Who’s really who in nursing?


I’ve written before in this blog about images of nursing, elsewhere I’ve touched on nursing heroes and icons, and a bit of nursing history.  I’ve been considering for a while the ‘famous names’ of nursing from an historical perspective, and wondering why there aren’t rather more.  I’ve had a few conversations with colleagues about it – this lack of a UK roll-call of nurses who have contributed significantly to nursing practice, research and education and also to nursing’s image and status in a positive way.

When I Google ‘famous nurses’ I get a list of mostly American women (nurses in the USA do seem to do celebration rather better than here at home).  The UK representatives on the lists are the expected ones – Florence Nightingale, Mary Seacole, and occasionally Edith Cavell.   Nineteenth century women, two of whom were – arguably in my view – not really nurses as we recognise the term today although the contribution of both is undoubted,  and one who is recognised for her heroism and war-time subterfuge rather than her nursing skill.  Ethel Bedford-Fenwick is beginning to be recognised for her work on registration and she crops up occasionally in searches, but beyond the 19th and very early 20th century there is no-one clearly identified – and widely recognised – as having a significant impact on the development of the profession.   Yes, individual nurses can maybe suggest one or two who, to their mind, made a difference, but there is no formal recognition.  In fact, there is no list even of potential contenders.

This made me wonder how nursing students are taught about the history of the profession, and if that history teaching falters in terms of the contribution of individuals beyond 1918 (Nursing faculty – there’s a survey coming your way…).  I suspect that when we formally research nursing history we probably do quite well at 19th century women, and nursing in time of war.  Neither of which help to move us on more generally from the stereotypes/archetypes that give us only 19th century women as our icons.

So, I’m thinking of embarking on a piece of work to correct this a little.   I want to find out who were the nurses who made a significant impact on UK nursing practice, education or research, or the improved status or development of the profession between, say, 1920 and 1980 (or thereabouts).   A quick literature review reveals very little serious work on this subject in this period.   I’m not interested in later than that – there has to have been enough time passed for their achievements to have been consolidated and accepted.   For example who were the nursing ‘firsts’?  The first PhD in Nursing?  The first Professor of Nursing?  Who’s innovations in practice led to their name becoming a byword for a particular intervention or group of interventions?  Who was influential in nursing becoming an academic subject?  Who influenced professionalisation?  Who wrote the first undergraduate degree programme?  Wouldn’t it be fascinating to know?  Wouldn’t it be brilliant to hear the stories of these nurses?  Wouldn’t it be great if we could hold up half a dozen or so 20th century nurses as significant contributors?  Promote them nationally and internationally?  Get them widely recognised?  Taught in schools?  Move the iconography and therefore the image of nursing away from the 19th Century?

I could sit here and find all this out for myself – it’s a PhD waiting to happen really, but I’m old and don’t have the time or the inclination to sign up to a million years of part-time study.   I want to crowd-source possibilities.   Then the research would need to start on whether the suggestions are worthy of making the cut or not.  It’s exciting isn’t it?   Do you want to help?  Let’s add a bit to nursing’s history.

Update a few hours later: Give me time to get organised and now I know there’s interest, I’ll be on it!


Another blog on blogging…


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Last time on the blog (see below) I talked about getting started with blogging.  Hopefully by now some of you will have set up your page and given it a go.  In my last blog I also said that the whole point of a blog was to put yourself out there and have others read your words.  Publicising your blog is part of blogging – you can just publish and leave it to chance that the people you want to reach will find you, but far better to deliberately target the people you want to reach and the ones you think might be interested in what you have to say.  Once you’ve found your ‘Voice’ then you need people to hear it.  You need to try to do what’s called ‘driving traffic’ to your blog.

