I am on a journey of unlearning, learning and forming educated opinions, not simply repeating what I have heard.
—Jenna Platt RGN RMN
UK Column welcomes back Jenna Platt, the nurse that walks the walk and talks the talk.
Has nursing become too complex? In the last fifty years, the nursing profession has changed so much that it has almost become unrecognisable. In this frank and honest interview, Debi Evans herself a retired State Registered Nurse from the 1976 class, and Jenna (qualified 2006) go back to nursing basics to see where we may have lost our way in the three decades between their cohorts, perhaps without even noticing. Both Jenna and Debi discover that their professional worlds, although nominally the same, couldn’t be more different. While Debi walks us down memory lane, Jenna brings us back to the present, and in this interview they both look forward, with some trepidation, to an uncertain future.
What is a nurse? Beginning with this question, Debi and Jenna explain what a PIN number is in modern British nursing and how important is it for nurses to have one and keep one. What counts as basic nursing care? The Nursing and Midwifery Council (NMC) is the independent regulator for nurses and midwives in the UK, and for nursing associates in England. The NMC has a Professional Code of Conduct in place to protect patients and nurses. How can the NMC Code of Conduct help nurses today—nurses who may be feeling uncomfortable with what they are witnessing and what they are being asked to do? Speaking up is about being brave and professional. Jenna has proven she has both qualities in abundance. Speaking up doesn’t have to be confrontational or hostile, as Jenna has proven with her calm, measured, evidence-based questions.
How can you be angry at someone or with someone for simply following their code of conduct? You can’t. In a chaotic and unprecedented world, many nurses have been simply overwhelmed with information, data and instructions, many have not been able to keep up, and some may inadvertently have drifted from everything that they believe and stand for. Many feel coerced, silenced or under threat if they dare to speak out; many feel isolated and alone. Jenna has already navigated her way down a path few others choose to walk; from her experience, she is able to shed some light and advice on what nurses need to do in order to be heard, listened to and taken notice of.
Jenna allows us into the world of a modern-day nurse, a very different one from that which Debi was trained in. No longer would there appear to be the camaraderie and support that nurses in the 1960s and 1970s enjoyed. No nurses’ homes or subsidised accommodation, no hospital nurses’ transport, no peer group support and no Matrons. The love, friendliness and sense of belonging that Debi once experienced within the NHS appears to have been snuffed out. Today’s nurses find themselves isolated and unsupported in an impersonal leviathan of an organisation. Most don’t even know the name of their direct managers, let alone where to go for help.
The nurse of today requires a degree in order to call herself a ‘registered nurse’. In Debi’s day, most student nurses were accepted for nurse training at the tender age of 18. Student nurses were the heartbeat of the hospital, thrown onto the wards after a mere six to eight weeks of intensive basic nursing care. Today, nurses require a university-based qualification in order to qualify, with less time spent at the patient’s bedside than half a century ago. Both Jenna and Debi agree that this is not in anyone’s best interests.
Selling off nurses’ homes was undoubtedly a big mistake. Often, hospitals are town- or city-central, making transport and accommodation close by very expensive. Unsocial shifts and long hours often mean long lonely journeys to and fro. Forcing nurses to pay extortionate rates to park their cars whilst on shift would have been unthinkable back in Debi’s day, when nurses’ homes had nursing home wardens, often a maternal figure who was there to make sure the nurses all behaved but above all that they were doing well, were not too homesick, were sleeping properly when on night duty—the good old days when hospital minibuses were provided in order to delivery nurses to hospital and back again safely and on time.
Who manages a ward in 2023? Does anyone know or does anyone care? Who looks after the nurses? Debi explains that in the 1970s there was never a question of who was in charge of the ward: it was always a Ward Sister or a Charge Nurse (the male equivalent). However, Jenna explains that times have changed and often confusion arises as to who, if anyone, is responsible.
Patients are no longer called patients; they are called clients, service users or a myriad of other names. Just as patients appear to have lost their identities, so have nurses. Debi’s generation of nurses wore their starched hospital laundered uniforms with pride and strove to gain the treasured badges from their professional organisation—and once they had qualified, felt fierce loyalty to their hospital and their patients.
Uniforms were a perfect way to identify staff. First-year student nurses had a different coloured belt, or perhaps just one stripe on their hats; qualified nurses wore belts and buckles, badges and different-coloured uniforms; everyone knew who everyone was. NHS Trusts were not around in Debi’s day; each hospital had its own unique identity, to go with the uniform and the training. In fact, the friendly rivalry that existed between the London hospitals where Debi trained was both healthy and fun.
Jenna reveals that for her generation of nurses, ‘rewards’ and praise come by successfully completing designated jobs for the day, which appear more important than patient-centred care. In 1976, on the other hand, reward was seeing a patient get better; reward was getting a hug from grateful relatives; it was often the personal unspoken rewards that meant so much. As Jenna points out, nowadays you don’t get praise or even noticed for being kind, or for a smile.
In 2023, it appears nurses’ eye level never rises further than an iPad screen. It appears tick-lists of ‘jobs to do’ have replaced basic nursing care. Washing a patient, changing their bed, brushing their teeth (even false ones) aren’t regarded as ‘sexy’ tasks now; what nurse wants to do that anyway? With all the gadgets and gizmos on the wards, what could possibly incentivise a modern-day nurse to sign up to learn to feed people?
Jenna explains that the fundamental principles of nursing appear seem to have disappeared, almost by stealth. How has this happened, and why are nurses so much busier now? Busy doing what? You can never be too busy to ensure you know your patient’s name, to smile and reassure them, help them take a drink or some nourishing food, hold their hands or sit on their bed and have a chat over a simple cup of tea with them. Yet it seems that those small but enormously important tasks have been overshadowed by tech experts.
In 2023, as modern medicine, medical devices, state-of-the-art, cutting-edge equipment fill our hospitals, both Jenna and Debi agree that perhaps nursing has become too complex; maybe we need to bring it back to basics. Whatever was wrong with ‘tender loving care’ (TLC), a prescription which was always free at the point of contact and never ran out? Whilst many may argue that we have to move with the times and never return to the past, others will agree with Jenna and Debi—from greatly different generations—that precisely going back to the past, going back to basic nursing care, is where we should be heading, at breakneck speed. Bring back Matron, essentially.
Jenna Platt is continuing to ask questions and travel the country. If you see her out and about, please give her a smile and some support. You can find Jenna podcasting here.
Debi and Jenna’s message to all nurses out there is to do your bit, however small. Smile and stick to what your heart and soul tells you is right. Know tonight that, when you come to lay your head on your pillow, you can sleep soundly knowing that to the best of your ability you followed your professional code of conduct and your moral compass.