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Exclusive: ‘Our image is out of date’, says nurse academic

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The outdated image UK nursing presents to the world is one of the key problems for the profession in this country, according to an influential nursing leader and academic.

Despite the fact nurses are leading the way in many different fields, Professor Laura Serrant told Nursing Times the image of nursing was still far too “narrow”.

“The image of nursing hasn’t changed, it is quite old-fashioned and it is too narrow”

Laura Serrant

Nursing leaders needed to do more to explain the profession’s vital role in matters of global concern, such as tackling health inequality and helping ensure sustainable development, she said.

“What mainly worries me in nursing is the narrowness of how the profession is presented. The image of nursing hasn’t changed, it is quite old-fashioned and it is too narrow. I don’t mean that what nurses do is out of date but how we are presented is out of date – even the language we use as nurses to talk about our work is out of date,” said Professor Serrant.

She said: “There are nurses in everything from politics, education and research to innovation, business, private practice and practice in the home – all of those things – yet we still have the image of a nurse as someone who works in a hospital. That is in our gift to change, but I don’t know whether we as a profession are ready to speak differently about ourselves.”

She said the enduring stereotype of a nurse caring for patients on the wards was about as far removed as possible from where the profession was seeking to go with a drive to deliver integrated care in the community – and this stood in the way of change.

One of only six black nursing professors in the UK, she was recently named among the top 10 most influential people of African and Caribbean heritage in the country in the annual Powerlist published by Powerful Media. She told Nursing Times her place on the list was not just about personal recognition of her work to tackle inequality but also about recognising the importance of nursing in wider society.

“There were people there [on the list] from the arts, sports, the media, entertainment, literature and it was good for nursing to be recognised alongside other professions,” she said. “Sometimes in nursing we only think about ourselves in relation to other health platforms and that’s what struck me most – it was about the profession standing alongside other professions.

“We can sometimes become too introspective in our conversations and who we talk to and network with – so nurses go to nursing conferences, nurses go to exhibitions about nursing or health. It’s not to say that is not important but it’s also important for us to talk about our profession outside the health sphere.”

She said she was struck by the fact many people at a dinner for those named in the Powerlist did not realise nurses could be academics or become professors.

“Lots of people said they did not realise there were such things as professors of nursing and many of them had members of their family who were or had been nurses,” she said. “Obviously there is quite a large proportion of BME people who work in healthcare and as nurses and midwives. Yet they didn’t realise there was variety in the profession beyond working in a hospital and didn’t realise there were any black professors of nursing.”

However, Professor Serrant, who started her nursing career working with vulnerable groups before moving into academia, admitted it was hard to tell a different story when nurses were struggling to do their jobs in an “over-loaded, time-bound, resource-restricted” environment.

As well as re-vitalising the image of nursing at home, she said it was also crucial for the UK nursing profession to position itself as a key player on the world stage.

Professor Serrant whose own research focuses on global issues and inequalities, said she was dismayed at the Royal College of Nursing’s decision to withdraw from the International Council of Nurses in 2014.

Professor Serrant is currently professor of nursing at Sheffield Hallam University and chairs the chief nursing officer for England’s BME strategic advisory group.

She is also a member of the government’s independent advisory group on BME issues and an ambassador for the Equality Challenge Unit for Higher Education.

She told Nursing Times she did not see herself as a pioneer but accepted she was regarded as such by others. “What I see myself as is a black nurse academic and I use those words exactly in that order because the order is important,” she said.

“I have never been in a cohort with a large number of other people who look like me whether that was my initial training or whether it is now,” she said. “It is important for me to be seen not just for other nurses coming through but other students working in the university. When I go to graduation students and their families come and talk to me, not just because they are nurses but also because they have never seen a black professor.”

She said there were ongoing challenges when it came to tackling inequality in nursing and ensuring people from different backgrounds had the same opportunities to progress in their careers.

“We definitely have issues and barriers, otherwise there would be a much more even spread – that goes without saying,” she said. “But we mustn’t beat ourselves up and say ‘everything’s as bad as it always was’, because some improvements have been made. It is never going to be an endgame – it will always be a work in progress to an extent. I’m in the role that I’m in but who is coming next?”

