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