Personal Views Personal views

Doctors have become more caring than nurses

BMJ 2000; 320 doi: (Published 15 April 2000) Cite this as: BMJ 2000;320:1083
  1. M Fletcher, nurse and health service manager
  1. Birmingham

    How life changes. As a clinical nurse, manager, and educationalist who is about to celebrate 25 years in nursing in some guise or another, never would I have imagined that I would admit that the medical profession has become more caring than my own. Yes, those very same nurses, who I believed prided themselves in providing high quality personal care, the real essence of nursing, have changed. What I see now bears little resemblance to the service I entered. An unfeeling leviathan seems to have been created.

    Nurses must take stock of where nursing is going before it is too late

    Sadly, I reach this conclusion after a short spell in a large teaching hospital. I had what ministers would describe as a patient experience. Many members of my profession will undoubtedly view me as a heretic, and I can understand them. But nurses must take stock of where nursing is going before it is too late.

    Nurses have been indoctrinated with the belief that doctors are capable of exercising only a cold, scientific medical model. They treat the disease, not the patient. Nursing literature is full of anecdotal accounts of the distant approach that doctors have towards patients and their carers. Nurses, on the other hand, claim to practise in a holistic manner, caring, not purely about individuals' physical wellbeing, but also their emotional and spiritual needs.

    Rapid changes in technology and new treatments have necessitated changes in nursing practice. Many of these have been welcomed. Nurses have extended their clinical competencies, and as a result have challenged traditional roles of other healthcare professionals, particularly doctors. This would seem to be in line with the government's modernisation agenda for the NHS to improve access, shorten the wait in the system, and decrease lengths of stay.

    Indeed nurses may congratulate themselves in that the profession has spent the past two decades building up its unique body of knowledge, complex theories based on sociology and psychology, creating a pseudo science out of assessing patients, and writing care plans as part of the nursing process. But in this somewhat evangelical search for professional status nursing has slipped into the same trap as befell other professions and has created a professional mystique all of its own, with its own complex language and behaviours.

    Nurses claim to practise patient centred care, based on problem solving and the search for resolving individual health needs. I must challenge this. What good are sophisticated and lengthy care plans that bear little or no relevance to the actual care that patients receive? It is purely an academic exercise.

    As a patient, I looked to nurses to make me comfortable and to restore my independence. I believed that they would help maintain my hygiene, tend to my nutritional needs, and keep me free from pain. Sadly, all this was lacking. On the other hand, my cannula was well positioned and my antibiotics were given intraveneously with great regularity, and my cardiac monitor was interrogated and monitored regularly. But caring seemed to be viewed as subordinate or perhaps it was not seen as important at all.

    As the vocation of nursing has evolved into the profession, we seem to have lost fundamental values, in particular a concern for patients. Nursing now focuses less on patients and more on the acquisition of knowledge and skills purely to further its status. I am terrified that we have on the horizon a new breed of nurses, nurse consultants, who may well have modelled themselves on the Sir Lancelot Spratt school of medicine. Perhaps they are motivated by a belief that it is time to seek retribution for the years of oppression by the medical profession.

    A caring ethic and professionalism need not be mutually exclusive. It was interesting to witness how medical staff now seem to be able to combine both traits. Who was it who made me comfortable and cared about my wellbeing as I lay helpless in my bed? It was the medical team. The nurses were no doubt busy, but busy doing what? It was not caring.

    Nursing is not yet a mature profession. Like an adolescent it manifests behaviours that challenge those around. This is not necessarily all bad but nurses must not lose the confidence of patients and colleagues at the same time.

    Let there be a warning to nurses, managers, and educationalists. Professionalisation in itself will not guarantee improved patient care. Our only hope is to re-educate nurses to care again. Or is it too late?