Professor Serrant said the key was to take a “whole systems” view of diversity and leadership.

“Leadership in nursing occurs from the bedside or classroom right through the levels,” she said. “It is about people being able to have an equal chance of success wherever they are and whichever level they are at.

Laura Serrant

Laura Serrant

Laura Serrant

She also noted that “not everybody wants to climb the ladder upwards”, and that some wanted to have different experiences by moving sideways. “Allowing people to have an equal chance and do the work they want to do is really what it is about,” she told Nursing Times.

While there have been high-profile national initiatives to boost diversity and bring on BME nursing leaders as well as raise the profile of nursing generally, Professor Serrant said achieving change was really about what happened day to day and called on leaders to consider their situation locally.

“If I am a director of nursing in a trust working in one area of the UK, then how diverse is my staff across the board? How does it reflect the population where my hospital is located – because they are the people that are going to be walking through our doors,” she said.

“If we are in education, then are we actually training and teaching nurses to be able to provide care for a diverse population – and that is not just about religion and food. Do they know how to look for skin integrity differences in different skin colours? We are talking about the everyday things and they are just as important as what our board looks like,” she said.

She said ensuring equality was also about going beyond trite mission statements about treating and respecting “everybody well”, and making a real effort to measure the impact of work to reach different communities.

“How do we know that within the populations we are looking after, people have an equal chance of good health? How culturally safe are the good practice pathways we are using? That is the work that needs to be done,” she said. “If there is no way of measuring, evidencing or showing we are making a difference then we fail.”

When it came to the future of nursing education, Professor Serrant said there was a need for it to evolve to meet the demands of future healthcare models. She said the switch from bursaries to loans would probably change the type of people applying for nursing degrees.

“People usually come into nursing because there is a personal drive for them to care and that’s not going to change,” she said. “But the likelihood is that over time we may see many less mature students coming into nursing because of the financial changes. We will probably have younger people.”

Meanwhile, course content and practice placements would need to change to reflect the move away from hospital-centred care, she suggested.

“Will we still need the same clinical competencies in 10 years’ time? That is probably the challenge for education moving forwards,” she said. “We need to be brave enough to have a conversation that doesn’t revolve around how we do more of the same with less money.”

Professor Serrant said nurses could also play a crucial role in re-designing services so they worked better for patients and communities. “That is about developing more entrepreneurial and innovative practice. However, at the moment, when we are all focused on performance targets and workloads – that is not an environment in which innovation and entrepreneurship can thrive,” she said.

Biography: Laura Serrant

1986: One of the first nurses to qualify with a degree, graduating from Sheffield City Polytechnic

2011: Joined University of Wolverhampton as professor of community and public health nursing

2014: Awarded Queen’s nurse status by the Queens Nursing Institute

2014: Health Service Journal named her one of its inspirational women, top clinical leaders, and a BME pioneer

2015-16: On secondment as head of evidence and strategy in the nursing directorate at NHS England

2016: Appointed professor of nursing at Sheffield Hallam University

2017: Named in the Powerlist 2018 of the most influential British black people

  • 9 Comments

Readers' comments (9)

  • I agree with some of what is said in the article, however it represents and idealized picture. Of course we should have a diverse nursing population and of course it should represent the people walking through the doors of a hospital or any other health care facility. However, that is far less likely to happen now, since the bursary has been removed. I agree nursing should be represented across all spheres of life. I have experienced the look of indifference that glides onto the face of another when I tell them I am a nurse. The sad fact is that nurses are not respected as professionals in this country, especially by the other professions (think teaching and still, many doctors.) You can throw as many degrees at the profession as you like, be as academic as you like but the sad fact is, we are still seen as bum wipers and emptiers of bed pans and this will not change.

