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With friends like her…: A response to the ‘shiny’ blog

February 2, 2015

Over the last few weeks, Sarah O’Donnell and John Walsh’s blog on Why Being Shiny Matters has received a rapturous reception from much of Twitter’s nursing community. Anyone who regularly reads my own blog could probably have guessed that reaction at Grumbling Towers was rather less enthusiastic, but after careful consideration, I decided against instigating any direct engagement with the authors about what they had written.

There were two reasons for this. In the first place, Sarah is a fellow-nurse and I am not generally in the business of criticising individual ‘ordinary’ nurses: it seems so unsupportive  of people whose working lives are already stressful enough. Secondly, Sarah is someone for whom I have a great deal of personal respect – despite our differing views on nursing, she has, in the past, been brave enough to extend the hand of friendship. I was reluctant to repay that bold act with public disagreement.

However – following an exchange of views on Twitter on Sunday, I now feel the need to express my thoughts in a more measured way. In the strongest possible terms, what follows is not a personal attack on either of the ‘Shiny’ authors; indeed, people like them, who have the guts to stick their heads above the parapet to try to make things better, deserve our admiration. All the same though – if you put your ideas out there, you must be prepared to have them challenged. Below are my challenges, posed wholly in the spirit of constructive debate. No one has to agree with them.

1. When I read the blog, and compared myself to the authors’ friend whose caring attributes it enumerated, my first reaction was to feel totally inadequate. “What am I still doing looking after patients” I thought “when I’ve never been as wonderful as this person obviously is, and never will be? I might as well just jack it all in now and get a job cleaning toilets!” So although the aim of the Shiny movement is (according to Twitter conversations) the entirely praiseworthy one of creating support networks, I question whether setting up a role model of such unattainable virtue is the way to go about it. At best, I found the friend quite alienating. At worst, I wondered how she views lesser mortals like me? Is she never tempted to feel just the teensiest bit…smug?

2. Suspicions that the friend – despite her exemplariness – secretly thinks she is ‘better’, are heightened by her interactions with naysaying colleagues who don’t share her outlook. As a preface to this, I want to draw readers’ attention to the fact that the whole blog is predicated on the idea that good care is the product of individual personality traits: it’s all about having the ‘right’ attitudes, the ‘right’ attributes and the ‘right’ values. It’s left to the naysayers to hint at the very real structural impediments to the delivery of good care: excessive workload, shortage of staff, conflicting priorities, political agendas. “We were once like you” they tell the friend. “All shiny and sparkly. But you’ll change. The system will knock that out of you. Just see.”
Confronted with these objections, the friend declines to explore the reasons why people who were once as full of optimism as herself, have now become jaded. She merely observes that ‘whatever they have allowed the system to do to them, she won’t allow to happen to her’. I think she’s missing the point. If we don’t accept that caring impulses are likely to be threatened by severe systemic strain – and further, if we don’t research how to mitigate its effects and put in place strategies based on our findings – all we are left with is a ‘more-caring-than-thou’ personality pageant. Is this a good basis for effective professional support?
The friend’s belief in her future resilience comes down to ‘hope’ and a number of other attractive character traits such as ‘a compassion and reaching out that is healing and connecting’. In the context of the naysayers, the only conclusion to be drawn here is that while their compassion was puny and easily subverted, the friend’s is of an altogether higher order; she’s just ‘better’, in other words. But the reasons for this superiority are not convincingly explained: we are merely told that the friend ‘has always had this sparkle in her work’. Maybe it’s innate? If so, should those of us not so blessed simply give up?

3. John Walsh said (on Twitter) that the essence of ‘shiny’ can be found in the fourth sentence of the blog. This reads: ‘[the friend] works to be the most positive and supportive presence possible to her patients, colleagues and service’. While I agree that these are good aspirations, I think that lumping all three elements – patients, colleagues and service – together like this disguises serious potential conflicts between them. From the point of view of the service, for example, the most ‘positive and supportive’ staff are probably those who are prepared to prioritise work over family, work any shift, change shifts at short notice and even work without pay.
Staff who do these things may believe that they are ‘supporting’ colleagues – and so they are, in the short term. But in the longer term, does being so submissive to management demands really advance nursing’s professional standing? Are nurses who give in to this kind of pressure really supporting others – who may feel they have no choice but to do the same even when they don’t want to? And how does a nursing workforce browbeaten and demoralised in this way stay positive and supportive for patients?

