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‘Only with empowerment and investment can ‘we’ really exist’

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So I’m being tortured by a sports physiotherapist and trying not to scream. 

She is telling me why my internal obliques are “gnarled and grumpy” while pressing down on them with what I can only imagine is a hot poker. I didn’t even know I had internal obliques. I wanted to ask “might they be gnarled and grumpy because you’re pounding them like Mike Tyson?”; it didn’t seem timely so, instead, I settled for “yes, I think you’ve discovered a gnarly bit there…well done”. Albeit three octaves higher than usual.

Then she said, “I think we are getting past the pain now”. I wanted to agree because I was a little bit (she really is very good), but I couldn’t quite get past the word ‘we’ and how often we use it and how rarely I understand to what or whom it refers. I suppose it started with austerity politics. ‘We’ were all in that together, except there were two different lots of ‘we’ weren’t there? The doers and the done to-ers. 

Perhaps it’s similar to the ‘we’ so often cited in the Brexit campaign. ‘We’ want our sovereignty back – and when I say “we” I obviously don’t mean the Scottish or  Northern Ireland ‘we’ who voted against leaving the EU. The Brexit ‘we’ is a nebulous one, isn’t it? One that assumes a wide membership comprising people who don’t want anything to do with Brexit, didn’t sign up to it and are, in fact, part of a whole different ‘we’. A ‘we’ some might casually characterise as European.

It has always been a constant confusion in nursing too. I began nursing in 1986 and had my head down for the first few years trying to learn my trade. But, when I lifted it and discovered that I, a mental health nurse working in a decaying asylum was part of a ‘we’ that included nurses working in operating theatres, general practice, care homes and oncology, it didn’t make any meaningful sense to me. In fact I couldn’t even make sense of the ‘we’ that  I was supposedly part of in mental health nursing. I didn’t like psychiatry, I didn’t think it made philosophical or clinical sense (I still don’t), and so I sought to practise differently to the supposed ‘we’. I think many nurses do that, regardless of their branch or location or clinical focus. Perhaps I was part of a wider, more-abstract ‘we’, bound by being in eternal opposition to whatever fad emerged? But, if I was, we didn’t have meetings or matching sweatshirts or even a secret handshake.

‘We’ are currently being rallied again. A new improved, politically post-pubescent Royal College of Nursing is promising a rebirth that will better represent its members and, more vaguely, “the profession”. More generally, the much-vaunted NHS Long Term Plan is laced with all the things “we” need to do. The ‘we’ that is claimed by politicians, administrators and policy makers is always generic, always assumed and often perceived by nurses as a demand to carry out new tasks, more processes and manage more change without meaningfully additional resources.

Of course, that is not to say that nursing is not laced with important collectives. But usually those ‘we’s are small: a team (often multidisciplinary), a location, a research group – people bound by something that feels achievable or meaningful and empowering. Beyond that, if we want to form a wider sense of membership, we need to find ways of binding the doers to the done to-ers. That involves better resourcing, staffing, education and investment before leading to wider professional empowerment and less top-down policy making. Until then, it isn’t really a ‘we’ is it? It is still ‘us and them’.

Mark Radcliffe is author of Stranger than Kindness. Follow him on twitter @markacradcliffe

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