Nursing: A Crisis in Practice

By: Diane E Pitt,
Research Fellow,
Tuke Institute.

350px-nursing_studentsIn recent years we have seen an increasing number of people, including high profile people share their disturbing stories of their experience of nursing practice in the UK (politicians, writers, journalists, cf: Hilary Mantel, Ann Clwyd, and others). Added to this have been the voices of academics also sharing their personal experience of nursing, and their difficult trajectory through illness, which has been compounded by their experience of poor practice.

For those of us who are familiar with the literature on illness narratives, and patient experience this has been all too familiar for far too long. The talk of a lack of humanity in practice, and the now almost daily stories of neglect, are pointing a critical gaze upon the profession, in a way that would have been unheard of 20 – 30 years ago. Nursing was once a profession to be proud of being a part of, and one that enjoyed unrivalled respect from the public. This is now far from the reality across the UK. So how, and why did we get here? And most importantly, how do we stop the collision course we are on?

One of the proudest moments I had when nursing back in the 1980’s was receiving recognition by a patient who was being barrier nursed in a side ward, and by definition she was isolated, which meant that she felt particularly alone, and vulnerable. In-between the times I would be involved in recording her observations, administering medication, and bed changing. I made sure I went into her side room, to talk, and listen to her, and share a few jokes. This became a regular routine for me during her stay on the ward. The patient singled me out on her discharge, and commented to the Sister on the ward that she would not have got through her time on the ward if it had not been for me. It was second nature to me to do that, because it would have been what I would have wanted/needed someone to do for me. It was also central to what I regarded as my role as a nurse. Care, compassion, and attention to detail, and an ability to recognise the vulnerability of the patient, and a desire to alleviate suffering as best I could.

Most of my childhood was spent wanting to be a nurse when I ‘grew up’. My Mother was a nurse, and later a ward Sister, and Nursing Officer, and she loved it. She was often late home because a patient needed her, and she couldn’t leave. She would come home with inspiring stories of the job, and always I was left with a clear understanding of the vocation that nursing was, and I was so proud of her, and all she achieved, and the difference she made to her patients. I did volunteer work on one of the wards my mother worked on, and got to hear the appreciation of her from patients, and staff. It became clear to me from a young age that central to nursing practice was indeed, care, compassion, kindness, attention to detail, the ability to recognise the vulnerability of the patient, and a desire to alleviate suffering as best you can. These were not, and are not simply desirable qualities, they are necessary qualities.

How devastating it is now for me to hear patients, and their relatives talk of nurses in terms of their, coldness, resentment, indifference, and contempt. My Mother is no longer alive, and often I wonder as I read yet another report on poor standards of care, just what she would have made of where we are now. I spoke recently to someone who has now retired from nursing, who told me that she is very reluctant to even state that her profession was nursing, she said: ‘maybe I am just ashamed, how sad is that’.

I know there will be many who point to the endless systemic changes, and demands on nursing and nurses, along with resource deprivation to explain the crisis we are experiencing. Clearly the profession has been fundamentally let down by nurse educationalists, and politicians, who’s involvement in policy formulation has been deeply flawed for years. However to suggest that this is the problem per se, is to demonstrate similar flawed thinking.

Let me outline a few examples to illustrate my point. Above I told the story of my patient being barrier nursed, and how I thought it was central to my role as a nurse to include, talking, and listening to my patient in my regular routine. It was clearly not enough to do her observations, and medications, she needed much more. I didn’t need to be told to do this by anyone else, it was obvious to me, and basic, and I enjoyed it very much. However fundamentally it was key to the care I offered this patient. It was during these times that I was able to learn about her condition more throughly, pick up subtle clues in her condition, reassure her, and make her feel safe; in short, I was being a good nurse.

So turns out that nursing is about CARING: caring about what you do as a nurse for your patient. It is you that is responsible for how you treat patients, you make the decision as a moral agent in the world, going about your daily life as a human being to care or not. It is that simple. This is not about systemic failure, and resource deprivation. If a patient is slipping out of bed it is you who chooses to help them or not. It is you who chooses to make sure a patient is hydrated, and able to reach their fluids. It is you who chooses to empty the bulging catheter bag or not, to turn off the IVI that has run through, and requires replacing, you choose to change a wet bed, a wet patient. It is you who chooses to talk to your patient, and ask how they are feeling. It is you who chooses to care about your patient as you would want to be cared for yourself. No system, or flawed policy should be a reason for choosing not to do this. This is what you are for. This IS nursing. This is attention to vital detail. This detail here is the humanity of your practice. Without this patients die. What could be more important? The lack of this is why the practice of nursing is in crisis, and why we need nursing back. If you cannot recognise this, then do not be a nurse.

To stop the collision course nursing is on, we need to recognise fundamentally what nursing is, and what the role of a nurse is at its core. I am no Luddite, I know nursing has evolved from Florence Nightingale. I also know that the technological and medical advances made mean that we need the core basis of nursing to be valorised, it needs to be its starting point, and not something that is disrespected, and discarded by the profession in some vain attempt to pretend that nursing is medicine; thereby denying what nursing is. When the profession wakes up to this reality we will have nurses who can be proud to be nurses, and patients who get the care they deserve, and need.


Comments are closed