role? I define myself as Jane, wife of Alec, grandmother of Caitlin and a nurse. I identify myself as a nurse because I’m on the NMC register and I have a uniform. I also have some badges and qualifications. I also think like a nurse because I worked in a strong nursing culture for over 20 years.

I trained, and later taught, in colleges of nursing where Florence Nightingale’s image served to remind me of a shared history. Where pictures of nurses were proudly hung and where nursing students were imbued with an ethos of duty and discipline. I had a clear image of what a ‘good’ nurse should be.

The uniform and the way I wore it told others who I was and no one could confuse us with other grades of staff. Sister was to be obeyed and her standards of care were unquestionably good. I absorbed the unique and strong culture by osmosis and needed no manual to define how things were done. I felt secure in this culture of absolutes.

But in those traditional nursing cultures, not all was good. Innovation was seen as rebellious and creativity was stifled. Such
a highly conservative culture resisted change even if it transmitted clarity of purpose and role.

I’m not sure anymore that it is so easy for a nurse to identify herself with any organisational or professional culture. Organisations and nursing now change so rapidly that existing cultures are fractured and new cultures are not established. Sustained development of a rich culture requires nurturing and commitment. It requires investment and clear direction. Yet if one enters most NHS establishments, what evidence does one see of this? After you push past the smokers by the entrance, do you enter a building that looks like a centre for healing or is it more like a shopping mall?

I am always heartened if I can see some evidence of what an organisation’s purpose is. Are there any awards on the walls? Any evidence of success? One hospital I know put up a large noticeboard in the canteen.

On it they put pictures of project successes, news of new developments, awards, complimentary letters and examples of good practice. Everyone could see what the trust was doing well and staff could take pride in being part of those successes. Most importantly, nurses and other staff could see what it was they and their colleagues were doing. The board’s message was: ‘this is who we are and this is what we do well’.

Of course culture is not just about what is hung on walls. Strong leadership is vital. Unfortunately, as organisations become larger and senior managers become busier, it is difficult for them to remain visible. Thirty years ago matron may have carried out daily ward rounds, but hospitals were smaller and there were fewer demands on her time.

Matron was also in post for years and so had time to build relationships with subordinates. Now senior nurse managers will often spend only a year or two in a post before moving, thus making it harder to establish their presence. Senior nurses should be figureheads for nursing culture but without leadership ability, a clear idea of the culture they want to manifest and time to influence others, they are unlikely to have much success.

Nevertheless, outside senior nursing circles I see evidence of supportive team cultures. Over tea breaks, mealtimes and nights out I see nurses supporting each other, bonding and discussing the rights and wrongs of the profession. I don’t know any other professional group that can become so passionate over even the smallest differences in opinion.

Perhaps nursing culture has not so much vanished as moved to the noticeboards in staff rooms. The important symbols of nursing culture have not been eradicated, they have just changed from badges and uniforms to facial expression or tone of voice. But can this serve as a valued and perceptible form of identifiable culture? Perhaps so and perhaps it may be even the better for its informality.

Jane Wright is nurse education consultant
in Belfast

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