Monday 6 April 2020

Nurses in the time of COVID-19

Did anyone else’s heart sink or eyes roll just a little at the naming of the new NHS Nightingale Hospital in East London – the Nightingale name soon to be replicated in a number of locations around England? Scotland, at least have named their hospital after Scottish nurse Louisa Jordan.

Until the last week, nurses have been virtually absent from the political discussions, policy development or media broadcasting.  Nurses have been denied a seat at the table when the purchase of ventilators and PPE was discussed – yet they have more sustained contact with patients than anybody else.

It took the bombshell, dropped calmly by RCN general secretary and chief executive, Donna Kinnair at Question Time on 2 April 2020, that the numbers of nurses dying in the UK from Covid-19, was not being counted, for nurses to be noticed at all. As a result, next day, the chief nursing officer, Ruth May appeared for the first time at the daily Covid-19 press conference. Her appearance, again calm and respectful of all healthcare workers, brought a refreshing change from the usual wartime talk of battles, fights and Dunkirk spirit.
Until this point, the lone nursing voice in the field has been that of Nicki Credland, Chair of the British Association of Critical Care Nurses (BACCN) and a Lecturer in Critical Care and Advanced Practice at the University of Hull. Not afraid to speak truth to power Ms Credland, has said, she doesn’t think government understand that nurses do more than ‘make tea and pat you on the head’. I don’t think they understand that it is a safety critical profession’, she told me.
The conversion of the Excel Centre in East London into 4000 beds with supportive services in just nine days, was remarkable. A fantastic feat of modern day logistics. For this reason, if no other, the naming of the hospital is fitting - there is no doubt that Florence Nightingale would have been up to the task of designing a hospital of this size and mobilising a workforce to fill it – estimated to be some 200 people per 42 bed ward, including ancillary and support staff.

Florence used mathematical modelling and drawings to illustrate the effect of infectious diseases as well as battlefield wounds on soldiers in the Crimea. She also played a large part in the design of St Thomas’ Hospital in London - where the prime minister, who has coronovrius is currently being cared for. At a time when germ theory was still not fully understood, she recognised the importance of design for improving hygiene and health and calculated the dimensions and efficient use of space in hospital. She proposed full-height windows at specified intervals in the wards, with the beds set between to encourage ventilation and allow air to circulate without creating draughts. She stipulated that clean and dirty areas should be separate so food and clean linen were stored at the ward entry with washing and sanitary facilities at the other end. The so-called Nightingale wards.

But it was not for any of these reasons that her name was taken in vain for the new Covid-19 hospitals; it was because of the sentimentality about nursing that her name invokes among politicians and the media.

Nursing has a hugely rich history but so little of it is chronicled or appreciated outside of nursing academic circles. That and the fact that virtually all nurses over the last 100 years have been women, adds to their invisibility.

It is to raise their profile, celebrate their skills, their commitment and their sheer importance in this pandemic, that I am chronicling their experiences for record  If you are a nurse, whether at the frontline of patient care, delivering education and training to nurses or developing policy, please get in touch with your stories, via this website, via twitter @Claire_Laurent or email me at:
#nurse #COVID-19 #Nightingale #criticalcare #RCN

Thursday 30 May 2019

Nursing Nostalgia

However fantastically today’s nurses demonstrate their knowledge and skills, their decision making and their compassion, too many people would prefer nurses to be dressed in white aprons, frilly hats and gleaming buckles and, more troublingly, be poorly educated. As Jessica Anderson discovered, a nurse is preferably someone in pantomime dress-up rather than scrubs.
I trained in the early 1980s at a fabulous London teaching hospital of which I’m very proud  but I wished I had known about the degree course – although with my qualifications at the time, I was never likely to have been accepted. My mother – a former nurse was firm - you didn’t need a degree you needed good solid practical inculcation of ‘how to do things properly’. I learnt a lot that was indeed useful for life as well as nursing but the demands of healthcare have changed monumentally since then and that old fashioned ‘learning on the job’ is insufficient today. 
Project 2000, introduced in the 1990s, began the move from hospital to university- based nurse education and nursing has been a degree based profession since 2013. Yet there are still former nurses, retired majors and contributors to Tory papers who long for a return to the ‘good old days’. 
Nurses have always been consummate professionals, able to run a ward with military precision and spot a poorly made bed at 30 paces, but these days the care they give is based on evidence rather than tradition. They are required to have high levels of scientific learning, technical ability and managerial knowledge. Where once upon a time doctors were called to the wards to perform technical tasks, nurses now take bloods, give intravenous antibiotics, read an ECG. They do this in addition to all that basic nursing care that is so often referenced.
As demands have grown, so have nurses, acquiring higher degrees and greater skills, becoming advanced nurse practitioners, able to asses and treat patients – invaluable assets in busy departments such as A&E. None wish they were doctors. The two professions are quite different.
There is a strong body of evidence that in any clinical setting, the greater the proportion of registered nurses with graduate level education, the better the outcome for patients. Aiken et al (2014) found that a 10% increase in degree educated nurses in the RN skill mix was associated with a 7% reduction in 30 day inpatient mortality. Subsequent studies have supported this finding. There is also evidence that increasing the proportion of graduate nurses is linked to shorter hospital stays and reduced incidence of complications such as venous thromboembolism and pressure sores.
A recent spate of letters to the Times (as well as previous articles over the years in various papers including the Express and the Daily Telegraph), extolling the virtues of apprentice style training and complaining that the ‘rot set in’, when nursing degrees were introduced, had my twitter feed apoplectic.

Rooted way back in the last century, it seems the retros would rather be nursed by someone with a low level of education who can perform repetitive tasks under the beady eye of matron, rather than someone who is well educated, can think for themselves and provide practical care.

It is the latter that some folk claim is missing today. Apparently, an education precludes you of the ability to help patients with hygiene. It robs you of compassion and disables your ability to give ‘basic nursing care’ (no definition offered).
Of course, this is all nonsense as I’m sure the green ink writers and disgusted of Tunbridge Wells brigade know but nostalgia and nursing go together like back rounds and pressure sores, maggots and matrons.

 It’s the theme that forms the backbone of my book – Rituals & Myths in Nursing: A Social History – due out in November 2019 in which I relay the extent and variety of routines that kept nurses busy and patients neat and tidy. Doing the washes, doing the obs, one for the book; from high, hot and a helluva lot, to egg white and oxygen, our work was locked in a task based approach to care that left little room for questioning.
All kinds of rituals were handed down from generation to generation: bed making, ward cleaning, bedpan rounds, evening drinks, patients’ breakfasts. And the more bizarre: flowers removed from the ward at night for fear of their oxygen uptake, Marmite smeared into pressures sores, fluid charts recorded in Roman numerals. Nurses of yesteryear can enjoy reminiscing and laughing at these rituals but hopefully, most will recognise that whilst such stories are part of nursing’s rich culture, they belong in the past. 

Aiken et al(2014) Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study (accessed May 2019)
Belgen et al 2013 The Journal of nursing administration (accessed May2019)

Rituals & Myths in Nursing: A Social History will be published November 2019.