The “professional cleansing” of nurses
BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7170.1403 (Published 21 November 1998) Cite this as: BMJ 1998;317:1403
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I vividly remember the day about 35 years ago when my younger
sister learned that she had been accepted as a student
Nightingale nurse at St Thomas' Hospital. Pride, excitement
and happiness launched her on a career that lasted for six
years, until she married (a Thomas' doctor, of course).
She was not well paid and she worked hard wiping locker tops,
doling soup into the elderly, plumping up pillows, listening
to her patients (Mister Smith, Miss Jones, not Jack or Jill)
and learning her trade. She learned to sympathise with the
living and to lay out the dead. She was given a classroom
training too, but most days she was learning on the wards.
Gradually she was introduced to the operating theatre, where
she specialised later in her career, and to the more technical
side of her profession.
My sister lived in a small room in a nurses' home redolent of
boarding school, something she had not tried before which she
found fun. A room in central London is worth having when you
are 18 and so were the three hearty meals a day she was given
(free of charge) to keep her fit and energetic during a long
day's work.
She had not been particularly well educated and could never
have been a barrister or architect, as Professor McKenna (who
can have precious little understanding of those professions)
suggests as alternatives to nursing. Nor did she want to be
anything other than a nurse. What she had in abundance was
kindness and she saw instinctively that nursing was a job
where an ordinary young girl with a kind heart could get great
satisfaction from helping the sick get better.
The hospital saw that in return she should be made to feel
special; not with money, but with the small things that make
young people feel good about doing unusually hard jobs.
She got a smart and distinctive uniform; it showed the
dimmest-eyed patients she was a student nurse just as the
grander uniforms she later wore showed clearly who was sister,
who the staff nurses. She acquired a sense of being part of an
elite and readily assumed the responsibility to be better that
that entails.
She enjoyed the comradeship of the small intake of
Nightingales she trained with, several of whom became
life-long friends. They felt proud of belonging to a great
hospital, cheered its rugger-playing medical students, got
excited about rag days, carol services and parties, believed
that there could be no better place to work - as their
counterparts at the Middlesex, Westminster, Barts and St
Georges, etc, no doubt did too. She was given clear
leadership by people who had been trained the same way that
she had and who understood how hard nursing could be on the
feet and on the heart. She earned the thanks of people she
either respected or cared for.
Every regimental officer or old-fashioned hospital matron
knows the importance of all these things in building .sprit
de corps and the importance of that on morale and performance.
Managers, trained in a different school where money is the
measure of everything (and encouraged by the unions whose duty
it is to press for better pay), attach less value to them.
In a sense she was following a vocation, just as her friends'
brothers were, many of whom became soldiers and sailors. She
was obliged to join prayers on the ward each evening - just
like a Victorian servant, but she had not been prompted to
resent that. She and her friends found prayers rather 'cosy'
and it must have heartened many patients watching from their
beds in the long traditional wards.
Our mother is in hospital in London today. There is food on
the floor and her grandchildren's letters lie under the bed,
unopened until her visitors arrive; no one showed her how the
radio works; six tablets she should have taken early in the
morning were still in a cup by her bedside when the evening
drugs round came; and they have lost her dentures. She cannot
tell who is in charge and cannot understand the Somali who is
meant to clean her room. The nurses I have talked to do not
seem very happy, for all their degrees. Except, perhaps, the
Spanish girl who likes to sit and stroke my Mum's cheek. She
gets something out of nursing that has nothing at all to do
with money.
END.
George Pownall.
Competing interests: No competing interests
EDITOR - the account related by Dr Iain Mackenzie is familiar to
myself,and (once thousands but now) hundreds of other nursing staff. It
reminds us of events we experience on a daily basis and the misinformed
medical opinion of what nurses are/do.
There is little doubt,that staff shortage is a key element of the
increasingly reported poor care problem but Dr Mackenzie has ignored the
crux of the discussion. It is the shortage of QUALITY nursing staff that
Professor McKenna describes, those driven from their posts NOT by desires
to be engineers or doctors, but crucially by an inability to deliver care
to an acceptable moral standard. In the course of a nursing shift, I may
witness a wife, husband, father, mother, child depart from this world in
less than satisfactory circumstances. Within the nature of my role, they
are all`personal` to me and take their toll. Given a choice, what kind of
person would remain in such an unrewarding working environment? And what
kind of person could continue to strive to maintain and improve patient
care without knowledge, education and a framework for practice? Would
they not be deemed negligent in their duty of care?
The "Professor" is not a symptom of the disease that is, to use Dr
Mackenzie`s phraseology, "suffocating the nursing profession". Rather, the
"Professor" is at last an opportunity for Nurses to have a voice, to make
explicit their contribution to health care, gain deserved respect and for
the practice of Nursing to be valued per se, no more to remain the
scapegoat of all and sundry.
I fear Dr Mackenzie`s views may be as clouded as those he ascribes to
Professor McKenna. The National Health Service (NHS) has changed- but
Professors of Nursing have not altered caring and do not live in ivory
towers. Caring is still about holding an old lady`s hand as she lays
dying. I myself, am tired of hearing about those who have left the
profession and would not come back to "modern" nursing - there is no such
thing. If those people really mean that they could not cope as a nurse in
the NHS of today, then I sympathize, but this in fact adds weight to
Professor McKenna`s words. We, that is, the people who do care, be we
nurses, or any other member of the multidisciplinary team cannot do our
job properly. The system is overworked, under resourced and encumbered in
administrative legislation - the "good old days" are long gone.
