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'Drop the pointless pep talks – support nurses to improve care'

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“What have you been doing today, Dad?” asked my daughter in an attempt to distract me from suggesting she do her homework. I fall for it none the less.

“Talking to students about culture,” I reply, before momentarily forgetting she is 12 and not 6. “You know what culture is, don’t you?”

She raises her eyebrows and decides to patronise me back. “Think of it in terms of music, Dad. Different types of music make different types of sense to different people.”

“So it’s about being different?”

“Its about how we might be different or similar as groups of people, I think.” And I’m quite pleased with that, to the point that I think about not mentioning the homework. But then I say: “Homework?” Almost apologetic. Almost.

I’d been teaching first-year students the unfashionable but increasingly important Psychosocial Studies. They’d been on the wards for six months and had lots of experiences to make sense and learn from.

“What is it to be a nurse?” I’d asked with a shrug, hoping the reluctant-to-engage 10% would put their phones away without being asked and behave like adults and not wait to be turned into children by me.

Inevitably - because students are implicitly preoccupied with all that they don’t know and cannot do - they say “Skilled”. What else? “Calm”, “capable”, “knowing”, “brilliant” and “compassionate” (a few raised eyebrows). What else? Eventually, the veneer cracks. “Tired?” Someone smiles. “Cynical?” “Annoyed?” There is some nodding. “Irritable.” “Downtrodden.” They wonder if they are entering forbidden territory now. They are waiting for me to ask them about “irritable” and “annoyed”, as if I have never heard them before, as if they are strangers.

“So,” I ask, “If that is what it is to be a nurse, are they all things you have to acquire to qualify? Or to fit in?” They think it is a trick question, which it isn’t. Finally, a young woman sitting at the front nods and says: “I don’t know if we have to actually be cynical, annoyed or downtrodden to fit in. I do think we might have to act as though we are or we might be considered a bit odd or stupid.”

When Jeremy Hunt talks about a culture of complacency in hospitals, he is offering a cursory, shallow analysis. He isn’t talking about culture in any real sense. He isn’t talking about the way relationships, habits, language, morality and sustainability develop over time in closed environments. He isn’t talking about how healthcare is delivered in difficult, austere, personally exhausting and emotionally violent environments. He is, essentially, doing little more than throwing out a poorly considered pep talk aimed at managers.

Should we ever become genuinely interested in pockets of nursing culture that have been left unsupported, unconsidered and unattended, I suspect we need more than a pep talk.

I have an overriding belief about modern healthcare: if we want to make things better, we have to give proper and due attention to the resilience, restoration, maintenance and sustainability of the nurses who keep sucking up the pain they attend to and carry around with them. Call that better supervision, call it better continuing professional development, call it a wider educational remit, hell, call it a compassion curriculum if you like. But without it, every speech, every criticism and tub-thumping expression of disdain is simply a hollow exercise in blame shifting and self-indulgence.

But we know that we are nowhere near forbidden.

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

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