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Nurses get a tongue lashing

BMJ 2006; 333 doi: (Published 27 July 2006) Cite this as: BMJ 2006;333:265
  1. Jane Salvage (work{at}, nurse and international health consultant

    But are attacks in the media really a doctor's cry for help?

    A bout of nurse bashing has hit the headlines. Is it just the silly season, or a rush of blood to overheated editors' heads? Nurses have enjoyed favourable press lately. The spirited barracking at the Royal College of Nursing congress of health secretary Patricia Hewitt—herself called Nurse Hewitt by unimaginative hacks—undermined the usual submissive stereotype. Then there were all the sob stories about nurses' jobs jeopardised by the NHS cash crisis. Time for a bit of “balance,” surely.

    Balance was duly provided not by journalists but by the nurse's oldest enemy, the doctor. It started in the Independent (“They're no angels,” 20 June) with a tirade from a junior doctor in an inner city hospital, the pseudonymous Lucy Chapman, infuriated by incompetent, sulky nurses who prefer reading trashy magazines to obeying her orders. Poor Lucy (whose criticisms were also published in the Belfast Evening Telegraph on 20 June) berates the lowly jobsworths for their lack of initiative and expertise, loathes the clinical specialists for presuming to suggest how she might treat her patients, and thinks nurse managers are merely Nurse Hewitt's henchwomen, forcing doctors to work faster to meet government targets. Whatever nurses do, she doesn't like it. What she really wants is “people willing to empty bedpans and take old ladies to the toilet on time.” The sort of people, presumably, who won't ignore her or answer back.

    Lucy sometimes talks sense, understanding that it is increasingly difficult for nurses to care in a society that does not explicitly reward or value caring. Understandably for an overworked junior doctor, she is stressed and angry, but she still finds time to moonlight with the media. She, or someone else with spookily similar views, popped up barely a month later in the Daily Mail (“Angels? I don't think so,” 18 July). (The “angel alert” is approaching the red zone. Angels in a headline are a sure sign that much silliness and stereotyping will follow.)

    This anonymous account purports to be from a different doctor, interviewed by Mail hackette Kitty Dimbleby (and yes, she is the granddaughter of Richard and daughter of Jonathan, and therefore should know better). If it is actually Lucy, she's had a sex change, described as “he” in the introduction and making great play of his “girlfriend, who has achieved a Bachelor of Science in Nursing” (though it would have been much more interesting if they were both women). This article follows the same structure as the one in the Independent and makes the same arguments. It also throws in a dig at “African” nurses whom Dr X finds mostly “indifferent in the extreme.” Thus the nurses of an entire continent are dismissed out of hand. If the articles do come from the same source, it is a shameful episode of self plagiarism and sneaky, parasitical journalism.

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    Like Lucy, Dr X hates nurses who are “pretend doctors” and thinks that widening nurses' prescribing powers is a political stunt by Hewitt. A little knowledge is a dangerous thing, Lucy says—“Would you take a flight in hazardous conditions if you knew that the pilot was actually an air hostess who had watched quite a lot of pilots at work?” She's presumably too young to know how many years of painful negotiation led to this belated recognition of nurses' capacity. Dr X uses a different, bizarre analogy—“If your house was on fire, would you want it dealt with by a teenager with a hose whose only qualification was watching London's Burning?” His girlfriend has obviously not dared to tell him that nurses earn the right to prescribe through special training of greater depth and length than medical students' studies of pharmacology. The risk of being likened to a stewardess or hose toting teen must have put her off.

    Both articles sound curiously old fashioned. Lucy says she may be thought “unsisterly” and “arrogant,” but goes on to be precisely that, while Dr X regrets the decline of the “old school” of nursing. They could have been ghosted by old Lancelot Spratt himself—or Conservative Central Office. Above all, though, they sound like a cry for help. Embattled and unsure of their role in the new order, they lash out at a soft target, when what they need is a listening ear and a considered exploration of what is really going on.

    The Mail is inviting responses: “Are nurses really lazy and incompetent?” It is hard to resist such provocation, so we may not have seen the last of this. Drawing the battle lines this way stifles intelligent, rational debate about the relationship between doctors and nurses—so crucial to the quality of health care. A few years back, when I was editor of Nursing Times, we ran a special joint issue with the BMJ (15 April 2000) with precisely that goal. Quite apart from my shameless attempt to boost sales by having George Clooney in his ER persona on the cover, both journals carried a number of thoughtful, stimulating articles, but the response was disappointing. It seemed no one really wanted to talk about doctors and nurses. Could it be time for another look at the elephant in the room?

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