I was talking to some second year student nurses this week. I have always thought the second year of a nursing course is the hardest - what with being part university student charged with trying to construct the knowledge and understanding needed to nurse, yet also part working nurse, charged with being increasingly capable and also with fitting in.
What they are engaged in looks like some sort of cultural transition. From “idealism” to “reality”. Or as one student said: “We have to function on hectic pressurised wards and that isn’t always what we are taught it will be like.’
I think most of us understand the power of a work culture and what that can mean. Compromise sometimes, a process of socialisation perhaps. Learning to live with the “harsh realities”. Dealing with pressure and not wanting to let people down. Modern nursing can generate some powerful cultures - as we were reminded by last week’s report into care at Mid Staffordshire NHS Foundation Trust. The question is of course: what is nursing going to do about it?
‘History, managerialism, economics and emotional labour have combined to make brilliant care that bit too distant and poor care too close to possible’
Now it may be that there are some truly awful nurses out there doing really bad things. They may not care a jot about patients or their pain, they may even resent the fact that they have to nurse when really they want to be in Girls Aloud or the Bahamas. But if there are, I think they are a very small minority. Mostly I think nurses want to be good at what they do and I think they do care about the suffering of others. Which begs the question: how do we get bad care? Is it because of bad management? Did we run out of compassion? What allows us to be immune to wrongdoing?
We, as a profession, have to wonder, formally and systematically what happened in Staffordshire Hospital. We have to find a way to share responsibility for it because otherwise we cannot stop it happening again. And one of the things we need to wonder about is the culture of care that is constructed by those “harsh realities” - the trench warfare culture that can strip nursing of its brilliance and patients of their hope.
The frontline nursing reality is constructed by us all: politicians, nurses, managers and consumers. It is often considered too complex to unpack and reconstruct. However, Mid Staffs was swept along on a culture of care that failed patients and, if it can happen there, it can happen elsewhere.
So what can we do? Wait for professional bodies or government quangos to issue new guidelines? Condemn anyone who worked there as somehow different to the rest of us? Different in a way that releases us from self doubt? Or do we simply promise ourselves that we will never offer poor care, never be immune to the sound of pain?
I fear that the history, managerialism, economics and emotional labour have combined to construct a culture of struggle for too many nurses. It makes brilliant care that bit more distant and poor care too close to possible. Nursing has sought to tolerate pressure and struggle in order to protect patients. It’s time, I think, to stop tolerating it for the very same reason.