In conclusion, I repeat that I applaud Sarah O’Donnell and John Walsh for having the initiative to set up the Shiny movement. I do, however, question whether it is helpful to imply that a reliance on nothing but random personality traits and nebulous ‘inner strength’ is sufficient to overcome substantial structural problems. The dangers are twofold. First, we risk condemning as failures people who – unlike the super-human friend – are just normal human beings. Normal human beings do sometimes buckle under pressure. And when they do, they need help, not blame. Unfortunately (and this is my second point) a blind insistence on personality alone may deflect from the search for structural solutions that could provide that help.

To those nurses who feel burnt-out and unshiny, I’d like to offer understanding – and actually, I think that’s what O’Donnell and Walsh want to offer too. The one I’m unsure about is the friend. Because with friends like her, who needs enemies?

I would be happy to publish a response to this article.

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33 Comments
  1. Barbara Bradbury, Halland Solutions permalink

    Well, with an intriguing post like that, I just had to follow the link.
    After all, I couldn’t resist the bright shine – just had to neglect to blink.

    Who, I pondered, would call themselves “shiny”?
    Could this be my new imaginary friend?
    Oh, would they see my own light, so tiny?
    Am I worthy enough to follow this trend?

    And what of the doctor, so incredibly radical …
    What a message, it’s wonderfully magical!
    People have names – who would have thought that?
    Adopt that approach now, or go eat your hat!

    I’m feeling unwell, it’s too much to bear
    I don’t want to be shiny, I’m all in despair
    I do make a difference, so people tell me
    And I am very positive but, fiddle dee dee
    If I have to be labelled with something so bright
    I’d rather stick my fingers right down my thrite!

  2. Stuart permalink

    Is the danger of this ‘movement’ a bit like a student who is involved in 3 brilliantly run, successful, ‘headline grabbing’ resuscitations, and whilst they take in all the great things from this success, technical and otherwise, forget to remind themselves that it won’t always be like this and the next one is almost certainly going to be a let down? It just seems like an overly complicated way to set yourself up for a fall, which is easy enough to do without a ‘system’…

  3. Basket Press permalink

    Sorry Shinies, but you need bitter, twisted, argumentative old cynics like me or my sister: the ones who had the fights with managers to get more staff, who insisted on continued training to up-date old skills and learn new ones, who argued for support and supervision mechanisms, who said “No! We cannot and will not do that!”, who would take industrial action in defence of pay and pensions for all of us, who would take out grievances against bullying managers…

    Still you carry on shining, eh? Me? I’m off to pick an argument with someone…

    PS most of my patients liked me, but then I worked mostly with teenagers. Actually most of their parents did too, as I would fight their corner with education, social services, whoever…

  4. Thanks to all three of you for commenting. I did not expect to win many friends with this post, and over on Twitter, despite my efforts to make it clear that I have the utmost respect for the Shiny Blog authors, I have been accused of launching a personal attack and called ‘not nice’. I think there is a need for people to learn to distinguish personal attack from debate about ideas. If we cannot debate ideas, then how is nursing ever going to move forwards?

    There are two ways of looking at the resilience of compassion in nursing care. Either, we say that there are a few special individuals who are just naturally able to sustain high levels of compassion over an entire career (presumably the friend is one of them). It’s nice and simple, but what it risks creating is firstly, a kind of compassion arms-race as we compete to show that we are the ones with the ‘best’ compassion of all; and secondly, a grim future for those who, for whatever reason, are not so favoured.

    Or we say that all nurses are human: and like all other humans, their personal attributes, including compassion, are subject to change depending on contextual factors. Our task then becomes one of looking for ways to help basically compassionate people who have gone a bit astray, to regain their compassion and sustain it in the face of challenges. I think the friend, who seems to have managed to do just that, may be able to help us here – if she’s willing to get down off her pedestal. Additionally (and to this extent, I think #teamshiny is onto something), social media can have a very positive role to play.

