As health care seems to be enjoying something of a nostalgia fest at the moment, I thought I might reflect a little on part of my own past. Not in general, but specifically on my time as a student nurse in that rosy-tinted, glowing period that was pre-degree nursing, pre Project 2000 nursing, and probably pre-history for many nurses. The early 1970s. The time when some people think nurses were nurses, Matrons were fierce but wonderful, you only needed to read the six books on your reading list and they would fit you for practice for the remainder of your career, and caps and aprons came starched with ready-made authority. I remember it well.
I also remember being very frightened a lot of the time. I remember feeling ill-prepared for most placements and trying desperately to look as though I was supremely confident. I remember being taught neat little recipes for how to nurse specific conditions – not people. This is what you do for an MI. This is what you do for ‘congestive cardiac failure’ (that must date me, surely?). This is what you do for ‘a diabetic’, an appendicectomy, a lobectomy. I’m trying to remember a patient from those three years where I knew anything about their home life, their social circumstances or their family. I’m struggling. Sociology and psychology were introduced into the course during the second year but with no relationship to practice. Nobody talked about research. The term ‘evidence-based practice’ was not something we heard, or did.
Everything seemed to come with somebody’s name attached to it – not just those awkward little bits of anatomy – Oddi’s sphincter, Langerhans’ islets and Willis’ circle – but equipment – Pearson knee support, Roberts’ motor, Paul’s tubing, Thomas’ splint, Nelson’s inhaler, the Charnley tent, and the show-off pocket piece for every nurse who was a real nurse – the Spencer Wells – the 1970s equivalent of the stethoscope around the neck. And even surgery came courtesy of someone – Bilroth 1 and Bilroth 2 (partial gastrectomies), Gritti-Stokes (amputation), a Ling-Lee hip replacement, a Girdlestones op. This really was the naming of parts.
I remember being one of three staff on night duty on 32-bedded wards. One RN, me and a Nursing Auxiliary. I remember being left on my own for an hour during supper breaks and being so scared that something would happen I could scarcely breathe. As a third year, I would be on nights with no RN. Eight nights of unbearable responsibility. But it was normal. A perfectly reasonable expectation of a third year student nurse at that time. It was do or die, one of many baptisms of fire. I thought I was the only person who was scared witless, everyone else seemed so confident, and we never discussed these things. Mostly, I think we didn’t know what we didn’t know. As long as nothing happened, it was all ok. It terrifies me to think of it now – the risks, the casual attitude to patient safety and the arrogance. The expectations, the inadequate theoretical preparation, the unimportance of knowledge beyond the task. As long as you could carry out a list of procedures at certain points in the three years, you were doing well. It didn’t matter why you did them, or when it might be better not to do them, or how to tell if it wasn’t appropriate; no, doing the task well was everything. We would tick them off in a little book, confident that being able to do the procedure meant we were good nurses. Thank goodness things are different now. (There is a hint of sarcasm there, but just a hint).
Support on placements was a hit and miss affair. You might be with staff who enjoyed working with students, you might not. There was no formal student supervision or regular assessment. People talk about how marvellous it was to have Clinical Teachers. The only time we saw a clinical teacher was if they came to do a formal assessment – watch and sign off one’s aseptic technique, or a drug round, or some other isolated task. There was no equivalent of Link Lecturers or Practice Educators, no Mentors. No student services, no counselling, or help with study difficulties.
In spite of this, I (mostly) enjoyed my time as a student nurse, and I learned many lessons that have stayed with me always. Being in a large University Teaching Hospital (hospitals with ‘University’ in their title were pretty few and far between then and usually located with a medical school) meant that I was getting some of the best experiences possible and learning with and from exceptional professionals. But being a student nurse then was a million miles away from being a student nurse now and I know that I would be loving it more if I was a student today. Formal, academic award-bearing education, the deliberate linking of well-taught theory with practice, fabulous university libraries, the support of Link Lecturers and Practice Educators, practice supervision and supernumerary status. Curiosity and questioning encouraged, an incredible variety of placement opportunities, good academic support, academic rigour and real scholarship.
I could have chosen today to blog about how wonderful it all was – telling you amusing anecdotes and how those fiery baptisms made fantastic nurses of us. But I know that The Good Old Days were really not the good old days at all. We should beware of misplaced nostalgia. As George Ball said, and we would do well to remember, ‘Nostalgia is a seductive liar’. I wouldn’t go back there for anything.