First I have to say that I am no expert at this.  I really only use two mechanisms for publicising my blog – Twitter and LinkedIn.  Before I started blogging I had already built up a following on Twitter, so I knew that if I tweeted a link to my blog it would reach quite a few people and some of them might actually read it.  I also found that if I blogged regularly then some people signed up to follow the blog and so received any new blog automatically.  There is a setting on a WordPress blog where you can put a ‘Follow’ button (see my sidebar), there is also a setting (Post Settings) where you can automatically share your blog to Twitter and to LinkedIn, so it’s worth doing that.  I also might send the blog via Twitter to a few specific people.  If they like it, or think it may resonate with their own followers, they will often retweet it to all their followers.  This builds up a fairly substantial reach.  But there is no point just tweeting it out once.  For the first couple of days after I’ve published a blog I will tweet a link to it every few hours – especially at the times when I know my followers will be likely to look at their Twitter accounts – lunchtimes and evenings.  I then retweet the link a couple of times a day for the next few days and at the end of a week I will do a couple of Tweets with ICYMI (In Case You Missed It) and the link.  This way you will catch more of your own followers and they will in turn catch more of theirs in a retweet.  Some people I know feel slightly uncomfortable about ‘pushing’ their blogs in this way – I did at first – but if you don’t keep resending, then you simply won’t reach as many people.  Just think how much stuff rolls through your timeline that you don’t ever see – that’s your blog tweet rolling through there, unseen.

I also allow comments on my blog – again you set this up when you start.  I allow comments but I always see and approve them before I let them appear on the blog.  I respond to comments if they need a response, and even if they don’t, I always respond to say thank you, or to ‘like’ a comment.  I think that not enough people comment on blogs – I love it when my blogs attract a comment!

My blogging process goes something like this:

  1.  Write the blog. Publish. Tweet a link to the blog saying something like “Here’s the latest on the nursing blog…(link)”
  2. Tweet a link to the blog to individuals who I think might be interested in it, so it    appears in their Notifications rather than just in their Timeline
  3. Retweet a link to the blog every time I use my Twitter account over the next day or two and retweet a link to the blog every day for a week
  4. Retweet a final ICYMI link just a few hours before I post my next blog.  I do this to keep me fresh in their timelines as a blogger.

And that’s about it really.  You just have to start doing it, and see what works for you.  It takes a while to build a followership, but if you’re interesting, then you will get readers and if they like what you say, they will become regulars.  In summary then, here are my points for blogging about nursing:

  • Read blogs by other nurses to get a feel for how they approach subjects, style, format etc.
  • Think about your subject matter – topical, controversial, educational, illuminating, musing – be focussed, then go for it.
  • Be careful about unintentionally identifying people or patients. Be mindful of your professionalism and don’t blog anything you wouldn’t say out loud in a public place.  Because you are saying it out loud and in a public place.  Follow the NMC Code of Conduct and their social media guidance.
  • Check your blog before you publish it and edit and format it properly.
  • Be part of a social media community/ and build some followership BEFORE you start blogging if you can.  That way you have a ready-made audience.
  • Respond to comments positively.
  • Remember that what goes out there, stays out there.


Go on – give it a go! And tag me into your first blog link!!




A blog on blogging…



Coming late to a WeNurses Twitterchat last week, I caught the last bit of a conversation on nurses and blogging.  I think it was called ‘Why don’t nurses blog?’ or something similar – you can find it here .  I made a few comments but I was really too late to join in the main conversation and I was cross with myself because I wanted to contribute.  I’ve been blogging for nearly four years and I’ve learned quite a lot about the process in that time.  If you’re thinking about starting a blog and you’re a nurse or a student nurse – then just do it.  Try it.  Don’t betray any confidences,  don’t abuse people,  be sensible in terms of the NMC Code and their guidance on using social media.  Find a platform (of which more later) and get what you want to say out there.  If you enjoy it,  and you’re not frozen by fear of what people might think, then start to work at it a bit more seriously.  Looking at some of the questions and concerns from the Twitterchat, the following might be useful.

What would I blog about? Blog about anything that moves you enough to want to share a view.  You might give your blog a theme.  This blog is about nursing, but sometimes I write about other things on here.  This question really should be Why would I blog? Here are some reasons why I blog:

To give my opinion on something I feel strongly about.  To provide information, or to add information to something if I think it might be useful.  To agree with something and to be  persuasive to encourage others to agree, or at least, to think again about something.  To disagree with something or to challenge something.  To tease, needle, irritate or provoke.  To be controversial and start a discussion.  To berate or to rant if I’m cross enough about something.  To educate or explain or debate.  To sympathise, empathise or otherwise show solidarity.  To describe and share an experience or my feelings.  To encourage people to think and think again.  To help myself think a bit harder.  To rethink.  To amuse.  To make contact.  To entertain.  Lots of reasons.  Often I am prompted by a snippet of conversation, a news item, a Tweet, something I’ve read or heard.  Sometimes people ask me to blog about something in partiular.  There are no end of motives for me.  You will find your own motives, and when you do, you will want to write.

