Cowgirl Nurses With Great
Traditionally, nurses are
beyond criticism. They are `angels' and they have always received a `good
press'. But nurses have changed. And they have changed a good deal. The result
is that today's nurses are nothing like their predecessors. If they are to be
forced back into doing what they should be doing then they need to be criticised
- and their shortcomings need to be identified.
The big problem is that
today's nurses are too self-important to carry out any of the traditional tasks
entrusted to nurses. Modern nurses don't like to bother caring, touching,
feeding or comforting. They regard themselves as above collecting bed pans or
plumping up pillows. Nurses are now too self-important to feed patients or to
lift them and too protective of their past to let anyone else do these things
either. It is a tragedy that as nurses have become too important to nurse no
other group has been allowed to take on the most essential caring tasks.
Auxiliaries, for example, are not allowed to do anything with to or for patients
and the result is that there is no one on the average NHS hospital ward to wash,
feed or care for patients.
In the bad old days nurses would help their
patients in a thousand tiny ways. They would make sure that their female
patients wore clean nighties and had their hair brushed before visiting time.
They don't do these things any more. And it isn't that they've got other, more
important things to do. Go into any hospital these days and you will see half a
dozen nurses sitting around the nurses station chatting and eating chocolates.
(It's no wonder they're all so fat. you'd think nurses would be more concerned
with their health. If they got up and moved about a bit occasionally they would
burn up some of the calories.)
Nurses should bandage wounds, make beds,
empty bedpans and soothe sweaty brows. They should take temperatures and record
pulse rates and give out prescribed medicines. That's what they are there for
and it's what they are best at. It is also what patients need from them. These
are important tasks. Sadly, most nurses consider themselves far too grand for
such work. Nurses have become lazy. It is their responsibility to make sure that
hospitals are kept spotlessly clean and that patients with dangerous infections
are barrier nursed. But nurses consider themselves too important to deal with
practical issues. They prefer to sit around having meetings with social workers.
On many wards these days it is impossible to find a nurse. Patients who need one
must wait until one appears and then try to catch her attention. Sympathy and
comfort are not qualities required of nurses these days. Indeed, I suspect that
they are regarded as unsuitable weaknesses. Today's Mrs Gamp is too busy
attending meetings to attend to her patients. Mrs Gamp has acquired ideas well
above her station.
In some hospitals these days the sheets aren't
changed when patients leave and patients arrive. Instead, to save money, the
sheets are just turned over. Top to bottom. The sort of practice that is frowned
upon in the sleaziest of seaside boarding houses. It is, of course, the
administrators who decide that this will be done. But it is the nurses who
supervise its doing. (It's the auxiliaries who do the actual work, of course.
Nurses don't do physical stuff any more.) And so the nurses are responsible.
Just as they are responsible for allowing men and women to be put onto the same
ward, and forced to share the same bathrooms and lavatories. Why don't nurses
stand up against these despicable practices? Easy. They say nothing because they
have been institutionalised. They work for the Government and they don't have
the guts or the knowledge to realise that if they say `no' the authorities wonít
dare do anything to them.
Many of today's nurses are graduates; awash
with diplomas and certificates. But their patients lie in their own faeces and
urine. They do not have their faces washed or their teeth brushed or their nails
cut or their hair combed. These are things that are beneath the new graduate
nurse. Today's graduate nurses are too busy chatting and playing with their
computers to check that there is soap in the bathroom or toilet paper in the
lavatory. Graduate nurses are different from their predecessors in that they are
never around when needed. They tut and look cross if they are disturbed and
asked to do something practical. Nurses, like administrators, have acquired
authority but shed responsibility. There is no sense of caring. There is no
accountability, no discipline and no supervision. When things go wrong (as they
often do) noone is blamed except, possibly, the patients. Nurses chase
promotion, attend seminars and perform useless research. They demand to be given
time to attend to their office duties and to attend meetings. They insist on
personal project time, time for research work and study time. There are, in
short, many chiefs but no Indians. The young people who go into nursing with
great aims and ideas are quickly broken and destroyed.
They still have a
sort of ward sister in hospitals but these days she is far too important to do
anything practical. These superior nurses, full of qualifications but empty of
compassion, sit in cubby holes, with the door closed. They share their cubby
holes with a computer screen, a packet of biscuits, many grievances and much
ambition. They spend their days plotting to gain more power from the
administrators. (They've already beaten the doctors to a bloody pulp.)
