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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.