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The trouble with nurses
One NHS manager said they were `a liability on the wards'.
When I was a child my girls' comics were full of stories about young nursing students. They were always sweet and pretty and lived in a nurses' home attached to a hospital; when they had time they swooned over the young doctors, but they had very little time because they worked extremely hard on the wards and were strictly supervised; they lived in terror of their ward sisters, and especially of the all-knowing, omnipresent matron, whose standards were almost unattainably high. It was a very proud day when a girl emerged from all this as a fully-trained nurse.
With this inside information, gleaned from Bunty, it came as no surprise to me to hear, when my elder brother became a medical student in 1967, that most of the doctors deferred to the senior nurses and their experience, and that the ward sisters and the matrons played a major role in training junior doctors, and indeed in rescuing their patients from their inexperience.
Everyone recognised, without the expression, that most matrons and ward sisters were "supernurses". Yet they were already on the way out. Radical changes were about to overwhelm nursing. Matron, to many people's regret, was soon to be a figure of the past. So it comes as a particularly irritating irony, now that nursing has been reduced by all these changes to a state of serious crisis, that the Prime Minister should suddenly announce a wonderful new solution - the supernurse!
Mr Blair used the Royal College of Nursing's Nurse of the Year Award ceremony on Tuesday to announce his radical new highly paid "consultant nurse" idea; it is no less ironical that the winner, Paula Taylor, immediately took the opportunity to say that she did not think this was going to solve "the malaise at the heart of nursing". Indeed it won't, although I think it is essential to pay good nurses more, at every level.
The malaise at the heart of nursing , I believe, has largely to do with the training of nurses, and the ideology that lies behind it. What we need is not so much a new (or, rather, old-fashioned) kind of elite supernurse, though they will always have their place; in terms of numbers what we need is a new (or, rather, old-fashioned) kind of super-ordinary nurse, and plenty of them. To call them ordinary is to ignore their extraordinary importance to patients. I mean the kind of nurse who is not academic, and not ambitious, but who loves looking after the sick - making them comfortable, helping them eat, or walk, changing bandages, taking temperatures.
This was the role of the State Enrolled Nurse of the bad old days, before the nursing reforms, and the new Project 2000 nursing training programme of 1989. State Enrolled Nurses were not as academic or as highly trained as State Registered Nurses, but nonetheless they received two years' intense practical training on hospital wards, and some theoretical training too. A good SEN was invaluable. However, this very practical distinction was felt, in those egalitarian times, to be divisive and demeaning. One of the many objects of Project 2000 was to abolish this distinction. Henceforth there would be one nursing qualification only. Much of the important work formerly done by SENs is now done by others - nursing auxiliaries, who need have no qualifications, or Health Care Assistants, who also need no qualifications, though some of them may get a chance to get an in-service National Vocational Qualification. In Project 2000's attempt to "professionalise" nursing, in trying to boost everyone's self-esteem by pretending that everyone is the same and equally academic, and its determination to make nursing training more theoretical and take it out of the hospital and into academe, the invaluable tradition of the super-ordinary nurse was lost. This goes a long way to explaining the hospital horror stories so many people have to tell of bloody sheets and bed sores, filthy lavatories, more and more hospital-induced infections, and lying hungry, thirsty and in pain.
Another part of the responsibility must lie with the training itself. Although Project 2000 was a response to the greater technical and intellectual demands of nursing, all too often nursing courses produce nurses who cannot take blood pressure, insert catheters or understand the principles of cross-infection and asepsis. One NHS manager described them as "a liability on the wards". No doubt that is because such a large part ofthe teaching is heavily theoretical, dealing with matters sociological, such as "gender studies", "race awareness", and politics as well as more relevant subjects such as ethics and pyschology.
There has been for a couple of decades a kind of intellectual madness that has inserted itself into public life, a nightmare combination of pretentiousness and impracticality - in social work training and teacher training as well as in nursing. Some of this has been imported from America, where it is often much worse. My elder brother, now working in Vermont, said recently highly skilled nurses were whisked out of theatre to attend obligatory courses on "humanistic nursology" and other fashionable nursing theory, such as the "existential" definition of the "interface" between patient and health worker.
To whatever extent as this is happening here it must be stopped. What we need is less of the nursology tendency and more practical nursing. Bring back the State Enrolled Nurse.
The Sunday Telegraph | Sunday, September 13, 1998
Comments:
Very interesting points made.I like the concept of nursology.
Thank you.
Posted by: Dr.J.P.Bhoyrub | 23 Aug 2007 11:24:46
