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‘Don’t speak until you are spoken to’ and other lessons from the past


Lecturer, Mark Gagan, recalls a the strict hierarchical system that existed when he trained. How things have changed!

Mark Gagan_SNT

Mark Gagan is Senior Lecturer and Programme Leader at Bournemouth University

I was a 19-year-old, first-year student nurse at North Manchester General Hospital, Crumpsall, Manchester in 1977.  I had never worked in a hospital before and I was allocated to a very busy 30-bedded medical ward.

The ward sister was Sister Jenny Thompson. In those days there was a strict hierarchical system amongst the nursing staff, with sister at the top. This system of hierarchy was as strict as any caste system and you had to obey the rules or face instant stigma and abuse.

Therefore, a first year student didn’t initiate a conversation or query with a third year without going through a second year first, because status was very important.

I had been given the task of washing and making up the beds of patients who were discharged. It’s easy now to make “hospital corners” on bed sheets (no duvets in those days!), but as a neophyte to the wonders of nursing geometry, I struggled to get those sheets tucked in exactly at 45  degree angles and the pillow cases lined up to 90 degrees to the bedstead .

I struggled manfully with my sheet that had a life of its own and slid everywhere it wanted to go, except to the corner I was making.

“Has the young male student nurse finished that bed yet?” I heard an unfamiliar voice cry out, “where is he then?”

I was bending down level with the bottom of the bed as a figure breezed in and started on the diagonally opposite corner of the bed.

“Ah, there you are! We were just going to send out a search party for you! Where are you up to?”

The bed maker was wearing a navy blue dress. It was Sister Thompson! Making a bed and talking to me-without a staff nurse, enrolled nurse or second year student in sight.

I felt sick, completely out of my depth, and my comfort and safety zone .

 “How are you doing down there?” Said Sister Thompson, now on her third corner and moving opposite my side of the bed.

 Oh no! She’s mistaken me for some other rank! I’ll be in trouble if I speak..

All of  her three corners done, Sister Thompson said, “Mr Gagan, is there something wrong with your neck, lad?”

“No sister, I don’t think so.” Now red as a beetroot, she knew my name, I must be in trouble!

“Because you don’t seem to be able to lift up your head and look me in the face when I ask you a question.”

I slowly lifted up my head towards her.

“Well that’s better,” she said, “why can’t you do that each time I speak to you?”

“Because you are a sister….sister; and you’re not supposed to speak to first year students. “

Sister Thompson replied, “Just remember, you are part of my team and if we don’t speak to each other, how will we ever give our patients the care they need?”

Well, I’m not sure my hospital corners could ever be as good as Sister Thompson’s but I suddenly felt respected as part of the team that delivered the best patient care it could.

We did it for the patients and for Sister Thompson, who demanded the best of her staff. She was always the first one in on the shift and the last one to leave, and she knew all of the patients and their families and spent time with them to ensure they felt safe and well cared for.

It was 37 years ago that I met Sister Thompson face to face (well almost!) and I hope that one day I will be as good as nurse as she was(I’m still trying!).

She showed me that you earn respect for what you do, not just because of your title and status, and that everyone in the team is important no matter where they are in the hierarchy. It does us all good to remember that.


Mark Gagan is Senior Lecturer and Programme Leader at Bournemouth University


Readers' comments (2)

  • Well Said Mr Gagan from a former colleague from Crumpsall . Those were the days That Teamwork did work for the benefit of Patients . In My experience all members of the Nursing Team have something to contribute towards Patient care

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  • Love it!

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