    Some people have spoken of this ‘sustaining’ as building in ‘resilience’ – and I think it’s a concept that has merit – but only as long as the goal is creating better cultures for both staff and patients. We do need to be aware though, that in the wrong hands, ‘resilience’ can become just an excuse for piling yet more work onto already overburdened staff because ‘they’re resilient, they can take it’. And that it too can degenerate into a macho ‘resilience race’.

    My main question, however remains simply this: of the two ways of looking at resilience of compassion in nursing care that I outlined above, which is the most inclusive? Which is the one that is non-judgemental and does not risk pitching nurses into a competition that nobody can win? Which holds out the possibility of change that benefits everyone? That’s my point.

  5. Basket Press permalink

    You encapsulate there some of the things I disliked about Twitter, such as the determination to willfully misunderstand and be “offended”. And all in 140 characters or less…

    There are times I think the whole “compassion” idea becomes a red herring.

    In my old line (CAMHS) it was certainly necessary, however I depended on a certain technical facility in working successfully with my patients. I am not a naturally sociable person, but for me to spend 3 decades talking to people for a living required me to convince others that I was. Essentially I spent 30 years acting a part which was expected of me, to the point that I almost believed it myself.

    Over and above this I needed certain specific skills in different treatment modalities, and I needed to be able to argue someone’s corner with other agencies.

    My sister, a general nurse, has worked in highly technical areas, again requiring specific skill sets.

    I sometimes feel that many of the technical aspects of nursing are over-looked in favour of more nebulous, and frequently ill-defined, ideas, like “compassion”, which because they are essentially unmeasurable can more easily be used to beat us over the head with.

    • I think your point about acting a part is an interesting one. I often feel the same way myself – although naturally quite introverted, I (I think) successfully project a fairly extrovert front when I’m with patients.

      Although it is now many years since Pam Smith outlined the concept of ‘the emotional labour of nursing’ in her seminal work, I sometimes wonder if the ‘dissonance’ she spoke of doesn’t go even further than she knew. Do some of us have whole ‘work personalities’ that we can deploy as a way to protect our inner selves? If ‘acting’ is a sign of self-awareness (because in order to act, an awareness of ‘otherness’ within oneself is required), is this something worth exploring in relation to resilience?

      As for compassion being unmeasurable, and therefore easier to beat us over the head with – I couldn’t agree more. I think the whole concept has become highly politicised.

      • Basket Press permalink

        Oooh, that is interesting: I had long discussions with one of my patients about such things. He was studying drama and English Literature, and suffered significant PTSD – he had days when he didn’t feel up to doing any work on the PTSD, so we would talk about whatever he wanted to as a means of strengthening our working relationship.

        We could not decide whether we adopted a whole new personality for particular situations, constructed an idealised version of ourselves or had found a means of allowing aspects of ourselves which were usually not shown (or allowed to be shown) to be shown.

        Whichever it was I certainly found it helpful in distancing myself from some of the horror stories I heard and had to wallow around in in order to help people – almost a dissociative effect. And my young man used a similar thing to help him function relatively normally in a busy 6th form.

  6. Stuart permalink

    Remember, everyone is shiny, but some are more shiny than others. #teamshiny

  7. Basket Press permalink

    No, my over-spilling bile has corroded my surface, dulling it! 😉

  8. Stuart permalink

    We don’t like the word ‘corrosion’ at #teamshiny, we have replaced it with ‘unfortification’

    • Oh Stuart, you mischief maker, you!

    • Basket Press permalink

      Stuart, I shall remember to tell the garage that next time I spot some reddy brown stuff on my car…

      • Stuart permalink

        As long as the garage is on the approved list, that’s fine #teamshiny

  9. RGN007 permalink

    I too respect the shiny passion the the article (I was inspired to follow the link too) and one unrelated harsh comment rung in my mind from the past, when I was a pupil nurse in 1976 and about to go through a divorce at age 23.

    Another nurse commented, “Oh I don’t believe in divorce. I’ll NEVER get a divorce. I don’t believe in them”.

    Neither did I. My mind flew back to the wedding day, the white dress, the love, my belief that for me, my marriage would be definitely one of the ones to last. I did not try to defend myself to the other nurse as I could sense she would never understand. I felt judged and superficial that real life had caught up with me and circumstances we all experience make us the sum of what we are.