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  • But while we still can’t get the ‘bum wiping’ and bedpan emptying right what good is it chasing degrees that have no interest in those aspects of care! Preferring to delegate it to HCAs who are not supervised by staff who have a sound knowledge of the importance of the tasks being carried out. I am so glad I no longer have to take students to task over shying away from the basics

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  • Thank you for this article. You are right, nursing has changed beyond all recognition. There is some amazing things happening. But it isn't nursing as we knew it. I trained in the early 80's I feel very fortunate that I learnt on the wards, I also had a very very good academic teaching at the hospital I trained at - UCH, nurses were respected. Then came the project 2000 and university training. Nursing today cant get the bedpan and bottom wiping right, or how to talk to patients and relatives, I have been both a patient and a relative of a dying relative. A degree with lectures, books and essays will not help this, being able to communicate with a sick person is vital. Nursing needs a name change e.g. health champion or something that relates to health. But doesn't actually do what nursing used to mean. Then a new type of care training programme needs to be devised so that caring for sick people becomes that persons role and academic courses and people who like them can do all the management. I recently had a student sit in on my clinic, she wrote an essay on my approach to the child in the clinic setting, it was amazing what she wrote and the quotes she used to reference the setting and assessment techniques. The essay wont make me better at what I do or will it make her better at what she is going to do?? Unfortunately good old fashion hands on approach teaches people how to deliver care. But I am biased!

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  • It is exactly the attitude of "Professor" Serrant that undermines our profession.

    I am sick of those nurses who cant be bothered to do the hard work anymore trying to justify their pen pushing positions.

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  • I agree with all the comments made, sadly the profession in my opinion has lost its way. I’ve mentored a masters degree student who admitted to me that they were only doing nursing because they couldn’t get a job in their preferred profession (performing arts and drama). This I feel is ruining the profession. As an intensive care nurse with many years experience I have to go and work in other departments when/if we’re not busy, I’ve also seen nurses standing around gossiping to each other instead of talking to the elderly man with dementia who was frightened about being admitted to a/e. Also I was horrified when visiting my elderly mother who had advanced altzheimers disease and could not swallow solids, lying there with a dissolving paracetamol in her gums. These are just a couple of things that show a lack of care and understanding about the patients. These small issues should never occur they are basic nursing. I acknowledge there is some superb nurses qualifying but something regarding nurse education needs to change.

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  • The good professor is evidently one of nursing's movers and shakers; I would say that modernising the image of nursing is the job of people like her, not we frontline grunts.
    Incidentally- Ms Sherlock, what is "altzheimers disease"? Do you mean Alzheimer's Disease? (note the capitalisation and apostrophe). Also please note, there ARE some superb nurses. "Is" would mean there is only one superb nurse. Proofread before posting.

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  • What Karen Sherlock says is absolutely correct.

    Rather childish to criticise grammar, often these posts are written in a hurry Ive done it myself.

    I wonder if the "good" professor is an advocate of the nursing associate post, not a mention of it above. It seems to me the role will be very prominent in the years to come as less and less nurses burden themselves with huge debt in order to obtain a degree. What a pity nurse leaders still arent prepared to clarify what the associate role will be despite such solid support for it. Disaster looms I fear.

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  • I think the elephant in the room here is pay- if nursing continues to be considered in low esteem (my friends think nurses are stupid and that’s why we live the lifestyle we do- because we can’t do anything else) then how can things change to make nursing better for employees? As one of many who works two jobs and does bank shifts and only just makes ends meet, imagine how much better care I could give my patients if I wasn’t exhausted all the time because I could afford to work more normal hours. I’m not complaining, I’m in for it and I love nursing. However if nursing was respected we would be listened to and valued in society. I don’t think given the professional and responsible nature of our work that our lifestyle can represent our skills. Perhaps this attitude change comes on that kind of level?

    Also I just want to make a point that having worked as an hca for years has really informed my nursing. I’ve never been too posh to wash and hope I never am. Bum wiping is just as important as any medical procedure for the health of the patient not to even mention dignity. My belief is that hca should be invested in more, trained well and encouraged, and their role should not be discounted.

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  • I am a band 5 and proud bum wiper and bed maker, the information gleaned about a patient whilst conducting those tasks can be far greater than reading a tick box care plan.

    I also think more time and money should be invested in HCA's rather than the ridiculous Nurse Associate role. It shows those at the top attending meeting after meeting and writing papers to get their awards and honours have no real clue what nursing is like anymore.

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