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The ignorance of 'certainty'

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Communications and engagement manager Martin Machray considers potential barriers to quality care provision and how these concerns perhaps begin with our own attitudes.

My return to practice classmates are an odd lot. Of course I don’t mean they’re strange, just that they are all very different to one other. You would think that there would be a number of things that we hold in common, but that doesn’t seem to be the case. There certainly are students of very different ages; my initial fear that I would be the oldest and therefore most outdated proved completely unfounded. Just as it was first time round, I am somewhere in the middle, although the confidence range is now measured in decades rather than a couple of years. We look around the room at each other and self consciously worry about the greying temples or leathering skin and we off-set these concern by reassuring ourselves - and one other - that we bring life experience and a depth of compassion that cannot be found in our younger compatriots. Well, maybe.

Of course we come in all shapes and sizes but there is a palpable concern amongst some of my colleagues that the ward - or clinic, will prove too much in one way or another. Back niggles and being “a bit overweight” seem to be the biggest physical concerns but both rather pale in comparison with concerns about “stress”. A handful of returnees have reflected more than once that they left the clinical environment when they did because they were finding it hard to cope or had “burnt out”. The hope is that by taking time away to bring up families, change jobs or being, like me, on the ‘Easy Street’ of management, they will have recovered their capacity to care; they will be ready to go back on to what is strangely, yet commonly referred to as ‘the front line’. Military metaphors aside, I think time will reveal how fit we are. In the days before improved equal opportunities legislation I dimly remember upper age limits to becoming a student nurse.  Will we demonstrate the necessary capacity and strength required of us? Possibly.

Interestingly there seems to be a range of social backgrounds, something that I wasn’t particularly aware of when I joined the profession. Thinking back it had always been there, only this time around, our beliefs and values - as well as our financial and social standing - have been self-determined rather than by those of our parents. One of the challenges surely we all have working within a universal healthcare system is ensuring that personally we are able to offer the same quality of care to all of our clients or patients. Our varied backgrounds and more entrenched beliefs and opinions are the things that are going to make this harder second time round, but at least we have the opportunity to recognise this before our behaviours become an obstacle. Certainly I have found myself questioning my own reactions to some of the views and behaviours demonstrated by my patients and carers. And surely that is how it should be? Yet, as I question my actions and reactions I cannot fail to notice those of my colleagues too, and I have to say I am not often encouraged; so many trenchant views - some which are downright unacceptable!

“It wasn’t like this in my day”, “degree nurses don’t want to do ‘real’ nursing” and even, “there are too many foreign nurses” are all things I have heard stated as ‘factual certainties’ in the last few weeks. My hope is that I have heard individual voices rather than a collective opinion, but even then I wonder how these views about my profession, held by fellow nurses might translate into interactions with the people they care for.

I must say that I have seen nothing to worry me unduly in practice. On the contrary, on my clinical placement I am reminded every day how caring and non-judgemental nurses are. For our patients - and our profession, I hope that this standard is perpetuated by those of us coming back to the profession after time away. I desperately hope that the ignorance of ‘certainty’ isn’t the one thing that binds my class together.

About the author

Martin Machray is a health service communications and engagement manager for NHS Islington. He began his career as a student nurse in the 1980s and was involved in frontline care nursing for a number of years until he moved into senior nursing management. From here he entered strategic and operational management posts, both in hospital environments and in national organisations before assuming his current role.

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