    Until we gain experience and choose how we deal with it, good or bad, perhaps some washes over and some cannot, depending on so many other issues intertwined, personal, professional etc.

    I arrived here looking for the views of others and who might share my cynicism of promoting the 6 C’s as a professional changing cliche and what might be missing. I think the nurses are missing in the gap between care and patients. Not their bodies or their minds, but care between and to ourselves?

    Dalai Lama on my Facebook page today:

    ” It seems that for some people the idea of compassion entails a complete disregard for or even a sacrifice of their own interests. This is not the case. In fact, you first of all have to have a wish to be happy yourself – if you don’t love yourself like that, how can you love others?”

  10. Hi RGN007, thanks for sharing some very painful personal experiences. I think that what you convey very clearly is that none of us knows in advance what life will throw at us and how we will respond to it. Things may not always turn out as we imagine (and maybe tell everyone) they will – and the question is, how will we feel then? #teamshiny ignore your story at their peril.
    On a slightly brighter note, we can also exceed our expectations sometimes. I was reminded of this last week when I was watching the 50th anniversary commemorations of Churchill’s funeral. Recent re-evaluations of Churchill’s long life have tended to conclude that, leaving aside his wartime premiership, his political record is a decidedly mixed one. But as ordinary members of the public repeatedly intoned in vox pops: ‘cometh the hour, cometh the man!’. Without the Second World War, Churchill’s greatness might never have been revealed to us. (Which isn’t an argument in favour of war, by the way).

  11. Basket Press permalink

    Oh man…I read that blog…I need mind bleach…”human potential”, quoting the sodding Shawshank Redemption…Let’s just jump back to California in the ’60s and go hippy dippy skippy to Esalen with Carl Rogers (as an aside my dissertation thingy for my counselling course back in the day was an evisceration of Rogers’ core conditions)…

    Patronising was the word that sprang to mind. Personally I always operated on the “do as you would be done by” principle (that Methodist background is a sod to get rid of) and I don’t, nor did I ever, need this sort of simplistic nonsense to tell me to do that! Let alone wrapping up our job in pseudo-mystical fripperies about reaching out and healing…

    Actually, it is that Methodist background which was probably most important for me: ideas of public service and duty to help others which are in no way “shiny”, but allied to my innate cynicism and tendency to question and not automatically accept things, as well as some personal pride in doing anything as well as I can.

    This “shiny” stuff is taking us back to the old ideas of nursing as a vocation!

    Chaps: the 21st century called. It says nursing is a job! And it doesn’t need to be dressed up in mysticism and quotes from bad films.

    • Stuart permalink

      In my experience you’re always on thin ground when you have to start quoting films to justify something other than a book of film quotes. Which is why I laughed when my tweets were favourited this morning by self-confessed shiners, including this one;

      “This is my shine. There are many like it but this shine is mine. My shinyness is my best friend. It is my life. #teamshiny”

      Or perhaps favouring even negativity is just #teamshiny giving it 110%?

  12. Honestly, you lot….*shakes head*

    • Basket Press permalink

      You started it: you drew my attention to this stuff. I would never have heard of this “shiny” otherwise.

      Stuart, I believe there is at least one line from a film which can be generally used: it is one of Captain Willard’s from the opening section of Apocalypse Now…I’m sure you can guess which one in this context.

  13. Basket Press permalink

    Lemme see now, can I find a song about shininess on the shelves here?

    Oh yes, I can! I believe Lou Reed had it nailed long ago:

    Shiny-shiny, shiny boots of leather
    Whiplash girl-child in the dark
    Comes in bells, your servant, don’t forsake him
    Strike dear mistress and cure his heart

    Kiss the boot of shiny-shiny leather
    Shiny leather in the dark
    Tongue the thongs, the belt that does await you
    Strike dear mistress and cure his heart

  14. Basket Press permalink

    Aaaaaaagggghhhhh!!!!!!!!!

    They are talking about being “authentic” now! Sorry Stuart but it is definitely time for a film quote: You keep using that word. I do not think it means what you think it means.

    If someone can explain to me what that actually means (yes, I am well-versed in the likes of Carl Rogers and it definitely doesn’t mean what he thinks it means) I would be most grateful, ‘cos I’m pretty sure they don’t mean what it says in Chambers here (<—– there actually). Lose points for using any terms which come from any hippy dippy Esalen type stuff, Carl Rogers, anything from the "human potential" movement, or anything psychoanalytical.

