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No more angels

I used to be a matron but as a patient I was treated worse than an animal. That was one of the headlines in yesterday’s Sun. I do mean headlines, too. Jean Emblen’s account was not top story but it was right up there among the footballers’ wives. The editor of the Sun thought the readers would go for a story criticising nurses.

When did that happen? When I was a kid everyone was all soppy over nurses. It was considered quite shocking when a 1970s BBC soap opera called, tellingly, Angels depicted them as less than angelic.

We can’t simply attribute this loss in esteem to the NHS. For round about the first half century of the existence of the National Health Service, nurses continued to be loved by all (it is only fair to say there are plenty of people, including those with recent experience of the NHS, for whom that has not changed; a huge amount depends on the individual hospital). So what has caused it? Does it reflect reality – are nurses really not as good as they used to be – or is it just fashion, a last ripple from the wave that knocked politicians over in the 1960s and teachers in the 1970s?

One possible explanation is that nurses are no longer paid that badly. There is nothing like low pay for calling forth guilty affection. Once the pay improved people no longer felt they needed to make up the shortfall with love.

However my impression is that the downward trend on the nurse popularity graph best tracks the increasing moves for the nursing profession to become more… professional. It’s all “nurse practitioners” and degrees these days, and being more like doctors. No one ever had any trouble hating doctors, once the thermometer went down. People think that nurses these days think themselves too grand to change a bedpan.

Is this charge fair? Lucky me: I don’t know. You tell me. All I can say is that it would not surprise me if there was a tendency for both human contact and the dirty but necessary jobs to be de-emphasised in modern nursing, and maybe I can find a way to blame the NHS after all. It is what I would expect to see from an old command economy. Compared to most command economies, the NHS in its early years had a huge amount going for it: a sense of mission was in its collective blood. But as time as passed the blood has thinned, or done something else old and dry and sad that I lack the medical knowledge to build into my metaphor. (The blood of armies dries up in the same way, but then a war comes along and de-mummifies them. Or replaces them. ) An old and somewhat ossified organisation instinctively prefers its staff to have measurable, academic and relatively high status skills rather than unquantifiable, physical and and traditionally low-status ones. But no one was ever loved for academic skills.

In the US, I learn, there has been a similar move from plain old nurses to nurse practitioners, but if the American equivalent of the Sun has started on the anti-nurse stories then I had not heard about it. This might be because US healthcare is, for the moment, not provided by the taxpayer. At least, a lot of it is, but not so visibly. My impression is that the extravagant love for nurses in the past and the extravagant annoyance with them now are both British phenomena.

13 comments to No more angels

  • Josh

    Turns out the same thing has happened to teachers. The same reason accounts for both: In the old days, teaching and nursing were the only professions open to women, and so they got the best and the brightest women. Today all those really smart competent women are executives and entrepreneurs, and our teachers and nurses are the third-raters.

  • Roue le Jour

    Interesting theory, Josh, but I’m not sure I buy it. I was a sickly child in and out of hospitals back in the ’50s and my recollection is that the nurses were the visible face of a ‘free’ NHS. Somebody looks after you (or your granny) for ‘free’ and you are grateful. I don’t remember them as being particularly sharp, but matron made damn sure they nursed you back to health.

  • I was in hospital as a child and as an adult (a month as a child so it was an extended experience). There were bad, nasty nurses both times, as well as kind, compassionate ones. Same with teachers.

    And neither teachers nor nurses are underpaid here in the US. Everybody with a teat on the public cow thinks they are underpaid. It is a systemic problem.

    As for me, I am not grateful when people do their job…the job they are paid for. . . by my tax dollars or by my insurance premiums. I expect them to do their job and I might be appreciative for good service but grateful??

    Why the hell should I be grateful? Am I grateful that the grocer doesn’t sell me spoiled goods?? No. If he does I make sure he refunds me, and I look elsewhere.

    That is one of many evils of socialized systems. You really can’t look elsewhere unless you have money or have a few other options (like charter schools here in the US).

  • Current

    It’s a calculation problem. In a simple economy we can all decide to whom we are going to give extra-monetary rewards – such as respect and adulation- to. But, in a complex economy we can’t make good judgements. As Raymond said “Love doesn’t scale”.

    Nurses may be no different now than they were in the past, in fact I suspect they aren’t. The problem we face is that there are so many occupations and professions now that we can’t analyse them as individuals, we can only approximate that crudely.

    This is an essential corrolary to Mises’ criticism of Socialism. If people could calculate with units of respect then there would be few problems with Socialism. But, calculating with respect is fundamentally impractical.

