No angels: nurses today
The best of them always hated that term; here's why
My connection to nursing started young: I was, in part, brought up by an NHS theatre nurse, my beloved Aunt Clare, who worked into her seventies, finally becoming matron of a nursing home. Much, much later, I was (very) briefly editor of Nursing Times, then the flagship journal for nursing in the UK; a decade later deputy editor, then managing editor, new media, for Nursing Standard, owned by the Royal College of Nursing. One of my early jaunts in the early noughties was to the RCN annual conference where one motion discussed was whether, with an all-degree nursing qualification on the horizon, nurses would consider they ‘were too posh to wash’ (their patients, that is).
But my relationship with a noble and vital profession pales into insignificance compared to my wife’s, who spent decades working in orthopaedic theatres; as well as, from time to time in general theatres. It was her calling; she relished the work. Over decades, she has seen it all. Sadly, she has also seen, over the past 20 years, the steady decline of nursing and what it used to mean, more importantly what the drop in the standards of care has meant for patients and their families.
This week, then, over to Vicky, for her take on nursing today. Read with care in mind: we will need a nurse at some point and forewarned is forearmed.
Vicky writes: Last week I received a questionnaire from the Nursing and Midwifery Council, requesting that I complete it so that they could understand my reasons for leaving the profession and letting my registration lapse. I felt this was another tick box exercise with little scope for telling them what they need to hear. I did fill in the section asking if I would recommend the job to a family member under the ‘highly unlikely’ column.
At the end of the box ticking there was a small free text option where I told them a 12-hour shift (now widespread) was far too long to give optimum care throughout and was not compatible with work/life balance and family commitments. I know what I have told them will not make a jot of difference to the people who really matter the most – the patients.
Recently, I have been closely involved with two older women, one on an orthopaedic surgical ward and the other on a medical ward. It has been an eye opener for me, as I trained in the mid 70’s where the term total nursing care had real meaning and was in evidence everywhere. Sadly, this is seriously lacking in many cases I have seen and heard about over the past few years.
I once was told by a nursing tutor from university that ‘one can’t nurse patients like you did in your day – it’s very different now’. I did ask her if the patients had changed so much. Did they still not need feeding washing, and turning with some TLC as a matter both of routine and plain humanity, along with any dressings or drugs? Incidentally, in the same exchange, I was also informed that my qualification was not worth the paper it was written on!
Surely ‘patient choice’ can’t be fully factored in if a confused female patient refuses drugs or doesn’t want to mobilise post-op to aid her recovery? Not giving this latter treatment will increase inpatient problems, but with a little gentle encouragement, a better outcome and faster discharge might result.
I am at a loss to know what is taught in university to today’s nursing students. My experience of students in the operating theatres has been alarming and disbelieving. There was the student who chose to work in theatres but who was so squeamish she didn’t like the sight of blood. Good career move! But the one that took my breath away, and who was in her final year and right at the end of her training who, when I was explaining about a knee replacement, could not name me one bone in the leg!
I do remember one set of nights as a student myself: we did a full week (not done now, apparently too onerous). I was in the middle of my second year of training and I had three deaths on my assigned ward in one week. The third death was a young man of my own age. I sat by him, talking to him and writing up the night report while the senior nurse was in the sluice, crying. I left work and went home to bed. No debrief, counselling, we just got on with the work. I would have been no use to the other patients on my ward who needed looking after if I had been an emotional mess.
My traditional training came to the fore a few years ago when I was redeployed to a Covid ITU. I was one of the oldest nurses in the unit, older than several of the sickest patients. I told the managers I could not do ventilator care, give IV drugs or naso-gastric feeding as this was not my area of expertise and I didn’t have the relevant paperwork.
But, I could perform total nursing care on these very sick patients and as the need arose – as it did, all too frequently in 2020 – lay out those that died.
This was where my ‘old-fashioned’ training proved to be invaluable. Sadly, today one hears of too many friends and relatives in hospital who are neglected, dismissed and generally uncared for. They are confronted with nurses sitting at computer screens filling in data and ticking boxes while they are calling for a bedpan, desperate for a drink, placed out of reach, or lay uncovered on their bed and not in any way part of a planned rehabilitation regime.
I do not think the requirement for nurses today to have a degree has improved the quality of care given to the patients, nor has it made attitudes more professional. And, we should all be concerned because these graduates will be the ones looking after us.
As Neil Kinnock memorably said in the 80’s don’t be poor, don’t be old – and don’t be ill.
