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OPINION

'Is nursing’s image going through a professional adolescence?'

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We seem to be too ready to boast about what nursing can do rather than focus on how we do it, says Rosemary Cook

I recently spent quite a lot of time looking at obituaries. Not for fun, but for part of a presentation with fellow members of the History of Nursing Society, which looked at the image of nursing from a historical perspective.

Between us, we looked at the portrayal of the original “Nightingale nurses”, the demonisation of graduate nurses by some of today’s newspaper columnists and the descriptions of Queen’s Nurses over the years – through their obituaries.

The idea was to identify qualities that were thought worthy of praise in the small space afforded by an obituary. And, in spite of the texts spanning more than 100 years, the constant refrain of certain qualities in these nurses was striking.

Key words were kindness, loyalty, untiring and unsparing. Goodness, sympathy and compassion were recurring themes, as were willing, gentleness, example and generosity. Just three other words hinted at other valued attributes - proficient, skill and research.

“Maybe the image of nursing is going through a ‘doctor period’ at the moment”

What was clear is that recollections about these nurses were less about what they did, and more about how they did it. One nurse’s patients were described as being “fortified not only by his professional skill and engaging manner, but by his compassion and natural generosity”. Another nurse was “cheerful and energetic, her example inspired her fellow workers to renewed efforts, and increased the public confidence in the work of the Jubilee Institute and its nurses”. A district nurse who died last year was remembered for the way she inspired her patients: “Patients have said that when A came to the door and smiled, they felt better already.”

The debate that followed turned to whether nursing today is too ready to boast about the “what” of nursing - we prescribe, we run practices, we are autonomous and high tech - and fails to talk about the “how”. We may be admired for our knowledge and expertise (though it is often taken for granted rather than lauded that we are competent) but we will really be appreciated for delivering that expertise with kindness, compassion, gentleness and empathy.

There is an interesting parallel here with the medical profession. When I was first nursing, the behaviour of doctors to patients was often condescending, inappropriate or even rude. Remember when doctors could talk over patients to their team, broadcasting the details of their condition and symptoms to a silent ward? When they used insulting acronyms and descriptions in their letters? When patients were expected to suffer untold humiliations and inconveniences to facilitate doctors’ timescales and idiosyncrasies? Yet doctors were held in awe and respect by the patients, because of their expertise and the value of their knowledge.

There has been a sea change in medicine since those days. Medical students and junior doctors are now held to account for their communication and interpersonal skills as much as their technical knowledge, and holistic medicine is a much more mainstream concept.

Maybe the image of nursing is going through a “doctor period” at the moment - like a kind of professional adolescence - when what we do is used to explain failings in how we do it. But, not having the traditional status of doctors, we are less likely to be forgiven for any perception that we value the “what” over the “how” – hence the vitriol of columnists.

The student nurses at our presentation from the University of York were the stars of the day. They assured us with passion and conviction that they were learning and practising both the what and the how of nursing. If they are the future, then nursing is turning out very well indeed.

Rosemary Cook is director of the Queen’s Nursing Institute

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Readers' comments (7)

  • What differentiates one nurse from another today? All should be competent and confident if we are to have faith in our nursing education system. So why is it that patients often talk about the 'nice' nurse - and also about the 'not so nice' one!Anyone who has been a patient or has visited someone in hospital will know the answer - it is the difference between the nurse who gets the job done and the nurse who treats all the patients as they would want their loved ones (or themselves) to be treated!

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  • takes all kinds to make the world go round as it does personality types in nursing. for instance there is the brusque and highly efficient type who has worked extremely hard all her career to develop her skills and is a brilliant nurse but maybe quite shy and/or studious and unable to project warmth towards others or may have had a traumatic background which affects the way she interacts but nevertheless cares deeply about the welfare of her patients and the quality of her work.

    at the other end of the scale may be the sweet kindly volunteer with few qualifications or somebody suffering from a 'wounded helper' syndrome who has scraped by and is not especially competent and may even make some careless mistakes, and may not always be very discreet or diplomatic in the way s/he handles others.

    there are also those who are very clever at minimising their shortcomings and sweeping their errors under the carpet and may not be perceived as others as they really are.

    there are the very hard working and the lazy.

