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The light at the end of the funnel

July 17, 2015

I wonder if Jeremy Hunt tuned in to Who wants to be a nurse?, BBC Radio 4’s new two-part investigation of the inner workings of the profession. ‘Aha!’ he might have rationalised it to himself. ‘One of the contestants might phone a friend, and the friend might come up with the solution to the whole nursing recruitment crisis thingy! I cannot afford to miss!’.

The half-hour broadcast explored the experiences of four student nurses ā€“ one male, three female – from the University of Essex. Background information was pretty sketchy – we learned little about their various employment and education histories or motivation to enter nursing. All appeared to be twenty-somethings, two lived with their parents, one was a single mother and all were studying adult branch. The answer to the title question seemed to be that most aspirant nurses continue to be drawn from the traditional pool of young(ish) white women. Sorry, Jeremy.

But stick with it though, because it turns out that despite ducking its own opening question, the programme went on to pose ā€“ and attempt to answer ā€“ a number of others, all of them very pertinent. In the closing minutes, presenter Jenny Clayton drew the various threads together by asking a new question: what do we want our nurses to be?

The phrasing here is very loaded of course. Implicit within it is an assumption that the nature of nursing is a matter to be decided on as much by public agreement as by debate within nursing itself. Nurses, or so the subtext reads, do not merit having the power to set their own terms of reference. In this context, it was telling that both Peter and Charlee had turned to service users for insights into how a ‘good nurse’ behaves. However warm and cosy it might look though, the idea that nursing philosophy is really dictated by service users is a pretty sizeable red herring.

All the students spoke about the high pressure and low morale they have encountered on placement. Peter, in an evocative turn of phrase, called it the ‘funnel of negativity’. But much of this is the result of the dead hand of political and economic priorities. It is the target culture and chronic underfunding that are largely responsible for removing ward nurses from the satisfactions of the bedside and turning them into what are effectively throughput managers and risk assessors. No wonder we no longer know who we are.

And it was this issue, the uncertainty and lack of definition around the nursing role, that was the real heart of the programme. Peter summed it up when he said ‘Nobody really knows what a nurse is. Are they senior practitioner, are they the carer, are they someone that’s gonna prescribe drugs, are they gonna diagnose a stroke – as nurses do – and give the thrombolysis to cure the stroke..? What’s their role? I mean, it’s sort of lost in this world of training’.

Training, or education, is of course the silent fulcrum around which the programme revolves. If it weren’t for the the Daily Mail and its ilk and their constant banging on about how much better life would be if nurses hadn’t gone all hoity-toity higher-educated, it’s doubtful whether Who wants to be a nurse? would ever have got made in the first place. But it’s also the place where basing nursing wholly on subservience to public demands comes unstuck. Because what the public wants (or so we are reminded ad nauseum) is the abandonment of degree nursing. Nursing should be fighting tooth and nail to preserve it.

It was disappointing then, the the programme did so little to challenge populist assumptions about nurse education. Of the four students featured, only Amy seemed to have much enthusiasm for academic work. Charlee, in particular, confessed to having little passion for essay-writing, preferring to concentrate instead on being ‘the best practical nurse that I can be’.

But we need degree nursing precisely because of the conundrums identified elsewhere in the programme. Not just because research suggests better outcomes for patients where nurses have higher educational attainments (and what patient wouldn’t want that?) but also because it is only through academic enquiry and debate that we can attempt to answer Peter’s question about what a nurse really is, make a case for what works for us and for our patients, and reach the light at the end of the funnel.

Oh, and just before you turn off in disgust, Jeremy, and despite this week’s semi-climbdown on unsocial hours payments, you should have known that no one ever goes into nursing to be a millionaire.

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