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Nursing lessons from beyond the grave

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A few weeks ago I went to a special church service in a small village in Nottinghamshire to celebrate the life and work of an inspirational nurse, Ethel Bedford Fenwick.

Reflecting on her life I wonder who our campaigning, influential leaders are today?

Born in 1857 Mrs Bedford Fenwick believed fervently in the development of nursing as a profession and became a driving force in the campaign for state nurse registration. Her reward came in 1919 when the Nurse Registration Act was passed by parliament and she became nurse number one on the register when it opened in 1923.

“Ethel Bedford Fenwick possessed the passion and drive to fight tirelessly for what she believed in”

Like many leading nurses of her time, Mrs Bedford Fenwick had a clear vision for the profession but she also possessed the passion and drive to fight tirelessly for what she believed in.

Nursing in 2017 is in a constant state of flux. There is a permanent crisis with nursing shortages exacerbated by a failure to commission enough training places to meet demand and there has been a lack of forward planning to address the growing numbers of highly experienced nurses retiring from leadership and specialist roles.

There has been a failure to protect nurse specialist roles in chronic disease management and community care and the profession has not articulated the growing problems in areas such as school nursing services.

The sad thing is that many nurses in senior positions saw this crisis coming but seemed powerless to do anything about it.

“She opposed the introduction of the nursing roll which led to the development of the enrolled nurse”

So as we embark on introducing the nurse associate, it is worth reflecting on what Mrs Bedford Fenwick might say. Near the end of her life she opposed the introduction of the nursing roll which led to the development of the enrolled nurse, believing that there should only be one level of registered nurse.

Evidence tells us that graduate nurses improve outcomes, but the nurses need pairs of hands on wards and in teams to keep the service going. Associate nurses and assistant practitioners will help fill the gaps in the short term, however there is a lack of a unified sense of purpose, direction and vision for the future of the profession when this current crisis comes to an end. This lack of direction could have long term implications for patient care and outcomes particularly if associates are seen as a cheap alternative to registered nurses.

“There is a lack of a unified sense of purpose, direction and vision for the future of the profession”

It is relatively easy to reduce the nurse’s role to a series of tasks that can be divided up and performed by anyone with some basic training but as Florence Nightingale noted “The tasks can all be done but the patient received no care”. This is illustrated clearly in the debates around the nurse’s role in drug administration and the problems with delegating the task to associates.

Without influential leaders who are prepared to articulate and fight to protect the unique function of the nurse we are in danger of putting patients at risk of poor care and outcomes.

So who is our modern day Ethel Bedford Fenwick? Who can provide a unified sense of purpose, direction and vision for the future and put the profession back in control of its own destiny?

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