Friday, 28 March 2014

Week 7: Does Nursing Have A Self-Image Problem?

Roy Lilley's daily blog on Tuesday 25 March was about the problem he has with compassion, which he sees as too superficial and lacking substance. He questioned whether 'love' would be a suitable substitute asking: "Can we do love in the NHS?".  Whilst I don't entirely agree with Roy and I do truly believe that compassion can be taught, developed and nurtured in many; this got me thinking about whether there's an issue with how the public perceive nurses.  Much media coverage of nurses continues to be either negative news stories about the tiny minority involved in scandals or frivolous representations.  This is a significant driver of public opinion.  Along with many others, the Royal College of Nursing is trying to provide positive images of nursing to the public and the profession through the This Is Nursing campaign.

Beyond the media and the public is nurses' own image of themselves and the profession.  I make no apologies that I will include generalisations in this blog.  I am well aware that nursing is a complex profession made up of many diverse fields and a multitude of specific roles; however, in this short post I will generalise for illustrative purposes.

After reading Roy's blog and then seeing a meme on Facebook; on Wednesday evening I tweeted, intending to provoke discussion about the values and qualities important to nursing.

Sometimes I am deliberately provocative in what I tweet to see the response that arises and to stimulate debate.  I don't always necessarily personally subscribe to every view I tweet, but am always interested in others' thoughts, feelings and opinions.  It was Trish Greenhalgh, shortly after I joined Twitter, who said that it is important to follow people whose views you don’t agree with to avoid groupthink.  It is the diversity of Twitter that makes it so interesting.

At the time of writing this blog, the tweet in the image above has over 160 retweets, almost 100 ‘favourites’ and also sparked an interesting debate about whether this sentiment devalued the skills & intelligence of nurses.  During this debate, I tweeted "IF you had to choose between 2 essential nursing attributes: RT for Care/Compassion or Favourite for Intellect/Skills (hypothetical Q only)".  This furthered the discussion with the majority of responses being along the lines of 'can't choose/won't choose'; however, of those who did make a choice one way or the other there was a small majority in favour of compassion over skill.

What was particularly interesting to me about the high number of retweets, the choices made in replies and the discussion that took place was that this mainly involved nurses along with invaluable participation from others.  This then got me thinking further about whether nursing as a profession has a self-image problem.  Whilst I don't want to second-guess the motivation of most people who retweeted or commented, but for the purpose of drawing a conclusion, I will assume that many did so in agreement with the sentiment expressed (some retweets did include comments like "so true!" so I feel I'm on fairly safe ground with my assumption).

A few, but far from the majority, of people who engaged with and me about this expressed a view that this overall response and many other frequently tweeted and retweeted sentiments are causing a problem.  The theory put forward was that by perpetuating a self-image of nurses as super-hero angels who hold people's hands and talk soothingly to them leads to a suggestion that the profession is less skilled and competent than it is.

We now have degree-only entry into registered nursing with many universities and employers using values-based tools to recruit new nurses to ensure we get nurses who have compassion and competence.  At risk of becoming a mouthpiece for the 6Cs it is essential that all six of the Cs are present and valued by nurses and nursing as a profession (two of the Cs being Compassion and Competence).

I'm not sure if nursing does have a self-image problem; I'm not personally connected to enough of the profession to form a view (and I'm probably not qualified to assess it either – greater research minds than mine may be needed here).

So nurses, academics, people of England and the world, carry on the conversation; does nursing have a self-image problem? If it does, does it matter? If it does and it matters, what’s to be done?  Discuss…


  1. I think we have a danger of being ONLY the angel, the compassionate one, the one that cries with patients. I can honestly say I have only cried with one patient, when in training, at the patients request. I view myself as a competent professional. I listen, empathise, advocate but I am competent in a narrow area of practice and fully admit that to my patients. We are still struggling with the professional vs vocational issue, and images - self or otherwise - as an angel play into that, I think.

    You can teach dignity, body language, compassion. I know, because it was taught to me in my placements. A gently reproving look, a correction of practice, an explanation - these things teach us how to practice the profession of nursing. You can't teach if someone won't learn, and that person would be best leaving the profession perhaps :)

  2. Thank you so much for your comments. I agree many of these skills & attributes can be taught and learnt.

  3. Hands up, I'm one of the ones who retweeted and favourited that tweet. But I have to say I've been thinking about ever since. Is "love" the correct word/term ? The feeling you have with a patient when they are at their lowest or most vunerable, for a split second I think you can feel more than just compassion and empathy. It's almost a split second of "love" but it's certainly not long lasting. Having been a patient feeling incredibly vunerable and frightened, the one thing I felt lacking in my care was compassion, no one came and sat with me to explain what was going on. However nursing proceedures were carried out with military precision. Maybe it was assumed that because I was a nurse I didn't need reassurance/compassion. Could I have complained? How do you complain when all that was lacking in your "care" was compassion? I think to cut a long story short (!!!!) You need both, maybe this is why nurses are getting a bad press, many focus on one and not the other. To me they are symbiotic!

    1. Thanks for your open and honest comments Rachel. No confession needed for the retweet; I wasn't trying to 'trap' or 'trick' people into it, just keen to explore and understand what was important to them. The debate that this has opened up on Twitter has been (and continues to be) really interesting. The one thing that has struck me most, but not surprised me is the passion shown in the conversation. The debate will continue and your contribution is really gratefully received.