Editorials

The “professional cleansing” of nurses

BMJ 1998; 317 doi: http://dx.doi.org/10.1136/bmj.317.7170.1403 (Published 21 November 1998) Cite this as: BMJ 1998;317:1403

The systematic downgrading of nurses damages patient care

  1. Hugh McKenna, Professor of nursing
  1. School of Health Sciences, University of Ulster, Jordanstown, Co Antrim, N Ireland

    Personal view p 1463

    All readers of this editorial will be looked after by a nurse at some time in their lives. For the vast majority the experience will be a pleasant and rewarding one—unlike that outlined by Hamon (p 1463).1 My initial response to her personal view was a series of depressing questions. Why would nurses who have received a rigorous and systematic education be party to such poor quality of care? How could professionals, trained to give high quality of care, allow standards to slide so far? How could nurses go home each evening and be content with what they have done and seen in the name of modern health care? I cannot defend the poor practices reported, but there are explanations.

    Nurses make up about 70% of the NHS workforce and cost 50-60% of the total pay bill.2 Unsurprisingly, therefore, some managers question whether cost effective quality can still be assured with fewer permanent registered nurses—indeed, in Britain the NHS Executive has stated that such a strategy could produce substantial savings.3 Similar reports have been produced in the United States, with one study finding that as nursing posts became vacant half were filled with untrained healthcare assistants.4

    A look at NHS statistics during the last government's …

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