Review

Looking in on nursing

NURSING A PROBLEM
Lesley Mackay
Open University Press, 1989

This study of nursing is by a research sociologist, who states at the outset that she is not a nurse, but ‘an outsider looking in’. This is no disadvantage. The overall reaction of a nurse, working with patients in a hospital, is likely to be one of delighted recognition.

Lesley Mackay’s book is based on accounts by working nurses of their own situation, and much of what she reports echoes, almost verbatim, conversations this reviewer hears every day on the wards where he works.

Among the topics she enlightens are: the disabling difference between what learning nurses are taught in the schools and colleges of nursing and what is actually done on the wards; the difficulties of operating in a hospital hierarchy traditionally dominated by male doctors; and, perhaps most important, the stresses nurses experience from their direct confrontation with acute situations where ‘matter of life or death’ means just that. The author highlights the way these stresses are amplified by poor resources and unsympathetic treatment by managers, whether nurses or not, and the overwhelming lack of support from other professions, from managers, from educators and, perhaps most worryingly, from one another.

She finds that what keeps nurses nursing is the satisfaction of the relationship with the patient. ‘The various difficulties’ she says ‘are not yet sufficient to counter the rewards that nurses obtain from their patients.’

It is noteworthy that in the largest nursing magazine, this book was reviewed by a nurse manager, whose reaction was so nakedly hostile that it produced protesting letters from Ms Mackay and from readers, of whom this reviewer was one.

If a book is crowing that close to sensitive toes it says much for its relevance and power. It is undoubtedly the best recent account of nursing, and begs the question, what will happen to health care when the difficulties of nursing start to outweigh the satisfactions? A situation that, in the current climate, grows nearer for many of us every day.