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No Stress: How the Media Hide the Truth about Nursing

May 6, 2013

Last week, I had a bit of a shock. Picking up a newspaper one afternoon, I chanced on a tragic and upsetting story about a head teacher who committed suicide because the pressures of her job were just too much. The article also gave some background information. ‘Teaching and education’ it said ‘are recognised as among the most stressful occupations in the UK’. I idly wondered how nursing compares. The reporter must have known I would be reading. The very next paragraph began with the words ‘According to the Health and Safety Executive (HSE), the teaching and education professions report 2 340 cases of work-related stress for every 100 000 employees each year. Only nursing has a worse record’. Nursing is the most stressed occupation? Since when?

The HSE’s figures are not hard to locate. A quick internet search pulled them up in seconds. Published late last year, the Stress and Psychological Disorders document states that ‘the occupations with the highest estimated prevalence rate of work-related stress in Great Britain, averaged over the last three years (2009/10 – 2011/12) were as follows: nurses, with 2 730 cases per 100 000 people working in the last 12 months’. To arrive at the this figure, the HSE makes use of three separate data sets, including information derived from GPs and the Office of National Statistics Labour Force Survey.

Obviously, the statistics have to be treated with a certain amount of caution. Straight comparisons between nurses and other occupational groups are complicated by the fact that unlike most of the latter, nursing is dominated by women. It may be the case that women are more likely than men to assess themselves as suffering from work-related stress, or to be diagnosed with it by others; it may also be the case that they are more frequently targeted by workplace bullies; but even taking these health-warnings into account – these are profoundly shocking figures. I knew – of course – that nurses were stressed; but I think the reason why learning that they are the most stressed occupational group gave me such a jolt was because in a media that often seems obsessed with finding reasons to blame nurses for the failings of the entire NHS, it’s a situation that has received scandalously little attention.

In late 2011, someone in what used to be called Fleet Street picked up on a story about East Kent University Hospitals NHS Trust, which had purchased (‘at a cost of £5000’) red tabards for nurses to wear while conducting drugs rounds. The Trust was acting on research showing that nurses who wore the tabards experienced fewer interruptions, and were therefore less likely to make errors while dispensing drugs. The problem? The tabards were emblazoned with the words ‘Drugs Round In Progress. Do not Disturb’. Cue media outrage. The Daily Telegraph asked a representative of the campaign group Patient Concern for her view. She was predictably strident: “Sends out completely the wrong message” she fumed. “They (patients) already see nurses as too important to disturb or too lazy to help…now these red tabards will send out a further ‘get off me signal'”.

One wonders how this lady, if asked, would describe a typical drugs round. Would she, for instance, make reference to the high level of concentration required to ensure that prescriptions are correctly written, that drugs are given at the correct time and in the correct order, or they are withheld if certain conditions are not met; would she mention the time-consuming work of crushing and dissolving drugs to administer down the now-common feeding tubes of patients who cannot receive them by mouth; would she acknowledge the frustration of finding, just after pharmacy closes for the day, that a patient has been prescribed a non-stock item that the doctor ‘forgot’ to mention at the time and which now needs to be tracked down by ‘ringing round’ other wards? Because these are the daily realities of the drugs round – and for the record, there are four of them a day, not three, and each one typically takes much longer than half an hour.

In the article, all these problems are perversely and wilfully ignored. The underlying assumption is that nurses are using the drugs round as an excuse to avoid direct patient care. The complexity of drugs round is completely dismissed. The view that it is an essentially straightforward job – which can even be multi-tasked – is summed up by the Patient Concern spokeswoman with the damning words that ‘if you’re a nurse and you can’t do more than one thing at a time, you’re a pretty hopeless nurse’. The irony is that many nurses actually resent the hours of their time consumed by drugs round, and see it not  as a screen to hide behind but as a hoop to be jumped through. They want to get to their patients, but drugs round is just another of the many obstacles that stand in the way.

