You can take the girl out of nursing….

I am a nurse. There, I said it out loud and on the blogosphere. “So what?” you might ask.

Well for a long time now, I’ve not actually denied it, but nor have I explicitly acknowledged it. In fact, for those who adhere to a fairly circumspect and traditional definition of nursing, it’s not what I do anymore. Nevertheless, in recent months I have come to realise that though it may not be what I do, it’s who I am.

When I qualified in 1987, and left a sleepy little DGH to work in the Regional Neurosciences Centre at a large, busy teaching hospital I was enthusiastic, passionate and ambitious. I loved the patients and the fascinating and rewarding work in neurosurgery and neurotrauma, but I soon became disillusioned by the politics and a system that I felt prevented me from doing the very best I possibly could both for my patients and to support my colleagues. Our wards were regularly understaffed, acutely and chronically. We often went without breaks and worked longer than our allocated shifts to deliver the best care possible to our (usually highly dependent) patients. Taking time off sick was frowned upon, but turning in ill just made matters worse for all concerned. Posts were vacated and not replaced. Inevitably there were those who didn’t pull their weight, and those who carried them. I never shrank from bringing such issues to the attention of my managers but not everyone had the courage of their (or my) convictions and I found this difficult to accommodate. I realised that I could not make things better for patients in the role that I was employed to fulfil, and so, after just 5 years, when the opportunity arose, I made a move to a role where I thought I could. It was at this point, when I became Head Injury Audit Sister – and stopped carrying scissors – that many of my clinical colleagues formed the opinion that I was no longer a ‘proper’ nurse. The fact that I still reviewed patient management and contributed to recommendations for overall improvements in the management of head injured patients was, apparently, of no consequence.

My subsequent shift to the role of Research Nurse and then Clinical Trials Manager further accentuated this rift. I continued to see patients, assess their initial status, carry out study procedures and undertake follow up assessments. This often provided patients with a point of contact when clinical follow-ups were being reduced. I still cared about them and for them, but most could not reconcile this with ‘nursing’. Thus, maybe at least in part because others ceased to see me as a ‘real nurse’, I ceased to believe that I was. In the 15 years that followed, although still registered and still having contact with research participants, I pretty much sidelined my nursing history. I moved away from pharma-led research but still, my projects, although healthcare focussed were not primarily or intentionally nurse oriented and did not specifically require a nursing qualification. But there were other, less benign reasons why I chose not to advertise my nursing background.

In some ways I was ashamed, of the profession and of myself. Ashamed of the profession because of incidents such as the Beverley Allitt case, and the ‘too posh to wash’ and ‘too clever to care’ stories that were already circulating with the advent of the Project 2000 training and the move towards relocating nurse education in HE rather than hospital based nurse training centres. And ashamed of myself because there was always a niggling doubt, that I should have stayed, and tried harder to make a difference. Sometimes I felt the impact of a kind of  intraprofessional snobbery, which saw nurses who moved out of direct, hands on clinical care branded ‘hard’ or over ambitious, alongside accusations that they had abandoned the fundamental tenets of their profession. Many of my colleagues had been conditioned to think that they could not achieve academic success, and were therefore suspicious of those who believed that they could, let alone those who did. Although I think things are changing, especially now that research is recognised as a career path for nurses, there are still those who think that nurses who pursue such goals have ‘ideas above their station’, or are ‘wannabe doctors’. Similarly, the notion that research and care are antithetical perpetuates the performance of the traditional nurse role and identity, alongside the idea that ‘never the twain shall meet’. It disturbs and concerns me that many nurses do not see the enormity of their skills and the extent of the contribution they can, and do, make to improving the nation’s health and healthcare.

And yet, in these last few months, my disillusioned self seems to have come full circle. I attribute this partly to the fact that I have completed my doctoral research, much of which focussed on the day to day working relationships between clinical and research teams, and which thus addressed some of the issues I had experienced myself. But also, unexpectedly, Twitter has played a part in reconnecting me with my nursing roots and helping me ‘reclaim my identity’. Perhaps perversely, recent events – mostly pertaining to the Francis Report and the incessant media onslaught against the NHS and against nurses in particular – have reignited my interest and pride in the nursing profession. On Twitter, and in blogs and Twitchats, the outpouring of indignation and hurt from nurses of all grades and specialties, across the country, although painful, has also been inspirational. Inspirational, because even amongst the hurt, there has been hope, aspiration and pride, and also a very strong sense of community and a desire to support and help each other, with the ultimate aim of benefitting patients. In my clinical role, yes, a few of us shared concerns and ideas, made battle plans over a coffee, but we never seemed to have the strength, backing or wherewithal to move things forward. This meant that discussions often degenerated into a mass moaning session, rather than a forum for support, innovation and change. Twitter has provided such a forum and although at first I felt like a bit of an interloper, my early experience and my continued involvement in healthcare, albeit from a different perspective, means that I can still participate and contribute. Nursing informs my work and my interpretation of it, and helps me to come to projects with an understanding that non-clinical researchers would not have.

And so, I conclude, nursing is not what I do, it is who I am.

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