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“Commuters have unwritten rules – and so have nurses”

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In recent months I have started commuting again. I may have done it for a bet.

mark radcliffe

mark radcliffe

 Like millions of others, I get up when it is dark, walk to a train station and wait to see if a train might come. Sometimes it doesn’t. A platform announcement might suggest the train has become distracted or that there are no train drivers left.

Other times it does come, but not in the form one might have hoped. Where a 12- carriage train with seats and the odd table is anticipated, we might get a six-carriage train or a shed on wheels, or a three-carriage train pulling a bouncy castle with a guard dressed as a clown saying “we hope you enjoy your upward and downward and upward again journey”. My, how we laugh. As we kill the clown.

The thing about commuting is that it is very rule-bound. Regular commuters are astonishingly well trained. We know, for example, that headphones are vital for fear you might have to listen to the sneezing, coughing or occasional frenzied business calls of other travellers. We carry water in case we find ourselves delayed or, I believe the official term for a hold-up of more than 90 minutes on Southern Rail, kidnapped.

We don’t look at each other, we don’t talk, we share the space politely. Regular travellers know who will work on the train and who will watch the boxset of The Walking Dead, and we adjust accordingly. Commuting is a habitually bound routine in which the rules are not written, but are quickly learnt. And so is nursing.

I’ve long believed that when we educate nurses, we are doing (at least) three things: helping them develop skills; helping them develop knowledge; and culturally integrating them. Fitting in is important for lots of good reasons. We need nurses to understand the importance of teamwork, of being reliable, boundaried, thoughtful and engaged.

We need them to wear the right shoes, to limit the eyeliner, to wash their uniforms, to not chew gum. Or tobacco. To arrive on time, to be flexible if they expect to leave on time, to realise that sometimes you have to rush even though we say you shouldn’t.

Circumstances demand that we need them to occasionally negotiate with excellence, to feel bad and not know why, to hear a decision explained, know it is nonsense, but to have to go along with it because it is made by someone with authority. In short, part of the complex culture new nurses have to join is messy, challenging and sometimes compromising.

Students are essentially invited into a culture of struggle and if they are to be a successful student, to become a nurse they have to join in.

Of course, experienced coping nurses will know that trying to absorb underinvestment, reduced staff and less time is what being a nurse often is now. But, sometimes, might it look like something else to the student nurse? Perhaps there is something important we should notice here about what we implicitly demand from new nurses – what sort of culture is normal now and what that looks like to them. And also, perhaps, realise what we’re losing when idealism fades early.

We ask a lot of our students – I suppose we always did – and question whether it is harder now. I suspect it is, learning in a climate of disinvestment, low morale, occasional despair… and, soon, being invited to pay for the privilege. Nursing culture is always live, always complex, always contagious. But sometimes might it be a little toxic? How hard is it, I wonder, to come into nursing now?

Mark Radcliffe is senior lecturer, and author of Stranger than Kindness. Follow him on Twitter @markacradcliffe

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