 
In Stress and Psychological Disorders, the HSE speculates only briefly on the reasons behind workplace stress. It quotes the Labour Force Survey which identifies ‘workload (including too much work, pressure or responsibility)’, ‘lack of managerial support’, and ‘violence, threats and bullying’ as the top three causes and/or aggravating factors. Most nurses can relate to at least the first two – if not all three – of the conditions listed here. In contrast, the media – and now it would seem, some nurse leaders too – stubbornly persist in refusing to recognise the complexity of modern nursing. Instead, they choose to portray nursing as essentially a simple activity of washing, toiletting, creaming sore bottoms and dispensing wise words of comfort and encouragement. The nursing of a fondly-remembered imaginary past, in other words.

The hit BBC series Call the Midwife, set in 1950s London, simultaneously promotes and feeds off this nostalgic myth. Although the story lines do include poverty, illegitimacy and other social ills of the period, the relationship between the midwives and their patients is uncomplicated by excessive paperwork, unrealistic management targets (their managers, if you can call them that, are a group of sympathetic nuns), out-of-office members of the multi-disciplinary team, having to scour the hospital in search of  basic equipment or any of the other multitudinous crises the average ward nurse is expected to solve on a daily basis. The midwives simply attend to their patients and, after a bit of soul-searching, come up with delightfully heart-warming solutions to their problems, leaving the patients happy and the midwives basking in the warm glow of job satisfaction and life-lessons learnt. Modern nursing is nothing like this.

In fairness, nursing is not the only occupation to fall prey to this kind of retro-sanitisation project. For the police, the situation is, if anything, worse. Recent Sunday night offerings from ITV include Endeavour (set in 1960s Oxford) and The Suspicions of Mr Whicher II (1860s London). The  BBC, meanwhile, has screened a number of detective series imported from Scandinavia. While there is nothing wrong with these shows as entertainment, by setting the action at a remove from contemporary Britain, they relieve the viewer of the necessity of engaging with some of the more uncomfortable issues that currently beset our various police forces – in particular, racism and (in the case of programmes set in the past) forensic evidence.

The conceptualisation of nursing as ‘simple’ has two benefits for the right-wing popular press. Firstly, it allows it to discount the complexity and, indeed, the stress of modern nursing and the operational and institutional barriers to compassionate care, and focus instead on the failings of individual nurses. Nursing is simple – so if nurses fail, it can only be because they are lazy or uncaring or both.

The second benefit is even more sinister than the first: by failing to report the very difficult  challenges nurses face every day of their working lives, the media is giving its tacit (and sometimes not so tacit) support to the view that nurses do not require over-much education. And this is a real issue: UKIP, the political party of the moment, has as a stated part of its health policy the restoration of ‘hospital-based vocational training, similar to the old State Enrolled Nurse (SEN) system’ on the grounds that ‘many people have expressed concern that the move to university training has changed the opportunities for those born with a vocational calling who wish to provide the crucial core nursing care’. So while falling short of of advocating the complete abolition of nursing degrees, UKIP certainly has plans to move back to the traditionalist view of nursing as an extension of the natural (female) caring instinct. If it were ever enacted, this policy would, at a stroke, worsen the educational and career prospects of thousands of women, and reinforce the image of caring as a low-status, low remuneration activity.

Much of the media appears to be in denial about the reality of nursing. When it takes the form of sheltering in some 1950s Golden Age, this denial may appear harmless enough, but when series like Call the Midwife give credence to the populist fiction that nursing is simple, they fuel the growing backlash against the education of nurses and by extension, women. We are now living in a country where a brink-of-mainstream political party is campaigning on a platform of less education for a female-dominated occupational group. If that doesn’t frighten you, nothing will.

Beckford, Martin (2011): Nurses Wear ‘Do Not Disturb’ Signs During Drug Rounds’. Daily Telegraph; 29/08/2011. http://www.telegraph.co.uk/health/healthnews/8728093/Nurses-wear-do-not-disturb-signs-during-drug-rounds.html

Health and Safety Executive (2012): Stress and Psychological Disorders. Available to download at http://www.hse.gov.uk/statistics/causdis/stress/stress.pdf

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