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Nurses are the problem
They arrive on the wards unable to take blood pressure
Over Christmas I decided to make New Year's Resolutions not for myself, but for other people. And one was for people to stop blaming the collapse of NHS hospitals on nurses' pay. It would be nice if complex problems had simple solutions, but they don't.
It is true that there aren't enough nurses. It is true that nurses are very badly paid. It is true that to public outrage and at great expense the NHS had to import emergency supplies of nurses from abroad, as it has done in the past. But none of this by itself explains the third world horror of NHS hospitals today - the old ladies dying on trollies in corridors, the filthy sheets, the overflowing urine bags. None of this explains by itself the malnutrition, the bedsores, the incompetence and the neglect, nor the request from two Portsmouth hospitals that family members should wash, feed and shave their sick relations themselves -nothing new in that anyway.
Paying nurses more is not the solution. It is not simply that we need more nurses or simply that we have a recruitment problem, though of course we do. Nurses themselves are part of the problem. So is nursing. I apologise to all those good nurses who struggle against terrible odds.
But as the winner of last year's Royal College of Nursing Nurse of the Year Award said herself to Tony Blair, when he presented her with her prize, there is a malaise at the heart of nursing. And what has gone so desperately wrong with nursing is not something that can be put right with money alone. It can only be put right by a radical revolution, or - rather - a radical reaction against the misguided changes that have helped destroy what was best about British nursing and made it the envy of the world.
What happened to nursing is what happened to many British institutions; it fell into the hands of the well-intentioned avant-garde of the Sixties. It suddenly began to be seen as very old fashioned. It was, of course, and I don't think anyone would like to see a complete return to the way things were: the ferocious matrons, the virginal seclusion of the nursing homes, the strict hierarchy of the wards, the constant supervision, and the extreme deference to doctors, the long hours, the unnecessary frills of the starched cap, the ugly black beetle-crusher shoes, and all this at a time of mini skirts and youth revolution - most of it seemed to the thoughtful and the thoughtless alike to be in need of change.
The result, however, was not reasonable reform, but extreme radical modernisation. Between the Salmon report on nursing structure in 1963 to the Project 2000 training scheme of the late Eighties, almost everything was turned upside down in a glow of misplaced egalitarian integrity.
Matron had to go - too authoritarian. The State Enrolled Nurse (SEN) had to go - her unacademic status and humble work was demeaning. Extensive workplace training on the wards had to go - exploitative. Nursing schools had to go - nurses now had to have professional status, with a diploma or even a degree, and from a proper college not part of a hospital. By 1995 all the traditional nursing schools had closed. Nursing training must include sociology, politics and race and gender awareness. Different uniforms and titles and hierarchies must go - unequal and therefore demeaning. Menial nursing jobs and simple bedside care must be done by unskilled or semi-skilled ancillary workers - they didn't matter, presumably.
The results were predictable, and we have got them. Intelligent nurses who squander half their training in the classroom, studying pseudo academic subjects such as race awareness, arrive on the wards unable to take blood pressure or insert catheters - "a liability on the wards", as one NHS manager described them to me. Perhaps it's as well that they tend to cluster round the "nursing station", ignoring the patients.
Unacademic people who would have made fine SENs in the old days now, if they want to nurse, have to apply for courses they cannot manage, but for which they get accepted; a young arts graduate I know, now training as a nurse, said that two of the women who passed with her out of their foundation course into a nursing course could barely read and write, still less follow the useless gender awareness arguments.
Of course we need high powered, highly qualified academic nurses, and they should be highly paid. But what we also need, even more, is nurses who simply nurse, and who have learnt to nurse the practical way, on the ward. Humble bedside nursing is too important to leave to underpaid and demoralised ancillaries. So many of the horror stories of hospital neglect today have to do with a shortage not of high powered high tech nursing but a shortage of low powered bedside nursing.
The Government may have some excuse for blaming the Tories for the current disaster, though I didn't notice the Labour party objecting to the new "structures" and the right-on Project 2000 training and all the rest at the time.
But it is no use for Labour to announce that it is going to offer 15,000 new places for nurses, if the concepts behind the training are all wrong, and don't produce the nurses we need. Nor will their hint of higher wages do much to help either. As I said, it's my New Year Resolution that they should think again about nursing, and think hard.
The Sunday Telegraph | Sunday, January 10, 1999
Comments:
Dear Minette, I am a nurse ,a senior staff nurse.I have been trained for 25 years.I now do less and less Nursing of patients,=I spend more ti me taking on Drs roles managinging and going on this course and that study day .I have been overtaken by nurses with far less experience but certificates for every course uder the sun, paid for by the nhs. Nurse now travel the world at the expense of the nhs, going to conferences. I feel this is morally wrong . Of course on going professional development is important ,but not at the cost to the nhs to the extent it is today. I am , and most of my colleges feel we are being made to take on roles beyond our remite and capabilities. If we do not take on these roles we are made to feel useless and overlooked. We are not allowed to nurse anymore, but that is what I went into nursing for.If I wanted to do a a degree I would of done one when I left school, If I wanted to be a manager or a doctor I would of done that.I TRULY LOVE BIEING A NURSE BUT IAM NOT ALLOWED T o be a hands on nurse anymore .This makes me angry and dissilusioned.The danger is nurses today do jobs there not educated enough to do and get promoted beyond there capabilities.They feel there degree makes them equal to a dr , I think not, a dr takes 5 to7 years to train. But the most important failing is that patients are not getting the best care,I am ashamed to call myself a nurse when I see patients not getting the hands on basic nursing care that I trained to do.Every other nurse i speak to feels the same but i feel it is like the Emperors new clothes, people are afraid to stand up and shout hey things are wrong.
Posted by: suzanne bowman | Oct 11, 2006 1:54:14 PM
