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Bedpans and Bandages Episode 3: Class Act

March 4, 2014

Oh fickle, fickle is the heart! Week One of Bedpans and Bandages and I was losing mine to cardiac specialist nurse Trevor. At least he’d know what to do with it. By Week Two though, I’m ashamed to say that TK – Mr Soft-but-Strong – had turned my head, and Trev was history, or so I thought. How could I have doubted? When Trev came storming back – masterful yet modest (“I could never understand how the kidneys worked, it just did my head in!”) with his electric cables, his irregular rhythms and best of all, his naughty asides about…ahem…erotic dreams, I was done for. Poor Dany may have not known where to look, but me, I’m Trev’s girl now. And it’s for keeps.

 

The heart had a starring role in Episode Three of BnB (as I’ve resolved to call it, for brevity). At one end of the scale we had absent-minded patient Geoff, who forgot to take his medication despite keeping it next to the dog’s medication as a reminder (Geoff, mate, you gotta re-think this one. You know it makes sense. And how is the dog, by the way?). As a result, he was admitted to ED with a galloping arrhythmia that needed Trevor’s expert input. At the other end, ‘raw recruit’ Alistair felt foolish and embarrassed after failing to locate Mrs Himsworth’s radial pulse.

 

It was also a good week for Clinical Nurse Specialists. As well as our Trevor, the programme showcased the work of Charlotte, an acute stroke nurse (who looked confusingly similar to last week’s Liz: same ward, same uniform, same hair – I’m beginning to understand how the patients must feel) and at last gave some real insight into the opportunities but also the responsibilities that a career in nursing now has to offer. We saw Trevor take the lead in administering DC shock treatment to Geoff’s heart and when it didn’t work, we were told that he was going to ‘prescribe strong medication’ instead. For her part, Charlotte was shown conducting assessments on putative stroke patient Dorothy, and ordering a scan of her brain. So, Daily Mail – still can’t see any reason why nurses need degrees?

 

Both Dany and Aimee, witnessing the specialists in action, were rightly impressed. For Dany, the experience encouraged her aspiration ‘to be a specialist…to convey that knowledge on to other people and be…a role model’. Back on the wards meanwhile, where hapless Alistair was still getting to grips with his first exposure to hospital life, things pottered along at a more leisurely pace. Sent to the sluice to rustle up a commode, he drew a blank (I think there might be a snappy new saying in there somewhere) while the programme’s entire nursing audience collectively yelled ‘it’s behind you!’ at the telly. He then looked at, but didn’t touch, some wounds and dressing materials. After the excitement of Trevor and Charlotte, it all felt a bit pedestrian.

 

It also felt rather staid when pitted against the adrenalin-rush of Junior Paramedics, the BBC’s rival offering in the ‘health care professionals in training’ genre, which began its own run on BBC3 last week. At an hour long, the show had the format that many have argued BnB deserves, but in fact the only thing the extra minutes delivered was a slightly ‘baggy’ feel, which then had to be padded out with a subsidiary ‘youngsters moving away from home’ narrative. You knew the programme-makers were getting desperate when we were presented with self-confessed ‘Mummy’s girl’ and tumble-dryer tyro Lucy learning how to use the campus launderette. Riveting…not.

 

The real eye-opener, however, was just how much responsibility the junior paramedics appeared to be given when called to real-life emergencies. After a mere six weeks in the classroom, they were out on placement and ‘rookie’ Amy, for example, was shown confidently attaching Electro-Cardiogram (ECG) electrodes to patient Ron. Contrast that with Episode 1 of BnB where we were told (by the narrator) that ECG was a procedure that second-year student Dany had never even seen.

 

It all added up to a message that while nursing may have its superstars like Charlotte and Trevor, the bread-and-butter of the general wards remains a bit, well…unfocussed – something fellow second-year Aimee unwittingly confirmed when she observed that “going onto a ward where the nurses have a hell of a lot more knowledge than a nurse on like, a generalised ward…that would be quite informative to me”. Interesting, isn’t it, that at a time when there have been a number of calls for doctors to become ‘more generalist’ as a way of meeting the needs of people with multiple long-term conditions, the best hope for nursing to increase its prestige seems to lie in increased specialisation? What does that tell us?