  15. RGN007 permalink

    I am uncertain whether it was original to the TV series/film Star Trek, but since a lot of their science fiction is evolving into fact in the making, body scanners, artificial intelligence, may I introduce one of my favourite quotes for mischief, ” The needs of the one can sometimes outweigh the needs of the many”.

    In nursing, as much as generally patients are at the centre of everything and put first (becoming a cliche in itself), I do think before any health professional is judged, it would be kind to see if their needs were met in performing the task/s.

    • You make a good point about how ‘putting patients first’ has become a cliche. But it’s important to bear in mind that because it is very difficult to argue against ‘putting patients first’, it’s actually a very clever cliche too. Specifically, politicians can use the ‘ppf’ message to imply that if any other group (for which read: staff) try to draw attention to their needs, for example their need for a pay rise, they are being selfish and not ‘putting patients first’.

      It’s an invidious strategy. While the government, on the one hand, preaches to nurses about how they must be ‘compassionate’, on the other it is actively trying to pit nurses and patients against each other. Most patients, I believe, don’t want this. Of course they want the best possible service, but they also want to see nurses supported in the workplace and fairly rewarded for the job they do. They understand that a demoralised and unfairly pressurised workforce is not in patients’ best interests either.

      We all want what is best for patients. I contend that a strong, confident, well-educated and fairly remunerated nursing workforce is what is best for patients.

  16. My feeling is that we connect more deeply with patients (and give better care) when we drop our masks and are more relaxed and honest about revealing our flaws and fears to others. Unfortunately, the way of the world and the current NHS climate, is that the slightest admission of weakness (or humanity) tends to be used against you. To me, the ‘shiny’ movement, whilst well intentioned, is just another expression of a society that is unsure of and uncomfortable with itself and its future. Yet more unhelpful political vomit spewing forth from terminally unimaginative ‘leaders’ and ‘thinkers’ who sit at the apex of a diseased food chain. A leadership unconsciously complicit with a government hoping to turn us into operatives and privatised units of production.

    It’s difficult to see how anybody could ‘shine’ when they’re constantly showered by this political crud!

    We are our best selves when allowed to be our complete selves. We are ‘shiny’ only to the extent that we are allowed to hold ourselves up as a mirror the community that we look after and all it’s values and failings, rather than as a reflection of some ‘inauthentic’, Aryan ideal. I’m sure all of us at some time, on a bad day, have actually felt ourselves being cared for watched over and nurtured by our patients (rather than by our colleagues and managers). This tends to happen when patients sense we are under pressure and are able to sense and feel our all too human failings. That we, are just like them. That we, can feel just as scared and vulnerable as them. Healing and community is greatly enhanced through the exchange of energies that takes place in this unique space.

    No one cares for robots and nobody wants to be cared for by robots.

    • Patients and the professionals who care for them have a lot more in common than government/’leadership’ rhetoric leads us to believe. But as I said in my second reply to RGN007 (above) and have also argued in other blog posts, there does seem to be an unacknowledged agenda of pitting us against each other.

      Counter-intuitively, I think the insistence on ‘compassion’ in nursing could be a part of that because it conceptualises patients as little more than passive consumers of compassion rather than active co-creators of their own care. Nursing, to me at least, is a relationship. I have certainly been ‘nursed’ by patients – not often, but it has happened, and when it did, what very special and memorable moments it gave me.

      Humour, by the way, is also very important here. Sharing jokes is a great way of bringing everyone together, but I sometimes think the climate of fear you spoke of is making even this a risky activity. The day you can’t have a laugh with patients is the day I hang up my hat, I fear.

  17. Mark Gretton @independent_mg permalink

    I do agree about ‘compassion’ being politicised. I’m not so sure about it being impossible to measure – just because we haven’t found a way to measure it doesn’t mean that we can’t. After all, we all recognise a lack of compassion when we see it.

