Tuesday, 25 September 2007


Yes. I actually learnt something (about biology, obviously) today. Which is good, in my book.

But on the negative side I've had my eyes opened to more pitfalls and downsides of my chosen career path.

Nursing is in a state of flux. To use the term 'is' is perhaps wrong as it seems to insinuate that it hasn't always been, which is has, in one way or another. But now is important to me, so that's what I'm talking about.

Articles and anecdotes tell us that there are some nurses out there who plain don't care. This is a bit of a tragedy, but hardly surprising. Public servants have become more tied down by paperwork, depending who you listen to. Paperwork is a blanket term but covers the problem rather nicely.

So, why do we have paperwork? Well, a personal bugbear of mine is this new, American-style sue-culture. Paperwork was created in response to this, in my experience. The sue-culture lead to accountability, and accountability can only be recorded through paperwork.

So that is a very simple way of explaining the root of the problem. It's the same sort of issue for the police. Paperwork Vs Accountability Vs Modern Life.

The Daily Mail routinely trots out the old 'Paperwork takes Bobbies Off the Beat' rhetoric, but through the repeated headline-grabbing-soundbytes there is a grain of truth. Paperwork has became a problem for many important public servants.

On the front of nursing, the problem is not simply paper. Other forms of red tape have been introduced in response to accountability by the giant, hairy monster that is 'Management'. This is adds up to nurses becoming occupied with arguably less important duties, leaving less time for actual caring.

I, personally, am prepared for such hilarity before my first placement. Nursing is hard work - it always has been and always will be. The reasons it has been hard have changed over time, but that's all in line with the changing world we live in.

Any nurses who have recently qualified who aren't prepared for the rigours of red tape and paperwork are, at best, naive. At worst, well... I don't want to be horrible.

Older nurses who have felt it coming over the last decade, perhaps more, have had a choice to make, in my opinion. Either they stay a job which they seem to hold in disdain because of the avalanche of bureaucracy and let patient care suffer, quit the job to go onto something which doesn't involve paperwork (Like what, I wonder?) or just get on with it. From what I've heard and experienced the first of these three is an unfortunately well prescribed choice of path.

In the first few weeks in training, the word 'care' has probably been the most used. I get the impression if you stop actually caring then you have no reason to be a nurse. Why even a small number of nurses - young and old - decide to pursue this course of action mystifies me.

Throughout my working life there have been many occasions when I've thought - or even said: "Not mah problem, luv". And I've laughed about it, or even quite sadistically enjoyed the experience. Because customers can be stupid, plain and simple (I meant the last two as the expression, but it sort of counts, too).

Patients (or clients, as the NHS seems to be leaning towards calling them) are often stressed, scared and distressed. I'm a critical sort of boy, but even in my book this gives them a little leeway when it comes to being a bit stupid.

In the same vein, being a nurse isn't like working behind a till a bar. Life, health and well-being are at stake, rather than... Well, a frozen steak or a spilled pint. Some die hard capitalists might want to argue with me, but I think that's a mostly true statement. When I worked in a well known computer games store I was head of PC Games. If someone asked me about XBox games, then, I would sometimes just shrug it off and half-heartedly explain: "'s not my area, mate,".

You read and may have even experienced nurses doing the same thing. 'Pillows? Not my problem.' 'Oh, I don't handle IVs, sorry.' This kind of attitude within the retail or service sector is regrettable and in a perfect world it wouldn't happen, but it's not the end of the world. The difference in the retail world is that, generally, you're selling something the public wants. And they're probably going to buy it from you, all things considered.

When it comes to nursing, though, this sort of attitude is despicable. It goes against anything and everything nursing stands for. To use the retail analogy, nursing (in itself and as a small part of the greater healthcare pie) is not about the end product. If you wait a while at a bar and get a pint with too much head (ooh er) you're probably going to shrug and get over it. Maybe get served by a different barkeep next time if possible, or - at an extreme - go to another pub. You wanted a pint. You got a pint. It's that simple. Nursing is more about the journey of a patient. In a large slice of occassions, nurses rarely ride in on a white charger and save someone's life. Depending where you're working in a hospital or in the community a nurse is more likely to refer a patient to a specialism or specialised department to 'cure' a patient. As mentioned, though, there is a journey from the moment a patient walks into a hospital to the second they leave - and often afterwards. It's the nurses' job to care for the patient throughout this journey.

Continuity is important, for sure, but the care is much more so. The pint example is a funny one, as there is no real place for the nurse and caring in that experience. You could perhaps chat to the customer as you pull it, giving a quick check on their personal well being, but it's not really the same. Identically, there is often no end product when it comes to nursing. Sometimes a nurse may hand over drugs to a patient, yes, but whereas a customer pops to the bar specially for a drink, most patients do not look for nurses specifically for drugs. Or any other sort of 'official' duty. The care should be of paramount importance, and as soon as staff start forgetting this you know they're in trouble. But still it happens.

Nursing is hard. As mentioned, the reasons for this difficulty may have changed, but the difficulty itself has not. Anybody going into this life choice thinking it will be anything less than hard is in for a shock - and may be part of the 8% drop out rate. Some girls on my course are shocked they're unable to take holidays inside of the academic year. If that's the worst surprise in store for them through these three years I'd count them as lucky.

Go in with eyes open, then. If you're already in and have been worn down by paperwork, red tape or any other modern evils, then do something about it. Get off the pot or piss in it, I say. Don't let the care, and by definition, the patient suffer because of it. Otherwise, what's the point?

(Additionally, thanks to Unity (over at: http://www.ministryoftruth.org.uk/2007/09/23/its-banner-time/) for my shiny new banner. Follow the link to get one for yourself.)

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