Nursing has always suffered from a bit of an inferiority complex.
As science and technology (and eventually bureaucracy) wrapped their tendrils into the developing health system, nursing became more uncomfortable.
It took a look at what it did and couldn’t quite put its finger on what that was.
There was never any doubt in its importance. Everyone seemed to appreciate that.
But when the profession looked at what a nurse did it just didn’t seem to be enough.
Nursing was a profession that just didn’t seem…well…. professional.
So it looked lustfully at how doctors had developed medicine into a science and saw the respect and prestige that it had achieved.
It sure looked greener ‘up’ there.
And so over the past decade nursing has made great inroads into developing a foundational integrity in areas of academia and research. Nursing became a science.
Nurse as a master craftsman.
This advancing of the science of nursing is vitally important. There is not the slightest doubt of that.
But as our professions rush to the head, we must not forget the treasure that lay in our hands.
A master craftsman is not constantly going off to do courses, and workshops to improve her work. Rather, she evolves her mastery by pattern recognition gained through years of repetition, by constant reflection, attention to quality, and the transference of something beyond words and letters from her own mentors.
Perhaps besides the usual courses and workshops and competency assessments we need to develop a new set of measures that recognise the value of the flourishing perspicacity1 that a nurse may in fact possess.
Perhaps that is what nursing is after all, not so much a science as a master craft.
Basic nursing care.
We need to take the ‘basic’ out of basic nursing care, re-value and celebrate these skills and qualities.
We must show less experienced nurses the challenge and importance of constantly infusing excellence into the so called basic activities we are called to perform each day.
To show them the deep satisfaction that can be found in cleaning a patient and giving them fresh sheets.
Or the importance of priming a drip properly and with great care for no other reason than the value that is added by doing it this way.
Or the powerful impact they can have on someones quality of life by the simple act of caring for a wound.
Or the privilege of helping someone to die with dignity.
Instead of short cuts, we must teach nurses the art of the long cut.
Instead of multitasking to meet KPI’s2 we must give ourselves time and space to slow down and ‘be’ a nurse.
 Space to explore those intimate interactions and processes that take place directly between the nurse and the patient at the bedside, in their homes or in the community.
We must begin take considered notice of the deep gratitude and appreciation that a patient can feel towards a nurse who is able to practice with art and with craft, and ask ourselves what is the value in this?
The great challenge is to re-imbue our profession with a pride and prejudice in this nursing craft.
I put it to you that at a fundamental level there is no difference in the skill or the value of a surgeon removing a brain tumour and a nurse caring for that patient after the operation. And before you scoff at this, let me assure you that the ability of many surgeons to provide the sort of care a nurse delivers is pretty much on par with the ability of most nurses to perform a craniotomy.
The difference is in our perception of their importance.
Take activities that on first blush are often taken as simple or menial such as re-dressing a wound. Drawing up antibiotics. Repositioning a patient. Making a bed. Counting respirations.
These simple things interact and inter-relate to the healing process in subtle ways that are no less important than prescribing a medication or removing an appendix. In some ways they may be more important.
Nursing is more a verb than a science.
Just the other night the news ran a story of a high-profile businessman who had suffered a heart attack. Tears streamed down the cheeks of this man as he spoke of the care he received from the nursing staff.
Not everyone will have such a positive experience, but we have all seen similar instances of people moved by the care they have received.
What these people often struggle to express is their exposure to something that our profession still cannot seem to put its finger on.
Unless you have actually experienced quality nursing care in the midst of a life threatening illness, the explanation of what it is that we do will probably never be really understood let alone described. I’m sure we don’t even appreciate it ourselves.
But it comes from our hands.
And it comes from our hearts.
One of my more meaningful moments as a nurse was with a patient who was having the defibrillator used as an external pacer. All this scary stuff was going on around him and no one was talking to him. He wasn’t my patient, but I could see his distress, so I walked up to the head of the bed and asked him if he understood what was happening. He didn’t. I calmly explained what was going on, who the various players were around his bedside, and watched him visibly relax. Took me less than 5 minutes, and is probably one of the more important things I’ve ever done in my life.
Too True.
I have felt for a long time that our basic vocabulary regarding what we do is undermining the importance of what we do.
For example, caring… a nice concept, conjures up images of love, butterflies and rainbows. But the general public do not understand the difference between ‘caring about’, and ‘caring for’ someone. I care about my husband, children, friends and family. I don’t care about my patients, I care for them by meeting the needs that they have as their symptoms present. Still have a problem with the word care.
A ‘bed bath’ conjures up images of a saucy, big breasted minx, lavishly throwing around a cloth and bubbles to some poor, sickly man. The reality is, the ‘good ole bed bath’ is a great opportunity to assess overall skin integrity, mobility, pain and to communicate with your patient about their symptoms and to glean history that may expidite their recovery. Also can provide a means for a sensory distraction and contribute to pain relief…
Anyway, I could write a book on this stuff.
Basically, we need to change the way we communicate with each other, and with the public, about what we do. It won’t change overnight, but hopefully it will happen soon.
This contribution is very timely and, from my perspective, very welcome. I think the key phrase here is “the treasure that lay in our hands”. Besides being quite beautiful prose, it says so much that is important in one little space. Having said that, I would like to take it a little further than the writer intended… here it is used to contrast manual (“hand”) labour to intellectual (“head”) labour but what we “have in our hands” is actually ALL THAT WE DO in fulfilling our professional service. This includes things from the head and heart as well as the hands (the “Triple H” triad). Drawing upon knowledge (anatomy, physiology, psychology etc), problem solving, using our personality and communication skills and effecting needed care with our manual skills are all intertwined and interdependent parts of a whole that is so much more – the professional service. I think that the professional service that we provide is still best described by Virginia Henderson, “The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge”. It is around this that we should research, teach, practice and promote our profession, i.e., what we can uniquely offer to the public as a service.