Where Nursing Went Wrong

Dr Vernon Coleman MB ChB DSc

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 much with caring, touching, feeding or comforting. They regard themselves as above collecting bedpans 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 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 have other, more important things to do.

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 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 anymore.) 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 don't have the guts or the intelligence to realise that if they say `no' the authorities won’t 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) no one 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 ideals 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 cubbyholes, with the door closed. They share their cubbyholes with a computer screen, a packet of biscuits, many grievances and much ambition. They spend their days plotting how 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.

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. 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.

Another problem 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 decision).

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. 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 want to grab the power the cheap and easy way, without having to spend six years at university. They want equality of money and power with doctors, without actually having to do all the hard work. And so the nursing profession has 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.

Nursing used to be a sacred vocation. Now it’s just a career. I’ve been in 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 not weightlifters.'

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 Methicillin Resistant Staphylococcus Aureus (MRSA) infection 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 were being nursed without washing or even wiping their hands. Garage mechanics have cleaner hands than most nurses.

Things have got so bad that the relatives of patients in hospital now need to take in antiseptic wipes and clean beds, tables and lockers every day because the staff won't do this. Patients 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.

Nursing 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 kind nurse with a little time to spend, 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 are in charge 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.)

Meanwhile, those nurses 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 unnoticed.

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 to be 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.

Adapted from the book `Why and How Doctors Kill More People than Cancer’ by Vernon Coleman - available on Amazon as a paperback and an eBook.

Copyright Vernon Coleman 2011 and 2022