    Where this becomes problematic is the automatic response that it is immediately all down to the one who hasn’t shown compassion, that if she had just tried a bit harder everything would’ve been fine. Far better – and ultimately more useful to us all- if we then analysed why compassion failed and then suggested remedies. This might be that the nurse should have understood compassion a bit better. But it is more likely to be that she had too many other things to do, that she was frightened that if she didn’t do carry out some audit she would be punished, that she felt peer pressure to not speak out, that she lacked the confidence to approach people about how to change things.

    I don’t really have a problem with people using the 6cs as exemplars, vague though they are – after all, my generation wasted much time trying to define nursing, even though we all knew it when we saw it – and, though the whole shiny idea automatically sets my teeth on edge, it is preferable to the ingrained cynicism of so many nurses who have had too much beaten out of them over so long. But instead of thinking we can sort out the latter by exhorting them to do better, much more useful to look at why they feel as they do and what we can do to help them do it better.

    Thanks as ever for This Sort Of Thing! It’s good that someone is making these points, and nice that you do it unfailingly politely, something I almost never manage.

    Mark

    • Basket Press permalink

      Mark, I believe some of my blog posts on here (and some which may follow if they meet with GA’s approval) give an indication of how and why NHS staff (not just nurses nor even clinicians) are ground down by systems which appear designed to do them down, victimise them, bully and blame them, thwart innovation and good practice.

      There is one (not used yet) in which I also point to a study by the LSE of how good management in hospitals actually leads to improved health outcomes. The sad bit is that what is identified as beneficial management practice is NOT remotely like what most of us experience and that many managers, despite their much-vaunted MBAs and the rest, appear to be unaware of what constitutes good management.

  18. Hi Mark! Thanks for your words of encouragement. I was very nervous about posting this blog for the reasons that I described in the second paragraph (of the original blog post). After publication, I was told on Twitter that I was being divisive and that nurses should stand together. But saying you agree with something (or remaining silent about it) when in your heart you don’t agree with it (and think it is potentially harmful) is a characteristic of what we now know as poor cultures. I thought this was something the health service was trying to get away from. And anyway, I don’t see how heralding the arrival of a kind of self-proclaimed nursing super-race is ‘standing together’. What about the rest of us? Where do we fit in?

    I agree that the energy and enthusiasm of #teamshiny is refreshing and in that sense, gives hope for the future. I wrote about the ingrained cynics in my last week’s post ‘Two Tribes’. I think that post was really a preface to this one – a way of testing the waters and working out if I had the courage to take on #teamshiny directly.

    So while I do – yes, really! – admire #teamshiny for trying to bring a new vigour to conversations about nursing, I wish they had based their campaign on something more intellectually rigorous than random lines from songs and films. I wish they had tried to be more inclusive. I wish they had looked at the evidence.

  19. pennyhaswell permalink

    Please forgive a no-longer front line staff, potential and sometimes patient – in both senses! – butting in. I have read both blogs with interest and, sad to say, some discomfort. I was filled with dismay when the idea of the six Cs was first mooted. Sorry Mark, if I may disagree with you here:
    ‘I don’t really have a problem with people using the 6cs as exemplars, vague though they are – after all, my generation wasted much time trying to define nursing, even though we all knew it when we saw it’, I do have a bit of a problem with the six Cs and I don’t think ‘we’ all knew it when we saw it – or perhaps we did but ‘we’ weren’t the ones that needed convincing that nursing is a profession and should be respected as such. Many years ago, a speaker at a Clinical Nurse Specialist conference elaborated in some detail why nurses should examine and report on what exactly they did. He said, quite rightly, that no-one else knew what they were doing – consequently they were under-valued. I have seen no real evidence of that reporting since. I fully appreciate it takes time that no-one has – I’ve been there and worn out the T-shirt – but does the #teamshiny approach really make the Daily Mail reader appreciate just how a nurse works or does it bring visions of ‘angels’ with ‘cool hands on hot foreheads’? Not that there’s anything wrong with cool hands I hasten to add, just that there is rather more. Nursing may be a vocation to some, but actually it is a highly skilled profession and needs to say so. If ‘we all knew it’ I would ask if the nursing profession feels truly valued – do I need to?

    Another speaker at another conference, this person was a Chief Exec. if my memory serves me right, said that he appreciated Nurse Specialists, he saw them as ‘the thorn in his side’, because they were the ones that kept reminding him when things needed looking at, when all was not working well. An interesting concept, but one that shows you don’t necessarily have to be viewed as ‘shiny’ to get things done.

