Voices: I’ve been a nurse for 40 years – you won’t believe what I’ve seen
The pandemic put nurses in the spotlight. The recent strikes have turned that spotlight on again, but the industrial action is about so much more than just pay.
Take, for example, recent news about the raising of the state pension age. There are fields of nursing where nurses can potentially (and do currently) work into their late sixties; roles that allow for sitting down, regular and guaranteed breaks, no night shifts – rotas that enable sufficient rest between shifts. For older nurses working in acute busy areas, where none of those things are realistic, it would be very physically and mentally challenging. Many of us would be forced to reduce our contracted working hours to protect our health. Most would need to make further significant changes to their standard of living to manage the resulting drop in income.
I have just over 40 years’ experience as a nurse in the NHS. My experience has always been in acute emergency services. I did the traditional “hands on” training in the 1980s – not a degree, not even a diploma. With my registered general nurse qualification, I progressed eventually to matron and lead nurse of a service in a large NHS hospital in central London. I‘ve seen what is possible in the NHS with sufficient resources used in the right way and managed by a small group of “can do” leaders.
I have spent my career in large, relatively well-funded hospitals. I have seen basic working conditions steadily deteriorate over the past couple of decades, the implications of which apply to staff in many clinical roles – nurses, doctors, physios.
From inadequate changing facilities – there is very little chance of any privacy, dignity or respect with 27 nurses starting a shift in the equivalent of a large cupboard – and not having somewhere to lock away valuables; to poorly maintained, overused, flooded staff bathroom facilities. We have small break rooms with too few chairs, and limited access to hot or nutritious food.
Compulsory nursing degrees were introduced in 2009 but I believe that the NHS needs a mixture of degree-trained and (paid) apprentice-educated nurses, so as not to miss out on the swathes of people who are less academic.
I haven’t seen solid visible evidence of our profession’s ability to influence decisions at grassroots level – one of the suggested benefits of the change to training. Yes, I have seen more qualified nurses continue in academia and research (important areas), but I have also seen an increase in newly qualified nurses who seem to find that clinical (shop floor) nursing is not for them after all, having been forced to a make a decision when they were 17 years old and didn’t fully understand what nursing was.
In my opinion, all decision-makers need to equip themselves with more rounded information. Managers should remain clinically credible throughout their career – from being visible on their shop floor and working shifts occasionally, to only sitting down and drinking and eating when the nurse in charge does. Only then will they understand the key issues, make sensible decisions and be able to report accurately higher up the chain.
As for new hospital designs or expansions, we have to be careful not to create glorified hotel facilities, in order to win design awards, while wasting valuable money. Any new space has to function as a hospital. Staff need to be able to provide the care needed. Having carpets on floors and leather walls does not work on any level except it might look nice for a couple of days. We want patients to move through hospitals but we need staff to stay.
On the subject of “awards” – the true grafters never get them. By this, I mean those nurses who are consistent in their hard work and dedication to deliver the best care possible, whether it is during a night shift or on Christmas Day. These are the nurses who can’t “work from home” when the weather is bad or when the trains aren’t running. They are the ones who have to be professional and perky even when they are exhausted or dealing with personal issues.
This leads me to another serious issue. Over time there has been a significant increase in patient and relative choice, combined with more leniency with patient and relative behaviour. While some aspects of this are positive, unfortunately clinicians and nurses are now regularly faced with verbal and physical abuse.
The stress that such intimidation causes staff has a direct link to their mental health and their ability to function professionally. It feels very much as if there is a lack of policy, legislation and will to properly protect the key workers on the frontline.
We are informed that there are more NHS staff than ever. Many of these will be business managers. Others will be nurses keeping patients out of hospital, enabling patients to be discharged quicker. But there is an ever-increasing shortfall in 24-hour services such as A&E and intensive care.
Most people re-evaluated their work-life balance during the recent pandemic. Something needs to be done to reward staff still willing to work in departments where night and weekend shifts (including bank holidays) are a necessity. We deserve more than an uplift in pay for unsocial hours. Basic things – provide free tea and coffee, quiet rest space and access to hot meals. Give us somewhere to lock our bikes or park cars so that when we finish shifts late at night we feel safe.
The overall objective of every manager should be to ensure that the patients receive the best and safest care possible. I suggest we return to a situation where HR does more of the HR work, recruitment does more of the recruitment work and nurses do more of the nursing work.
As a former matron, I know all too well that most nurse managers do their very best to look after their team but have little say in how their pot of money is utilised in practice. No wonder nurses feel tired and devalued, for reasons that go way beyond their pay levels.
We shouldn’t just accept experienced nurses leaving or retiring early – those who have experience of what works well and what doesn’t, what initiatives have worked or failed before, and why. This kind of information is invaluable now. There is far too much time and money wasted on reinventing the wheel. Nurses are generally kind, caring and hardworking people, with a few exceptions as in every walk of life. Look after nurses well and they will be able to look after patients well, too.
As I come to the end of my career, I know there is nothing better than a shift when the chips are really down, when everyone comes together to achieve the impossible – resuscitating a patient who is having a cardiac arrest, working through a major incident, admitting a clinically unstable and very sick child following a road traffic accident. That’s the NHS at its best.
Would I pursue a career in nursing again? I am not sure. I’ve certainly enjoyed the one I’ve had, and I only hope that conditions can be improved to ensure it is an attractive career option for future generations.