  • p.horne

    Gammon’s Law of Bureaucratic Displacement explains a lot.
    Useless activity always replaces useful activity in a state bureaucracy so nurses no longer nurse. They now spend most of their time pursuing useless paperwork or in seminars attending to the needs of the bureaucracy rather than the patients. They have become mere agents of the collective and have only the maintenance of the bureaucracy at heart and so people recognise them as such and despise them accordingly.

  • Rob

    It depends on the nurse clearly.

    My families experience is pretty awful.

    The day shift nurses were a delight but the night shift were terrors who just wanted to be paid to sleep. They refused to take my grandmother to the toilet as she could not walk without help (dislocated hip) and let her lie in her own mess for over an hour while they read hello magazine or slept.

    They took the emergency cord out of her reach (sackable offence) as she would ring it when she needed the loo. They were rude and when my grandmother resorted to shouting for help they took her out of the ward onto a lonely corridor so she didn’t wake the other patients and they could continue to ignore her. Just before the end of the shift they would have a hurried clean up and everything would look ship shape – my grandmother was exhausted. The Doctors seemed to despise the nurses, as did the physio who ended up doing the nurses job and fetching the necessary equipment themselves. When my grandmother left the young female doctor said to us: “She’ll better off at home, she’s in a safe place there.” Frightening.

    When we spoke to the good nurses they said that if you are a nurse who actually cares then you make god damn sure you are on a shift with likeminded people or you will end up doing all the work. Unfortunately this means that certain shift only have lazy arseholes as nursing staff.

    My sister inlaw is a hospital carer (basically is supposed to do all the jobs that nurses don’t do anymore). She likes the night shift because they take a 2 hour (sleep) break instead of a one hour lunch break on the day shift. They are only supposed to take one hour and when management tried to intervene the unions got involved but of course threaten action over pay and conditions not the real reason of being lazy shits. So they still get their 2 hours. I understand this 2 hour break is universal now on night shifts across the country in the NHS.

  • pete

    In my experience it isn’t the doctors or nurses who are that bad in NHS hospitals. Patients don’t see that much of them anyway and though some of them seem full of self-importance on the whole they are OK.

    It’s the ancillary/admin staff who are by far the worst. It is not rare to encounter bad manners and even outright rudeness as they bungle their way inefficiently about their tasks. I get the impression that hospitals, like schools with their legions of poor quality assistants and clerks, are often used to hoover up an area’s unemployables to keep the jobless figures down.

    I’d be interested to know the NHS’s recruitment policy for such staff. At my 2 local hospitals the main requirements seem to be uniform bursting obesity, gaudy make-up, tattoos, cheap jewellery and a surly attitude that makes the average teenage assistant at Curry’s or Comet seem like a shining example of good manners, hlepfulness and pleasantness.

    Luckily I’m fit as a fiddle and my experiences are based on many visits to an elderly relative over a period of 3 years.

  • Matt

    It would be interesting to chart the decline in esteem for nurses in the UK against the rise in non-UK born nursing staff. I would expect some correlation.

    Would this be racism? Perhaps, but perhaps it’s just that people tend to identify and sympathise more with people like themselves culturally.

    Note: I am not British and would not know if the UK experience matches the Australian one of large scale hiring of immigrant nurses but I suspect that would be the case

  • llamas

    I think I can pin-point when things changed. It was in the late 70s and early 80s.

    At that time, I dated a couple of nurses from (a major London teaching hospital) and so perforce I knew quite a few nurses. I used to read The Nursing Times, just out of interest.

    Things were changing. The NT had virtually no content about actual nursing of sick people. It was about a 50/50 mixture of articles about either a) realigning the hegemonistic paternalist patriarchal power-structure of the medical establishment to wrest control from the male-dominated sexist doctor-centric orthodoxy and freeing the nurturing female ethos (most of this stuff seemed to originate in US-dominated academia) and b) paths to specialist or management practice, preferably with as little to do with actual patient care as possible.

    Everyone agreed that nursing had to move to a degree-based profession – no other possibility was even allowed to be discussed.

    Time was when nursing in the UK was a highly-honourable occupation for lower- and middle-class gels without too much academic ability. The pay was crappy and the working conditions pretty grim, but most nurses were not in it for a career, it was something you did for 5 or 10 years until you got married or moved on into a job where your nursing experience was of greater value. It was such a highly-regarded profession, and there were always so many more applicants for nurse training than there was demand for nurses, that this cyclical model was perfectly sustainable.

    In the 70s and 80s, all that changed. Young women had a lot more choices opening up to them, including the choice to have a viable life-time career, and nursing just wasn’t a good long-term choice. The opportunities for advancement were limited, the pay still sucked and the conditons were still pretty grim. The system trundled along for a while on the residual goodwill of the public and the residual prestige of the profession, but those who stayed in the system and those entering it were busy changing it into a long-term career, preferably with as little work involving bedpans and enemas as possible. The unpleasant work of actual nursing was re-sourced to immigrants and (mostly) women who could not have got into nurse training in the past and would not have stood for it anyway. The professional ethos of nursing was lost, and those who used to be nurses were all busy trying to become doctors-lite – aided and abetted by legions of NHS bureaucrats who saw this as a perfect way to deliver free helathcare on the cheap. The newly-minted nursing ‘professionals’ and nursing ‘managers’ (and they are leguion) cast their lot in with NHS management to ensure that when the funding axe fell, it was the actual nurses who were cut – never them.