New pope; but old Roman Empire keeps rolling on
The election last week of a new pontiff by an elderly group of largely white, but wholly male, men, reinforces my long-held belief that the Roman Catholic Church is merely an extension of the Roman Empire of 2 000 years ago, which would make it the oldest empire known to humankind.
The evidence is overwhelming and I apologise to any historian, alive or dead, who has previously made this manifest. The Roman Empire, part one, was a military dictatorship, run by men, subjugating women to a secondary role – not far removed from myriad slaves, on which it also heavily relied. It was expansionist, ruthless and very successful.
One recurring internal annoyance to the empire was the constant squabbling over which particular deity (and there was hundreds) took precedence after Jupiter. Thus, it came about that in 380CE Christianity was mandated as the official religion of the Roman Empire by Emperor Theodosius I through the Edict of Thessalonica. It recognised Nicene Christianity as the state religion. An obscure Jewish sect, hitherto much persecuted, found itself propelled to the heart of a mighty empire.
The first pope under this new arrangement was Damasus 1, although Catholics claim popery began between approximately 30-60CE with the alleged arrival in Rome of Peter, a non-Roman but a Jewish freeman and follower of Jesus. Whatever, over time, and with endless schisms (the first within two years), the Roman Catholic Church began to usurp the secular empire and became what you see today: global, immensely powerful (despite Stalin’s gibe about ‘how many divisions has the pope?’), rich beyond the dreams of anything Musk could imagine, laying claim to the loyalty of 1.4 billion, making it the world’s largest Christian religious community, second only to Islam in its number of adherents.
It’s had quite a run but, one vital element in its success has to be noted. To a casual outsider, Catholics worship one deity, right? Except, in practice, just like their Roman ancestors, they don’t. Roman Catholicism contains, like its antecedent, a pantheon of minor gods and goddesses. There is, for example the powerful goddess, Mary, and endless numbers of lesser gods, cleverly renamed saints, whose followers are as devoted to their man – or woman – as any Roman citizen would have been to theirs. Furthermore, in an act of cunning you would expect from the likes of Augustus, who declared himself an actual god, the Roman Catholic Church goes on creating new saints (or minor deities).
The RC church also goes on adapting to circumstances. It was Pius 9 who brought in papal infallibility in the 1870s to counter what he saw as the brass neck of Italian patriots in their fight against the Austro-Hungarian empire in declaring independence (and winning it). Empires will always protect each other, it’s in their interests to back each other (witness Trump, Putin and Xi).
Expect the new guy to change a few things but – why would he? – not to rock the boat that much. After all, its continuance, sailing on deep waters, drawing on the fears (and guilt, emphasised by the confession) of the masses, is vital for the central structure, the money, the power: that, after all is the point. The original Romans knew a thing or two. How they would laugh to see their modern-day successor, beneath the veneer of declaring absolute divine right to act, just like Augustus (or Nero, Caligula, even Claudius at the end), still running so much of the world.
This week: Tim watched Boys from the Black Stuff on BBC iPlayer. It’s powerful and emotionally charged while bleakly funny (Scousers’ mordant wit abounds), not in the least tarnished by the 43 years since it burst like a thunderclap onto British television. It’s an indictment of Thatcherism and, of course, neoliberalism, the most toxic of incoherent mumbo-jumbo ever assembled to justify end-stage Capitalism.
Quote of the week: ‘Be careful what you wish for’, attributed to a Chinese proverb and relevant to so many circumstances. In the past week, Keir Starmer might be pondering this phrase as he sits of the horns of a dilemma of his own making: suck up to a maniac in the White House with his dodgy ‘deals’ or do the blindingly obvious and re-join the EU as a full member. Only Starmer, perhaps, could create a dilemma from this stark choice.
Music of the week: Mahler’s Lieder, a counterpoint to his symphonies. Mahler was an accomplished pianist and wrote the Lieder, drawing heavily on the poems and stories of Das Knaben Wunderhorn, originally for piano and soloist. He then orchestrated them into the wunderkind versions we know and love today. There are many versions – no boxed set as yet – of the various pieces, of which my favourite is Das klagende Lied, with Pierre Boulez and the London Symphony Orchestra.
Correction: in last week’s Newsletter, I managed to spell Magdalen College as pronounced, not written, an as egregious an error as it is possible to imagine. If he could, Anthony Smith would be laughing himself silly. ‘How very American, dear boy’, I hear him saying.