Because nurses are now too important, and too busy with their
administrative chores, to deal with patients, hospitals now employ untrained
assistants to attend to patients. These assistants prepare patients for medical
procedures. For example, my wife went to see a radiologist at a hospital. The
man who entered her cubicle, asked her to remove her clothing and then smeared
petroleum jelly onto her abdomen was a teenage male hospital employee who had no
medical qualifications. He could have been emptying our dustbins. Instead he was
allowed to attend to female patients. By himself.
Modern nurses seem to
be trying to reposition themselves as the new cheap doctors. They have managed
to acquire for themselves the right to prescribe and to perform surgical
procedures. (I am surprised incidentally that the British Medical Association,
the doctors' trade union has not moaned about this. As nurses have acquired more
of the powers traditionally reserved for doctors so an increasing number of
young doctors have found themselves unemployed - forced to collect dole money or
to leave the country to find employment.) Nurses are being given more power (and
allowed to make diagnoses, prescribe drugs, perform surgery and make life or
death decisions) because this is good for the State. Nurses are cheaper to train
and less expensive to employ than doctors. However, allowing nurses to have
these extra powers is exceedingly bad for patients because nurses are even more
likely than doctors to make serious errors when attempting to treat patients.
The news that nurses are to be allowed to decide which patients should -
or should not - be resuscitated is terrifying news that should frighten the life
out of every patient, every relative and every potential patient - and that
means all of us.
My main objection is that nurses simply don't have the
training to make this sort of decision. Nurses should stick to making beds and
reading thermometers and caring for patients and they should stop trying to turn
themselves into fake doctors. The horrifying incidence of superbugs in British
hospitals proves without a doubt that nurses aren't doing their present jobs
properly. The nursing profession has gone rapidly downhill since nurses decided
that simply `nursing' patients wasn't enough for them.
created by giving nurses extra responsibilities of this type is that the
traditional relationship between nurse and patient has been changed dramatically
- and for the worse. Nurses now either have to hold back from real contact with
their patients (in which case they are failing them) or they have to get to know
them (in the traditional, caring way) and then decide whether they live or die
(in which case they will fail them because they won't be able to make the right
I still believe that nurses should remain spiritually close
to their patients in order to be able to help them properly. Doctors need to
remain a little distant, a little objective. But if they do their jobs properly
nurses should develop real relationships with the patients they care for.
Sometimes they will like their patients. Sometimes they won't like them. And you
can't make good, clinical decisions when you have an emotional relationship with
Sadly, the modern nurse seems to be ashamed to be a nurse;
she wants to be a clinical professional. She wants to perform procedures,
prescribe drugs, operate computers and attend meetings. Lots of meetings. She
wants to behave like a doctor. It is considered demeaning for a nurse to provide
caring these days. They want to be doctors without the pain of a long, expensive
education. Nurses wanted to grab the power the cheap and easy way, without
having to spend six years at university. They wanted equality of money and power
with doctors, without actually having to do all the hard work. And so the
nursing profession lost its way.
There is, of course, a simple solution
to this dilemma. Nurses who want to pretend that they are doctors should train
and become doctors. And that, of course, is the problem. The vast majority of
nurses are, quite simply, incapable of completing a medical degree course. They
are, to be blunt, not quite bright enough.
Things started to go wrong in
the nursing profession when self-deluded, self-important nurses decided that
they wanted to be treated as academics rather than as nurses. Nursing used to be
a sacred vocation. Now itís just a career. I go into a lot of hospitals and the
situation almost everywhere is the same. Bedbound patients desperately ring
their bells needing attention while overweight nurses sit in meetings drinking
coffee and eating biscuits. I have even been in hospitals where nurses regularly
refuse to lift patients. `That's not what we're here for,' one told me. `We're
It's about time someone remembered that nursing is a
crucial part of medical care. And nurses should be proud to be nurses.
If you want evidence supporting the low quality of nursing care just
look at the hospital infection figures. Britain has the highest incidence of
MRSA in the world. There's only one reason for that: sloppy nursing. Nurses
don't wash their hands between patients. I've seen them go in and out of rooms
where patients with MRSA are being nursed without washing or even wiping their
hands. Garage mechanics have cleaner hands than most nurses.
got so bad that the relatives of patients in hospital now need to take in
antiseptic wipes and clean bed, tables and lockers every day because the staff
won't do this. Patients on hospital wards need to have antiseptic wipes so that
they can clean their cutlery.
And bedsores are now so common that no one
notices them. Today's nurses just regard them as `normal'. With rare exceptions
any patient who develops a bedsore has not been properly nursed. Bedsores used
to be regarded as a sign of bad nursing. These days they are simply a sign that
a patient has been in hospital for more than a couple of weeks.
ambition has been disastrous for patient care.