 

Also interesting was the fact that this specific episode, with the spotlight elsewhere so firmly on class-act specialist nurses, was the one where programme-makers chose to address the ‘too posh to wash’ issue. Co-incidence? Who knows. It actually made for rather uncomfortable television. Hoping to provoke a reaction, someone off-camera asked Alistair if he is ‘too posh to wash’. “I’m not too posh to wash, no, no” he replied, with what looked like slightly awkward laughter. “I’m not posh at all, no. Can you not tell with the [Lancashire] accent? Common as muck!” It was, perhaps, BnB‘s first genuine must-see moment. Suddenly you and I and all the millions of other viewers fell away, as Alistair spoke directly to the only group of people who really matter: his mates. His purpose was to reassure them: “All right lads” he was saying “I might be doing this la-di-dah nursing degree, but don’t worry – I haven’t sold out”.

 

Now I give Alistair a lot of credit for choosing nursing, and I have absolutely no doubt that he is a highly motivated young man who is ready-and-willing to wash patients, toilet them, feed them and carry out whatever personal care their individual circumstances might dictate. But his reaction to the ‘tptw’ question was revealing for a number of reasons. Firstly, the unspoken concern that signing up to the university might be interpreted as an act of class treachery said a lot about young men’s attitudes to education generally; but it also perhaps touched on rarely-acknowledged class insecurities within nursing too. “Can I be an educated person” Alistair seemed to be asking “and still maintain that vital common touch that’s so endearing?”

 

It’s unreasonable to expect someone at his early stage of training to have the answer to that one, but the fact that it’s being even hinted at speaks of a continuing ambivalence, in some sections of British society, to the benefits of education. And nursing’s enthusiastic championing of the so-called ‘compassion agenda’ could be seen as symptomatic of its own share of these anxieties; what is this insistence on compassion, after all, if not an admission that an insistence of education could be a PR loser?

 

There are reasons to be hopeful however. While some might read Episode 3 as a warning to nursing not to fall into the trap of reproducing the wider class system in microcosm, others will have taken heart from an area where BnB really scores over Junior Paramedics: while the JPs are all teenagers and early twenty-somethings (this may be an reflection of BBC3’s target audience) the would-be nurses on BnB proudly celebrate a huge variety of ages, genders, racial and social backgrounds and – even – isoglosses (look it up). The message couldn’t be clearer: everyone can find their niche. The nursing family welcomes you all.

 

For recent medical reports on the need for more ‘generalist’ doctors, see:  http://www.nationalhealthexecutive.com/Integrated-Care-Social-Care/the-kings-fund-calls-for-more-generalist-doctors
and
http://careers.bmj.com/careers/advice/view-article.html?id=20013743

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2 Comments
  1. Love this review! Cannot believe Dany had never seen an ECG! I did my 1st one on my 1st placement on an elderly mental health ward.

  2. Thank you for commenting – you’re too kind! It does seem surprising that by her second year, Dany had still not witnessed ‘close up’ as the script actually said, if I remember rightly, a procedure as routine as an ECG, but I think this is a reflection of how uneven exposure on placements is. To be honest, it’s always been a bit like this: even thirty years ago, when I did my training, what you saw depended to some extent on where you were sent. There was one ward that everyone wanted to go to because you were virtually guaranteed to see a cardiac arrest. These days, I’m less sure that I would view that as a recommendation – why did they have so many? I don’t know if the ‘unevenness’ problem has got worse over the years – certainly you hear about students who are nearing qualification with only very limited experience of acute hospital settings. Others I’m sure would argue that there are no problems.
    I’m glad that the programme is giving prime-time TV exposure to student nurses, and they are, without exception, very impressive. I’m yet to be convinced, though, that we are getting a coherent picture of what nursing ‘is’. I imagine the programme-makers would counter this by saying that an exploration of nursing philosophy is not their remit – but I think that would be disingenuous. This is – for the moment – nursing’s shop window. Is it tempting people in?

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