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
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