Misled by the enthusiasms
of the over-ambitious and the commercially minded, too much effort has gone into
curing and too little into caring. Ironically, there is ample evidence hidden in
the world's medical journals to show that a caring approach is not simply
compassionate but is also effective. In a paper which appeared in the New
England Journal of Medicine in America, doctors showed that when pregnant women
are given the sort of support that can best be given by a nurse with time to
spend on kindness, women delivered their babies in half the time and suffered
far fewer complications. Many other papers have illustrated the same point:
patients need less technology and more care.
Meanwhile, the present
system ensures that the nurses who run hospitals, who make the rules and who
provide the `leadership' are the ones who are least capable of, and least
interested in, working directly with patients. The nurses who run our hospitals
are the ones who are least interested in the art of caring, least passionate
about nursing as an art and most anxious to climb up the career ladder by
exhibiting their prowess at managing meetings, mastering the double-speak that
has invaded hospitals and giving good mouth. Nursing lost its way when it became
impossible for a nurse to rise in the hierarchy without becoming an
administrator. Nursing went wrong when nurses started collecting diplomas and
degrees. How can you have a degree in caring?
A few decades ago patients
were cared for in hospitals which were run by matrons and ward sisters - nurses
who still knew how to turn a patient, make a bed and empty a bedpan. Most
patients cannot, of course, remember how efficient hospitals were in those days
and so, because they don't know what to expect or what to look for, think they
are being well looked after. Most people have low expectations, are inherently
grateful for anything that is done for them, are frightened and don't know what
to look for. (This is the only possible explanation for those letters to local
newspapers extolling the virtues of the local hospital.) These days the brigades
of fat bottomed nurses who `administer' our hospitals are too self-important
even to look at patients, let alone speak to them. You can occasionally spot
these nursing administrators darting along the corridors, eyes averted lest they
accidentally soil their vision with the sight of someone in pyjamas or a
nightdress. Most of the time these nursing harridans lie hidden behind office
doors, planning their career progress. Many of them seem grossly obese - a
consequence no doubt of doing too little work and spending too much time
drinking coffee and munching biscuits. If the salaries of these grotesque beasts
were smaller, and they spent less time in meetings, there would be plenty of
time and money to make sure that agency nurses were unnecessary. (There is very
little continuity in nursing care in modern hospitals. Patients are lucky if
they ever see the same nurse twice.) Those who are left at the dirty end of the
profession, wander around almost uninterested in their work. Often slovenly and
untidy, they do not seem to care for their patients at all. It is frequently
difficult, if not impossible, to tell who is in charge. The modern nurses'
office (or `station') will usually be positioned in a spot where the nurses can
hide away from the patients to make their phone calls, eat their chocolates and
gossip. Inevitably, if the patients cannot see the nurses, the converse is also
true: the nurses cannot see the patients. Calls for help or bedpans go
Today's nurses are grotesquely unprofessional and are, far
too often, rude to patients and visitors. I have received numerous complaints of
hospital nurses talking loudly at night (and keeping patients awake). This is
quite unnecessary. It is also rude and bad medicine. When I last worked in
hospital doctors and nurses would whisper even when working on emergencies so as
not to waken patients. Today's nurses are badly trained. And most don't seem to
know how a good hospital should be run.
Ever since the Greeks built the
first hospitals it has been recognised that flowers are good for patients. They
look good. They smell good. They bring the healing beauty of nature into the
ward. But flowers are banned in many modern hospitals. They are considered
`dirty'. And a nuisance.
When I last took flowers to a patient in
hospital the nurses looked at me as though I were a madman. After I pointed out
that I had bought the flowers in the hospital shop one grudgingly agreed that
the hospital didn't ban flowers. `I don't do flowers,' said the nurse, as
indignantly as if I'd asked her to put on a nice little pinny and bake me a
cake. So I found a cleaner. And asked her for help. `I don't do flowers,' said
the cleaner, looking down her nose. Judging by the state of the ward she didn't
do much cleaning either. Eventually, I found a vase in a filthy cupboard and
filled it myself with water. I then put the flowers into the vase, arranged them
and left them on the table by the bed. Half an hour after I left the flowers
were thrown out.
Copyright Vernon Coleman 2012 Taken from Do
Doctors And Nurses Kill More People Than Cancer? by Vernon Coleman. This
book is published by EMJ Books. For details of how to purchase a copy please
visit the shop on this website.