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'It’s time to add courage to the code of conduct'


Despite challenging working conditions, many nurses are demonstrating that caring is still the profession’s number one priority, says Terry Ferns

Both nursing literature and the media have frequently stereotyped the traditional image of the nurse through, for example, a ministering angel, a glorified medical handmaiden, an uncompromising battleaxe or a giggling sex kitten.

Yet stereotypes can be positive and in the nursing world there is another stereotype. The one we have all met. She or he is an incredibly caring, dedicated and hard-working professional.

This committed person may already have experienced, through a long and varied career, change after change to their working environment. They have already tasted politically motivated alterations to the NHS. She or he has already been through the implementation of competitive tendering to hospital services and knows all about the negative consequences of clinical grading and Agenda for Change. This person can discuss with clarity the move towards the enhancement of the NHS manager’s role in controlling costs, previous reductions in the numbers of qualified nurses delivering care at the bedside, and the unconstrained rise in numbers and increasing utilisation of unqualified, unregistered healthcare assistants to deliver hands-on care.   

“Nurses, through both attitudes and behaviours, directly challenge the notion that nursing is losing its key value of caring”

This person may be struggling in an economic climate of rising costs in living, increased energy prices, food bills and transport costs. They have firsthand knowledge of reductions in child benefits and creche facilities. They may routinely miss Christmas dinner with their families due to the unsocial hours of their employment contract or may be constantly tired due to routinely moving from long day to night shifts in any given week. She or he may be forced to take a second agency or bank position to make ends meet, may miss their break because they are busy cleaning up faeces or vomit, or may frequently leave work late because of patient care requirements – but they do not get paid overtime for the privilege. 

They may be working in an organisational structure that is riddled with gender inequalities, is unfairly weighted in favour of the medical profession and is governed by covert hierarchical power structures. She or he self-funds professional development courses completed in their own time while worrying about cuts to pay and pensions. This person also works with a diluted skill mix based upon minimal staffing levels, is forced to reapply for their own position, attempts to defend their role but is pitted against lifelong friends and colleagues as “restructuring” takes hold.

Yet despite all this, despite such “progress and modernisation,” such nurses, through both attitudes and behaviours, directly challenge the notion that nursing is losing its key value of caring. On a daily basis they project themselves as positive role models, they display genuine leadership abilities, are evidence-based practitioners and clinical experts. They champion themselves as the patient’s advocate and make time to mentor students, listen to the fears of others and raise funds in their own time because they love nursing. The idea of going the extra mile is a daily, built in ethos.

In return, with dignity and integrity, they were forced to listen to the views of the health secretary Andrew Lansley at the RCN Congress in Harrogate recently. A health secretary lecturing on listening and leadership, while publically massaging statistics relating to staffing levels and overseeing the implementation of the most divisive and unpopular reforms since the poll tax. Can one seriously entertain the idea that he knows the NHS better than delegates sitting in that Harrogate hall?

In perhaps an even more ironic twist of fate, our professional regulator the Nursing and Midwifery Council, facing mounting criticism on a number of fronts, chooses to announce consultation plans to increase registration fees from £76 to £120. You could not make it up. Perhaps we should consider adding courage to the code of conduct. In these times, we all need it.   

Terry Ferns is a registered nurse currently working in higher education


Readers' comments (4)

  • I couldn't have put it better.

    Perhaps these words should make it to the newspapers, rather than the negative press fuelled by the uncaring compassionless few in our midst who attract that kind of attention.

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  • Juggling Dog

    This comes down to who holds the power, and that is usually, and currently, the institution or management: doing the right thing if you suspect that management will try and bite you for doing it, takes a lot of courage - what is needed is more protection for people who do the right thing, not telling nurses to be courageous.

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  • I couldnt agree more which this discussion.

    Terry Ferns has captured my own thoughts and has written it beautifully.

    I do not know many of the angel's, battleaxes, handmaidens or sex kittens, but work mainly with the hard working caring professionals.


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  • bob cat

    I disagree, I think courage, compassion and altruism are what is holding it all together already without issuing courage as another commandment via the CoC!

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