    My recollection of nurses in the NHS in the 60s and 70s is of legions of well-trained and capable women (some very nice, some not-so-nice, but all well-trained and capable) whose primary focus was patient care. They sought to do nothing else, that was their occupation. Even charge nurses, ward sisters and the dreaded Matron (Hattie Jacques was a stereotype, but stereotypes are that way precisely because they are at least partly true) were concerned only with patient care. They left the doctoring to the doctors.

    A quick persual of various UK nursing blogs will shows that the great majority of RNs these days have very little to do with patient care – most of their work of feeding the bureaucratic Leviathan that is the NHS. Most actual patient care is now done by lesser- or un-qualified staff, many of them immigrants, few of whom have any stake in their work – it’s just another job, less-pleasant than many. And their numbers are so few that there simply cannot be the level of patient care that was the norm when the NHS was filled with highly-qualified nurses willing to work for slave wages doing the nasty, dirty work that nursing involves.




  • Johnathan Pearce

    Excellent points throughout, particularly from Llamas. I found Rob’s description to be distressing but entirely believable.

    One of my cousins has been a nurse for almost 20 years and is now a sister running a unit up in East Anglia. She’s a gloriously down to earth, hard working woman with a droll sense of humour and enormous capacity for hard work. If I get seriously sick, I want her to be on the ward.

    One of my great aunts (deceased) was, like several of her fellow “gels” at the time, a nurse in the armed forces. She was on a ship that was sunk by a German sub and managed to survive off the coast of East Africa for several days before being rescued. She had the filthiest sense of humour of anyone I knew. I miss her.

  • Steve P

    As a nurse with 22 years post-qualification experience I suppose I ought to have my two cents worth here. Some of the criticisms made here are certainly valid; there were many of us who voiced concerns about “Project 2000 (this was the start of the emphasis on academic study over practical experience),” but we were basically dismissed as Luddites. Having said that, I can’t help but feel that not all of the mud that has been flung at us lately deserves to stick.
    “Well you would say that wouldn’t you?”
    Not necessarily. I will be the first to admit that there are nurses out there who I wouldn’t want looking after my dog. I also know from my own experience that there are many more of us who try to do our best for our patients, often under quite difficult circumstances (God knows where all that money that Brown poured into the NHS went but it doesn’t seem to have made much difference to staffing levels).
    Angels? Probably not, but not devils either.
    llamas: you are bang on the money regarding Nursing Times. I gave up on that rag years ago after getting sick and tired of its relentless political correctness and new-age nonsense.
    Jonathan Pearce: I have worked with a few “gels” like your cousin. every one of them was a privilege to work with.

  • Matt,

    > It would be interesting to chart the decline in esteem for nurses in the UK against the rise in non-UK born nursing staff. I would expect some correlation.

    I think the opposite is the case. Immigrant nurses tend to have trained in countries where they get taught that the point of being a nurse is to nurse, not to get a degree. Here in NI, loads of our nurses are from Ireland, and you really see their influence in the hospitals.

    It’s one of my biggest criticisms of the NHS. Go to hospital in the back of beyond in some Third-world hell-hole and you’re going to suffer from lack of facilities, but the doctors and nurses will at least do their best for you, whatever their best is under the circumstances. In a British hospital, you’ll suffer unnecessarily while surrounded by expensive high-tech facilities and staff who don’t give a shit.

  • Rob – my mother had the same experience when she was dying of cancer at the Alexandra Hospital in Redditch. The night staff on certain shifts (not all night shifts) made it plain to her that they bitterly resented having to take her to the loo at night (she was on a gyny ward where most of the other patents were young and fit, so night shift must have been pretty easy without an old lady).

    Llamas – that rings true. My wife trained at Barts under the ancien regime, and when she did a ‘return to nursing’ course after years as a full time mother, it had all changed and the course was like sociology – I blogged it here(Link).

    Nursing training since the late 80s has been designed to produce ‘mini-doctors’ for whom feeding, washing, cleaning, hand-holding, talking to patients or making beds is traditional ‘women’s work’ to be avoided at all costs.

    SQ2 – it all depends. A friend who nurses in Saudi said that the Filipino nurses are technically very competent, but they don’t “care for” the patient in the old-fashioned Brit nursing sense. But I guess fewer Brit nurses do that nowadays.