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'Nurse leaders are ironed into place to keep things the same'


Years ago, after I had written something gently sarcastic about nurse leaders being a bit uninspiring and tending to design their actions to please the people above them in the food chain rather than below them, I was “challenged” by one to “stop carping on the sidelines and do something myself”.

It was a fair point. Those of us who think nursing lacks meaningful leadership could, one supposes, reach for the

greasy pole.

So how might we go about it? Let’s face it, we might not fit in. Some of us have politics and clothes unbecoming of high office. We have tattoos and accessorise like nine-year-old girls playing dress up. Or at least I do. Such things do not go down well with the kingmakers. They want conventional, professional and circumspect - and it is the kingmakers we need to impress if we want to get on in the world because nobody gets to vote for a nurse leader. They are all appointed. By posh people, who don’t have tattoos.

So we’re going to have to compromise. Do you have any nice business suits? Two piece preferably, nothing too floral, certainly no brash slogans. We don’t want people to think you are frivolous. In essence, try to look like a minor royal but without any hats, no, not even a baseball cap.

Now, consider what you believe. That the real crisis of nursing is poor staffing levels? Uh huh. That demanding that nurses construct all of their interventions from a foundation of emotionally literate and well-constructed human qualities, such as compassion, means we have to invest in nurturing, protecting and reinvigorating those qualities? Righto. That nursing needs to have a transparent and key role in the development of health policy? Now you’re just being silly.

Because that is all very nice but, frankly, you will be measured on your ability to function within what we call “reality”. So, realistically, more staff is a no-no. We prefer tax avoidance to healthcare, so forget it. We don’t really understand that stuff about compassion - you’re girls, aren’t you? Doesn’t it just come naturally? And, as for helping with policy, well, you could sit in on some of the meetings if you like - maybe bring the biscuits?

Nurses leaders have to play by the rules. Other people set: the agenda; the principles (austerity); the language (public sector rather than public services, always ensure we think of healthcare in terms of expenditure not social good); the politics (make nursing defend itself rather than attack the circumstances that govern care). With the best will in the world, once those rules are established, our leaders are impotent.

Perhaps one of the reasons nurse leaders exist is so we can give a name to our disappointment. In reality the people who get called nurse leaders believe they can do good. I suspect they want, desperately, to make things better but how can they? They are valued and employed not according to their vision or brilliance but rather by their ability to help keep things the same. They are, I fear, ironed into place.

Perhaps the most good they could do might be if they all got together and said: “No, you are asking us to make the unworkable appear seamless, and the immoral appear acceptable and we are better than that, we are nurses, so no.” If they did that, we’d stand with them wouldn’t we? Or would they just get sacked, secure in the knowledge that some of us would step into their shoes and just do whatever they had to, to make sure everything carried on and stayed the same?

Mark Radcliffe is senior lecturer, and author of Gabriel’s Angel


Readers' comments (14)

  • tinkerbell

    careful we don't become what we hate. Born an original, die a copy.

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  • Are we not discussing the possible organisation of arnarchy?

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  • michael stone

    I'm with you.

    'In reality the people who get called nurse leaders believe they can do good. I suspect they want, desperately, to make things better but how can they?'

    I suspect you are right - I also suspect, it wouldn't be totally impossible for these nurse leaders to be more assertive, but they would need to present a unified front, and for any replacements to also be 'bolshy'.

    The bit I'm somewhat baffled by, is the lack of voice of nursing compared to the huge number of nurses: there has to be something here (hierarchy, some gender-related issue, or whatever - perhaps even the nature of nursing itself) that keeps the voice of nursing quieter than might be anticipated just from the numbers.

    What I do think (at present), is that as nurses are the closest clinicians to patients, I would prefer the nursing voice to be louder.

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  • tinkerbell

    i am posh (portside out starboard home) and have a tatoo.

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  • Mark -why not just say it ------most nurse "leaders" are useless, they care nothing for their colleagues and even less for patients.

    It is on the back of "nurse leaders" advise that nurse staffing levels are reduced and skill mix is distorted in favour of care assistants.

    Look at the TOP -here we have a siily person talking about 6c's and not about really important issues which involve patient/nurse ratios.

    These "nurse leaders" are sycophants to their bosses , who in turn are damn useless lay "managers" concerned with counting beans!

    Nurse leaders have contributed more than a little to the evolution of an NHS where patients and nurses count for little but where money and "managers" rule !

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  • Quite. I talk to a lot of nurses and in most instances, they are hard pushed to name their own director of nursing, let alone either of the chief nurse names (in fact, many are surprised that we are now represented by two invisible people rather than one)

    And why, oh why, hasn't anyone told Mr Hunt thay we have tried a patients 'charter' back in the 80/90s and it was as much use as a chocolate fireguard then...

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  • Anonymous | 27-Jun-2013 9:13 am

    "And why, oh why, hasn't anyone told Mr Hunt thay we have tried a patients 'charter' back in the 80/90s and it was as much use as a chocolate fireguard then..."

    would he understand. a good and empathetic communicator always has to put themselves in the shoes of others and talk to them at their own level of understanding as well as soliciting feedback to ensure they have understood!

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  • after my training in the NHS and staying on for six months in my training hospital, I have always been fortunate in enjoying a great deal of professional autonomy in the rest of my long career and even for a short term contract with the NHS. I cannot imagine how it would be if I were to return now and anybody attempted to iron me into place! If the iron got into my hands anybody who tried could end up severely scorched!

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  • tinkerbell

    it might be good to have the shot of steam feature on your iron too so that if anyone tries to press you too firmly you can hold your iron to their face, press the button and say 'back off i'm coming through'.

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  • tinkerbell | 29-Jun-2013 10:10 am

    a steam roller would be more powerful!

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