Demoralised, I look to the likes of Professor McKenna to lead the way
forward but also to ensure that as nursing develops, the interests of
patients are promoted and safeguarded (UKCC 1992)and do remain as the
heart and soul of nursing. I am not a frustrated doctor. I only wish to
be allowed to nurse expertly and competently. I believe in care at all
cost which is not necessarily cure. If you want people to nurse the sick
(and not become sick theselves), look towards providing appropriate
support, recognise their contribution and value them - do not condemn.
References
1. Hamon C Some NHS care is unacceptable BMJ 1998 317:1463
2. ".Mackenzie I. Electronic Resonse to The "professional cleansing"
of nurses BMJ 1998 25 Nov 1998
3. McKenna H the "Professional Cleansing" of nurses BMJ 1998 317:1403
-4
4.UKCC 1992 Code of Conduct. 3rd edn. United Kingdom Central Council
for Nursing, Midwifery and Health Visiting June 1992
Competing interests: No competing interests
Editor-
I read with interest and great concern McKenna's editorial 'The
"Professional Cleansing" of nurses" and Hamon's personal view 'Some NHS
care is unacceptable'.
There is without a doubt, a nursing crisis in the NHS. Staffing
levels have now plummetted to an unacceptable level. The "superfluous fat"
may have been trimmed in the past but we are now "cutting into the bone"
and as a result patient care is suffering. Dr Hamon's harrowing account of
the poor care her friend received is unfortuanately not unique and is
becoming more and more familiar to us all.
It is time for the government and the country to show the nursing
profession how much they are valued. This can only be achieved by a
substantial pay increase and by an increase in staffing levels. As Doctors
we must strive with our nursing colleagues to demand such changes so that
our patients receive the highest standard of care.
References
1. McKenna H. The "Professional Cleansing" of nurses" BMJ 1998;317:
1403-4.
2. Hamon C. Some NHS care is unacceptable. BMJ 1998;317:1463
Dr Helen Gentles, 40 Whichelow Place, Brighton BN2 2XF
Competing interests: No competing interests
Editor-The experiences related by Dr.Hamon are familiar to myself, my
wife and my mother-in-law, and remind us of events we experienced in the
last few months of the lives of my wife’s father and grandmother. There is
no doubt that staff shortage is a key element of the problem,
and that poor pay, low morale and stress all contribute through sick leave
and an inability to recruit and keep nursing staff.
The ‘Professor’ however is a symptom of the disease that is
suffocating the nursing profession. The ability to care for a patient in
its most basic sense means being able to wash, feed and dress them. These
are tasks which appear to be regarded as menial or unimportant to the new
breed of ‘nurse practitioner’, who is now too busy writing ‘care plans’,
‘learning contracts’ or ‘evidence-based practice protocols’. The view from
Professor McKenna’s ivory tower must be cloudy indeed if he thinks that
hospitals are becoming ‘large intensive care units’. Despite the
intelectualization of the nursing profession and the move to degree
courses, it is still the rule to find wards where none of the trained
staff know when ‘Mrs.Smith’ last ate or had her bowels open, let alone can
administer intravenous drugs or know how to measure the central venous
pressure.
My wife was trained as a nurse at a time when ‘caring’ meant holding an
old lady’s hand as she lay dying; time spent nowadays writing complete
nonsense in the care plan. She has left the profession to be a mother, but
sees nothing in modern nursing to make her want to go back.
Professor McKenna is right, however, to suggest that the people whom
‘nursing’ is trying to attract could equally well go into other careers
such as architecture, engineering, medicine or the law. Nursing has been
perverted into an academically demanding occupation by a small band of
frustrated ‘doctors’, but finds that the reality on the wards can neither
interest, pay or keep the calibre of recruit. If you want to send men to
Mars, look for rocket scientists; if you want to nurse the sick, look for
people who like to look after others.
--
Dr Iain Mackenzie
Competing interests: No competing interests
The "professional cleansing" of nurses
Sir,
I was saddened to read the personal view by Dr. Hamon and the reply
by Professor McKenna in the BMJ of 21st. November.
It was informative but not surprising to learn that the medical and
nursing staff were in dispute over the situation and to see that the
consultant’s input to the resolution of the problem was passed over in one
sentence.
There are several reason for this effective gagging of hospital
medical staff.
1. The ever present threat of suspension, which is carried out with
little notice and without the necessity for any reason to be given.
Unless we work directly with a colleague we are unsure of their abilities
and the fact of
suspension places that doctor under the suspicion of some type of
inadequacy or misdemeanour by medical, nursing and ancillary staff as well
as the general public. Often, on reinstatement, the doctor is told not to
speak to
colleagues or the press about the problem.
2. The presence of chief executives on discretionary points
committees which inhibits doctors from making necessary comments about the
structure and function of their hospitals as this may diminish the chance
of their merit being formally recognised.
3. The ever present efficiency savings which are likely to be applied
to the doctor’s unit or the staff of that unit and which will make the
situation for patient’s and staff worse.
I write from the comparative safely of my retirement but worry lest
my successor’s work is made more difficult or even that my pension will be
decreased for having stated these truths. Many doctors have seen similar
problems but know that complaining may well be ineffective if not counter-
productive.
The examination, identification and correction of such problems is
properly a function for the medical profession, possibly through the Royal
Colleges via their audit and accreditation committees. We can no longer
rely on
individuals to publicise them.
Yours faithfully
Geoffrey Cohen
Competing interests: No competing interests