The defining condition of nursing since I came into it more than 25 years ago has been this: nurses are held responsible for the care and wellbeing of patients but hold no responsibility for the politics, circumstances or organisation in which the care takes place
Against a backdrop of more modernisations than Madonna, nursing is required to stay solid - preferably docile - and deliver care, maintain standards and leave the politics and organisation of the health services they work in to the boys.
It is a mentality born of the last century and the one before that. Nursing was a vocation populated by strong, sometimes wise and usually servile women who eschewed things like money or a life in order to care unendingly.
Of course, such numbed dedication eventually became outdated and was replaced slowly by something more modern, slightly more thrusting and certainly more articulate. Professionalism, whatever that means, brought different expectations, wider responsibilities and a more sophisticated self-consciousness.
It did not, however, bring any political clout or will. Away from the bedside, nursing did not shape the political landscape, satisfying itself instead with a few crumbs from the table in the form of a seat on the board and a civil service post with the word “nurse” in the title.
There is something almost dignifying about that abstention. We have watched endless reorganisations and known it is a nurse’s responsibility to find a way of providing care in spite of the politicians; more often than not, nurses have managed to do that. We have watched new organisations, new economic relationships, new management structures and new ways of measuring services turn into mini-industries and mostly shrugged and got on with it, albeit at some cost.
But now it feels slightly different, doesn’t it? Now the political assault is not only on services but also on nurses themselves. Recruitment freezes? Pay freezes? And, in return for not making redundancies, an increment freeze? Was there even a pause between “frontline services will not be at risk” and “if you want to avoid redundancies, agree not to take your incremental pay rise”?
Most nurses are not remotely surprised but anticipating an assault is not a response. The response begins now and the question is: is nursing equipped to make it an effective one? How many times have we heard that “nurses are angry”? Angry with the government, the health secretary, bankers, insurance salesmen, each other, Wayne Rooney, themselves…. So angry they find a way of running a ward with no staff, working 15 unpaid extra hours a week and making themselves close to ill in the process, but stamping their feet occasionally while they do it and looking very cross for two or three days at a time.
Frankly, if nursing does not find an appropriate, powerful and intelligent response to this assault, it will remain a political adolescent - full of emotion but without the capacity to turn that emotion into something formidable. This is not about tired and divisive “should we strike or not?” debates - politicians are banking on arguments like that splitting a workforce as big and as malleable as nursing. It is about creative, considered and effective responses to protect not only nursing but also the interests it serves; patient wellbeing, standards of practice and a progressive, civilising society that values care.
For that to happen, nursing will have to act. The question is: does its leadership have the will or the ideas to act effectively?