In the post-austerity, post-Francis NHS, fear can hang over clinical practice in a way that it didn’t a few years ago. The fear of making a mistake and being considered “the bad nurse”.
That anxiety can affect us, can’t it? It can make us watchful, maybe defensive in our work or practice, more mindful of a wrong word or wrong impression.
I was talking to some experienced nurses recently who were reflecting on the new defensiveness. How they felt watched sometimes, as if people are waiting for them to slip up. How they felt seen with an eye that is less generous than it once was - an eye that can make them feel guilt over something they hadn’t done.
Twenty years ago, the mental image of a nurse conjured up a hat, a badge and a cape. Now it’s more sackcloth and ashes, ongoing penance and low-lying anxiety about, maybe, making a mistake that doesn’t only colour nursing practice but also shapes the experience of being a nurse.
Last week, my daughter had minor surgery. It went very well. From a clinical point of view it was routine but it felt profound and, of course, modern healthcare skilfully turns the profound into routine, doesn’t it?
Anyway, I want to mention two things because, in this climate against the seemingly nagging backdrop of “careful now”, they are not mentioned often enough. First, the staff who dealt with my daughter, the little boy in the room opposite, the baby next door, the frightened parents pacing the corridor outside, the terrified looking eight-year-old who was admitted mid-morning and the hairless, doe-eyed waif in the playroom were all brilliant.
The surgeon who did my daughter’s surgery and no doubt several other operations that day was brilliant. The consultant who referred and managed her was brilliant. The healthcare assistant, who told me he wants to be a nurse but wants to get clinical experience and better A level results, was brilliant. The nurses were brilliant. In terms of skill and professionalism, they were all great.
So, “healthcare professionals do job well” shock? Not really worth saying, is it? Nothing to see here, move along. Except that noticing good is as important as noticing bad, just not as popular.
The other matter I wanted to mention was the less tangible talent on show in that clinical environment and many, many others. The carefully crafted focus on the child as the person at the centre of the care, the balance between creating an environment that is welcoming and colourful yet well organised, professional and clinical. The tone that contains enough emotional engagement to ensure the children feel seen and understood while not allowing the place to fill with unhelpful or crippling sentiment. I wanted to notice the emotional labour, the application of thoughtfulness and the skilful way those things are integrated into the clinical environment because such things are taken for granted and not articulated very often. And, if they are not articulated, they are under-valued.
What most needs talking about now are those unheralded, unmeasured and under-valued abilities. The neoliberal backdrop that insists that the measurable and marketable are the only things to look at needs to be challenged. One way of doing that is to see, enjoy and thank the hidden skill of the thoughtful nurse. Excellence needs to be articulated more skilfully than it is now. And nursing needs to be celebrated because of that excellence.
Mark Radcliffe is senior lecturer, and author of Stranger than Kindness. Follow him on twitter @markacradcliffe