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‘Delivery of top-class care gets more challenging every week’

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I ’m chatting with a friend I haven’t seen for a while. Lovely man, works far too hard, last did exercise in 1989, likes Chardonnay and won’t leave it alone until it likes him back. 

He tells me that a friend of his has had to drop out of an upcoming marathon and has offered him his place. He is seriously considering taking it. I opt, as all friends should, for appreciative and supportive.

“I can’t help feeling that the despair that phrase alludes to is still a reality for many nurses”

“I didn’t know you’d taken up running? Well done.”

“I haven’t.”

“Okay, so the marathon will be an incentive to start getting a bit fi tter? Well done.”

“It’s in four weeks time.”

“Okay, so the marathon will be an incentive to … shop for running shoes and get some nice shorts? Before you die horribly at the roadside. Well done.”

He acknowledged that he is perhaps not best prepared to run 26 miles, but he said he had seen marathons on the TV and they look fun and convivial, and some people dress up as chickens – how hard could it be to do something really hard that you are not prepared or resourced for? Really?

I have talked about the Francis report here before. I have referred in particular to the evidence of former Health Commission chair Sir Ian Kennedy, talking about the tendency in healthcare services toward “guerrilla warfare”. Five years on, I can’t help feeling that the despair that phrase alludes to is still a reality for many nurses.

There are policy initiatives – some good ideas, some creative approaches to education and staffing – but there remains a chronic lack of nurses and investment. The space between what we want the health service to be and its reality is a big one. That space is often filled by the goodwill, energy, generosity and emotional labour of staff who can feel ill-prepared for the daily struggle that emerges from understaffing and limited resources

I don’t think anybody is surprised that more mid-career nurses are leaving the register. They are too exhausted, or perhaps cross, to face another 20 years of struggle. Nor are they really surprised to hear that universities are reducing their numbers. The continual pay cuts? The reduced respect that manifests itself in threats or abuse? Why would people flock to care?

“The cheerleaders will tell you that nursing will climb every mountain”

It is primarily a political issue. Underfunding and a blind eye bordering on negligence makes the delivery of top-class care more challenging every week, and there are important personal questions that more and more nurses ask themselves now: “how long can I do this? How long is this a thing I want to do?” And can anyone blame them?

While this happens, something else is eroded. The great nobility of nursing: the way it symbolises that most civilising cultural feature – the unquestioning care and commitment to the stranger in need. Nursing needs to be elevated again by what it means as well as what it does. It is regularly patronised and recurrently taken for granted. Of course, the cheerleaders will tell you that nursing will climb every mountain, run every marathon, never stop giving its everything and it probably will – but nurses won’t. They won’t be able to. They will leave or fall or break, to be replaced by others who will leave or fall.

I think we need to care about that much more than we do. I think nursing lets itself down when it fails to look after the wellbeing and sustainability of nurses. I think we ask them to put themselves at risk for a medal and a pay cut. Care for the carers and the caring will become more viable.

Mark Radcliffe is senior lecturer, and author of Stranger than Kindness.

Follow him on Twitter: @markacradcliffe.

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