Feature

Bandaged up by the nursing bureaucracy

Nurses should be well trained, then allowed to get on with the job, says Barry Clifton. But instead they are being overwhelmed by bureaucracy

I sometimes have a vision of the nursing establishment as a kind of Greek chorus of formidable women in sensible suits and floral shawls, crying disapproval wherever they go.

They are the weight of yearning for professional respectability that nurses struggle under, they direct what will reach the curricula and become fashionable, what will be thought, and said, enforce it through national boards and royal colleges, and re-enforce it through the old girl network of unwritten taboos and blacklists.

They, in the guise of the governing body for nursing, the UKCC, have now invented a new way of exercising power, called PREP (Post Registration Education and Practice). It is a compulsory way of ensuring that registered nurses keep themselves up to date. It sounds like something teachers impose on unwilling pupils, and that is just what it is — an imposition. It is no longer enough to satisfy them by a process of examination and surveillance that one is a fit person to bear the title ‘nurse’, and then go off and get on with it.

The idea seems to be that one of two nurses may be rotten apples, thoroughly unprofessional, who will get their registration and then just sit on their laurels. Therefore all nurses must be minutely and regularly examined to make sure they’re not doing so. It cannot be taken for granted that they have chosen to do the job as best they can, and that their efforts are intended to have good results. It cannot be assumed that, if facilities are made available for them, they will pursue the development of their knowledge so they can improve the way they do their job. And as for their experience actually doing the job and dealing with people, or their experience in the wide world beyond nursing, these do not count for anything at all.

What is much more important is that nurses attend a minimum number of study days, which they will probably have to pay for themselves as health authorities increasingly refuse to, and that their attendance should be written down on an official form called a ‘personal professional profile’, so that it can be scrutinised by the bureaucracy the UKCC is developing for this purpose. This bureaucracy is designed to keep tabs on nurses, who are required to pay up to two or three times the old fee, and every three years instead of just at registration, to finance their own surveillance. In effect, the UKCC is saying: ‘We do not trust you to want to do the best job you can. We are going to supervise you. Give us some money to pay for the supervision.’

If nurses are away having a family, they must come back for those all important study days or their registration lapses. And if a nurse is a mother of two, who can only work a few hours a week, the proportion of her income that she must give up becomes unacceptable and she gives up. So much for attracting people with families back to nursing.

It seems an unattractive prospect, doesn’t it? In pursuit of the much vaunted professional status of nursing all the front-liners, whose chief interest is in looking after patients, are cudgelled into a compulsory academic paperchase, disapprovingly matronised and if possible penalised by the matriarchal mafia, for any deviation from the approved route. The dogma goes like this: ‘Nurses ought to think for themselves. We have a selection of nice thoughts for nurses to think for themselves. Some people are thinking unauthorised thoughts that they have worked up on their own. This must stop. Woe betide any nurse found thinking thoughts for herself we have not approved.’

The worst thing is, they don’t know they are doing it. They work in a fairyland, where they cannot see the day to day stress of wards and the weariness of just getting along. If they visit the wards or the health centres at all, they sweep through in solemn procession, on the way from morning coffee to lunch.

Does this terrible chorus exist outside my nightmares? In writing this, am I calling them down in disapproving droves to perch about me, and re-educate me with chilling kindness?