I’d imagine it takes a lot to make Claire Rayner cross but nursing has done it. Not all of it, obviously. But some of it - a small but significant flake of it. And she has that look in her eye, like you’ve come round for tea and abused her hospitality by scoffing all the biscuits before everyone else has even been offered one. It’s a look that might make you melt with shame or at the very least rush out and buy some digestives.
A recent review by the Patients Association highlighted some “appalling” standards of care in NHS hospitals, and the ensuing debate led to many patients and relatives lining up to tell grim tales of thoughtlessness, neglect and cruelty. Some important people leapt to the defence of nursing. Bad care is unacceptable, but let’s not blame the whole profession for the poor standards of a small minority. Most nurses are great was the consensus.
But it’s too important to leave it at that.
I believe that if we asked 100 nurses “What do you think of the standards of basic care these days”, they would, after looking around suspiciously to make sure we haven’t smuggled anyone in, say that actually, for a whole host of reasons, things could and should be better. Of course, if there were any non-nurses, journalists or other outsiders at this imaginary meeting, those same nurses would defend both the standards of care and the circumstances in which they work.
‘When bad care is talked about, it is invariably good nurses who feel under attack - and who then feel the need to defend what they haven’t done’
In short, nurses know bad care happens. They know its causes (and these causes range from staffing numbers to some plainly poor nurses), and the ones I speak to feel a mix of rage, disappointment and contempt for poor care. But for a whole host of reasons, when bad care is talked about, it is invariably good nurses who feel attacked - and who then feel the need to defend what they haven’t done.
There are probably many reasons why it is difficult for nurses to openly acknowledge that they have seen bad nursing. Perhaps they feel traitorous or unsupportive if they speak out. Perhaps they understand why someone has become careless, and they somehow quietly accept it as part of working life.
However, I can’t help thinking that while government, civil servants or even professional organisations talking earnestly about nursing standards is inevitable, it isn’t going to help very much. In fact, if we genuinely want to acknowledge that standards are not what they could or should be - and that the act of caring (which is the essence of nursing) is being continuingly lost in the tasks of nursing science - we should hand the job to nurses.
Not the defensive ones. Not the tired ones. Not even the powerful ones. No, we should give it to the wise nurses, the “ordinary” nurses - the nurses who burn with anger when they hear of patients left to lay in wet beds.
If we really want to address standards of care - and let’s face it, it’s our responsibility to do so - then nurses should be the first line of response. Whether it be in addressing education and training curriculums, codes of conduct, protocol or policy. At their best, nurses can be their own harshest critics. And so they should be.