    In between there are many shades of grey including those who are great all rounders, whose personalities shine through and who are excellent at all they do and those poor souls who are rather lack lustre, miserable, spend a lot of time grumbling and seem to fail at all they do.

    there are the gossips and those who like to spread rumours

    there are those incapable to delivering and receiving constructive criticism and prefer to see everything in a very negative light

    there are many who are bright academically and many who are far better at practical tasks and tend to be more intuitive than analytic

    some are plodders some are doers and act very fast, some can think well and make quick decisions on the feet, some are too impulsive and others need far more time to think before any action is taken

    there are many who quickly grasp the needs of patients and others and these are always the main focus of their concerns

    there are others who will never really grasp this and are capable of turning their whole team upside down and some who often upset their patients

    there are those with impeccable manners, those who always treat others with respect and those who treat everybody with indifference or more rarely with disdain

    there are those who have a more confident and relaxed attitude towards their work and towards others and those who are perpetually stressed and snap at others and then there are those who bully and pick on others and especially those they perceive as the weakest such as a new student, a colleague who they know will not answer back, the brightest who is everybody's darling and never puts a foot wrong, somebody who is always at the centre of attention, or the prettiest, or somebody who has attributes they wish they had themselves, or they may just feel insecure and lacking in self confidence or certain skills which they try to hide, etc.

    the list goes on endlessly, but it needs to be accepted (as well as tolerated) that the personality types and traits, attitudes, values, motivations, expressions of emotion and behaviour are just as diverse in nursing as in all the rest of the population (and how can it be expected to be otherwise) regardless of professional training but to which everybody brings their own agenda.

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  • tinkerbell

    'O wad some Pow'r the giftie gie us
    To see oursels as others see us
    It wad frae monie a blunder free us
    An' foolish notion
    What airs in dress an' gait wad lea'e us
    An' ev'n Devotion' - Robert Burns.

    Beautiful.

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  • Empathy really defines nursing for me, the ability to put yourself in anothers shoes. Without true empathy for others we are lost.

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  • MeThinks

    tinkerbell | 26-Jun-2012 3:02 pm

    A pity Mr Burns didn't make his excellent point, in a decipherable language !

    But there does seem to be growing acceptance that 'we need to understand how others see us' is necessary and useful, even if it isn't quite so clear how to use the concept.

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  • tinkerbell

    MeThinks | 27-Jun-2012 10:53 amhoots man, och aye.

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  • Best Summer Reading for Nurses from Medscape Nurses

    Nursing Against the Odds

    Nursing Against the Odds: How Health Care Cost Cutting, Media Stereotypes, and Medical Hubris Undermine Nurses and Patient Care, by Suzanne Gordon (ILR Press; 2006), has been called a "a brilliant and long-overdue assessment of nursing at a time of crisis in healthcare -- what has gone wrong, and what can be done to restore this once-esteemed profession to a position of equality with doctors." One nurse who recommended this book said it was "one of the most interesting discussions of the nursing profession, culture, and role I have ever read."

    Other Recommended Titles: Timely Professional Topics

    Speak Your Truth: Proven Strategies for Effective Nurse-Physician Communication, by Kathleen Bartholomew

    When Nurses Hurt Nurses: Recognizing and Overcoming the Cycle of Bullying, by Cheryl Dellasaga (Sigma Theta Tau, International; 2011)

    Saving Lives: Why the Media's Portrayal of Nurses Puts Us All at Risk, by Sandy Summers and Harry Jacobs Summers (Kaplan; 2010)

    Photo courtesy of Sandy Summers
    How Doctors Think, by Jerome Groopman (Mariner Books; 2008)


    http://www.medscape.com/features/slideshow/summerreading?src=ptalk

    Available on Amazon

    The Checklist Manifesto: How To Get Things Right [Paperback]
    Atul Gawande

    The Plot Against the NHS [Paperback]
    Stewart Player, Colin Leys

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