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.
References
Aiken et al(2014) Nurse
staffing and education and hospital mortality in nine European countries: a
retrospective observational study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4035380/
(accessed May 2019)
Belgen et al 2013 The
Journal of nursing administration https://www.researchgate.net/publication/234123932_Baccalaureate_Education_in_Nursing_and_Patient_Outcomes
(accessed May2019)
Rituals & Myths in
Nursing: A Social History will be published November 2019.