    I have just read ‘Compassion in Practice: Two years on’, and I have to say I am no more encouraged. Whilst it’s fantastic to read all about these wonderful people providing examples of best practice, all very #teamshiny but – if I may use two clichés – in reality there’s an awful lot of ‘talk and no walk’ and ‘boxes being ticked’

    As a patient I find the concept of ‘shiny’ rather worrying, can the ‘shiny’ nurse truly empathise with me if I’m feeling dark or support the stressed colleague as implied in the six ‘C’s? As a patient I want someone to look after me – no order of priority here – who is kind, who really listens to what I have to say and involves me in my care, and who is competent – actually more than that – I want highly skilled! I suppose all of that is in the six Cs but it doesn’t leap out at me and it certainly doesn’t all revolve around ‘compassion’. Most of all though, I want and need a workforce who works together, who respects each other, who supports each other; and who argues their case rationally for proper funding and respect. As you so rightly say Mark – let’s look at why those who don’t feel ‘shiny’ are feeling that way and what can be done to help. As you say, GA, let’s look at evidence, best practice, and – please – nurses stop being so divisive. There are enough people out there trying to get you – you don’t need to do it for them!

    • Mark Gretton @independent_mg permalink

      Hello Penny,

      I think the point I was trying to make was that defining nursing was pointless for exactly the reasons you describe, in that no-one outside the profession took any notice. I’m not sure they do about the 6cs, either; I think it’s largely an exercise in navel gazing by the profession, so I don’t have terribly strong views about it. I completely agree that you need ‘highly skilled’ care as opposed to competent and – having spent the bulk of my clinical nursing career in acute cardiac care I worry increasingly that we are minimising the role of important ‘harder’ skills in favour of being compassionate or communicating effectively when the real trick is to attend to all of this according to the patient’s needs.

      More than that, I worry dreadfully about the state of the NHS. The acute Trust in which I work has a culture of bullying so endemic that some staff have clearly given up and seem to accept this as the way things are. Given that I am, for the most part, a nurse lecturer, I have actually felt guilty about students of mine going into that environment. I’m starting to think that my generation (I started over 30 years ago) has pretty much failed and the only hope is to try to prepare and protect the current new starters in the hope that they can achieve more than I have.

      Not an optimistic note on which to end, but these are not optimistic times. The financial squeeze on healthcare is not going to go away and we have the same issues in the university sector. I haven’t given up, as good nursing is more valuable and necessary than ever. But I do agree that we need more than platitudes to guide us through this.

      • I was just saying elsewhere, this debate reminded me of Katherine Curtis’ research on cognitive dissonance in student nurses as they’re exposed to the reality of practice. http://www.nurseeducationtoday.com/article/S0260-6917%2812%2900117-7/abstract
        It’s fine to strive for idealistic values, but we can’t be blind to the danger posed if someone were to think falling short in such a harsh system was some personal failure. There’s enough burnout to go around already.

  20. Hi Penny – feel free to butt in any time! I’m another person who has wondered what the public would make of all this.

    While I’m sure they would be gratified to by the levels of motivation on display in #teamshiny, I am unconvinced that ‘shiny’ is what they are really looking for in health care professionals. I would be satisfied with knowledgeable, educated, working from an evidence base.

    From the inter-personal point of view, someone who could identify with how people are likely to be feeling in whatever situation they are in would be enough for me. Someone with a sense of humour would also be really nice. I would feel uncomfortable with attempts to ‘understand’ me – I’m proud to be a unique individual; to ‘understand’ me, in my view, would be to diminish me – or reach out with some kind of semi-mystical ‘compassion that is healing and connecting’.

    If I may, I will illustrate my point with an all-to-common real-life example. If I were a member of a family that had just received bad news, I would neither want nor expect staff to ‘feel my pain’ or offer me psychic healing. Normal human acknowledgement, a hand on the shoulder, a cup of tea, privacy, an offer to answer questions later – these would be what I’d hope for.

    Of course, everyone is different, and it’s difficult to generalise about what a body as large and diverse as ‘the public’ wants. But maybe we should at least attempt to find out before we assume that we know.

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