Today we have been informed by the Patient Association that a small but significant minority of nurses are cruel and uncaring. We have been told that some nurses in the NHS hold (often elderly) patients in contempt, that they fail to deliver even basic nursing care to them. Sadly, I am not surprised by this.

Today also we are told that school students have achieved the best ever levels of GCSE results and that rather than being better educated and better prepared for modern life they are in some way lacking from the necessary skills for life.

On the basis of my knowledge of these two issues, I wonder if we are living in a dreamworld originating somewhere around 30 years ago.

31 years ago in 1978 I took my ‘o’ levels. I say that but actually in a few subjects I did something called 16+, declared to be a new exam of the future. Something where the whole of your school career would no longer rely on 1 or 2 exams, but instead would include some coursework. Also there wouldn’t be separate exams for the clever and less bright, but instead one exam, where we would all be judged along a single scale. These were the forerunners for the GCSE of today. Today, I heard a phone in show on the radio was asking if we should return to the O level. I didn’t actually hear the debate, but wonder exactly what would be proved by returning to something phased out 30 years ago?

29 years ago in 1980 I began my nursing career. We learned how to perform basic nursing care. We were taught ‘total nursing care’, we existed in a world where average length of stay in hospital was about 2-3 times what it is now, a world where evidence based practice, NICE guidelines and Health Care commission (now superceded by the Care Quality Commission) had never even been conceived.

In 1980 nothing had a cost or a price. We lived in the world of crown immunity, no one judged us and patients came to hospital half expecting that anything more serious than a hernia or similar operation could end in death.

Care in the world I inhabited during the 3 years of my training was excellent. We had fantastic staffing levels, mostly admitedly provided by students, though well educated and trained students at that. It was 1984 before I ventured into the world of the district general hospital where I realised that not all nursing care was the same as I’d experienced in a London teaching hospital. This is not to say that I was in any way superior (though some people suggested that I might like to dump my London ways at the door) but that not all healthcare was well resourced, that not all nurses were trained in the same way and that not all staffing levels were what I was used to.

Those people who want to return to those olden days of old time matrons, where all care was excellent and where all patients wore pink bed jackets are living in a world of fantasy. Lets face facts – Money and targets now rule the world. Everything must be cost effective. Throughput, bed managers, bed days, 18 week targets, NICE are the buzz words and acronyms. Qualified nurses are in short supply, and those that exist are often of a different culture to their patients. What is more people survive illnesses that previously killed them immediately and what is more life expectancy grows by the year. Doctors who worked day and night for most of the week in my day are now restricted to a normal working week. Who you might wonder picks up the work? Nurses no longer provide the basic and total nursing care of 30 years ago. Nurses now provide much of the work doctors provided in those days, they manage wards, budgets, staff and patients but often the actual care is provided to others. Nurses should supervise the care delegated to others, but how easy might that be?

I doubt that any  nurse gets up in the morning and decides to provide substandard care, but too many nurses are expected to provide the care expected in 1980 in a system that has moved on and that inhabits 2009. Maybe it is time for nurses to reclaim nursing? Or maybe we had better inform people what nursing means in 2009 and if they don’t like that, what it might mean to return to the world of 1980. The choice is yours!

The photo above is also from the past, since the Middlesex Hospital is no more!