Don’t blog if you haven’t got anything to say, or if you really don’t want anyone to hear/see what you say.  The whole point of a blog is to have your words read by other people.  Some people say that a blog might be helpful as a reflective tool just for them personally, and not shared with anyone.  It might.  It probably will.  But that’s not a blog.  It’s a diary, or a personal journal.  A blog is meant for an audience.  It is public.

Why would anyone want to read what I have to say?  This is the question on every start-up blogger’s lips.  And there are quite a lot of answers to this; it’s a much more sophisticated question than it seems.  First – You are part of a very large professional group.  So even if you don’t have very much to say, quite a lot of people will just swing by and read it anyway, just because you are a nurse, and so are they.  They aren’t reading YOUR blog, they’re reading a blog by another nurse.  Sorry to prick your ego straight away, but there you are.  The trick is to get them coming back to read YOUR second, third and fourth blogs etc.  And that’s about content, which is Second – Your blog is interesting/informative/topical/thought-provoking/amusing.  These are the things that bring people back.  If people get to know that your blog is interesting/informative/ topical/thought-provoking/amusing – they will come.  Your blog may not quite be their ‘Field of Dreams’ but it will engage them sufficiently so that they want to hear what you have to say.  Note that list doesn’t include ‘exquisitely written’, ‘grammatically awesome’, ‘spelling perfect’.  Not yet.  If you are interesting etc. then your readers will forgive quite a lot in terms of indifferent writing skill at the beginning.  That’s at the beginning – so don’t ignore the Third – Your style is easy to read.  Craft your blog a little more.  A Joyceian stream of consciousness is fine occasionally, but not all the time.  It’s difficult to read.  As is text with very poor punctuation, very bad grammar, a lot of spelling mistakes.  Very long sentences.  Very long blogs.  Eventually, it will put people off.  So work on your writing.  Be concise.  Go easy on the adjectives.  Use paragraphs shorter than this one.  Edit, edit, edit.

So, when you start, it’s less about what you have to say and more about what you are saying and how you are saying it.  Lots of blogs are written by people who aren’t ‘famous’, don’t hold positions of power or authority; their names are not well-known within the profession – and their blogs are very successful.  Sometimes they’re anonymous.  Nobody knows who is the writer and it doesn’t matter because the content brings the readers in.  Using your name or being anonymous is a matter of choice.  If you’re employed and you want to be controversial and you are scared it may have repercussions at work, then anonymity may be the way to go.  But what happens if you also want to write stuff that you would be proud to put your name to?  That you actually want people to know who has written it?  Just think this through and I’ll address it a bit more in part two of this blog.

How do I blog? Google how to blog.  Find a platform – there are free ones – WordPress and Blogger are two of the most widely used.  This blog is written on WordPress.  It’s reasonably simple to use, fairly intuitive to set up as long as you are patient, and there are good choices of template to use.  Generally speaking, you will need an email address, a name for your blog, and a name for your account.  A photo or two may be useful.  A bit of customizing, which can all be done through menus, and off you go.  Ask someone who already has a blog to help you.  At the top of your blog menu there will be a page called ‘About’, or something similar.  This is where you tell people what to expect from your blog.  Whether it’s focused or eclectic.  Whether it’s weekly or infrequent.  Whether it’s truth or fantasy.  You might also want to give a little information about yourself.  Maybe a photograph.  Take a look at my ‘About’ page above.  Read other blogs to see a variety of format and layout.  Keep it simple to start with unless you are a whizz at these things.  Once your template is set up, write your blog, tidy it up, be sure you are happy with the way it looks (you should be able to preview it) and press the ‘publish’ button.  Your words will be out there – available for however many zillions of people may choose to take a look.  That feels a bit scary at first.  Less so when you check your stats and see that only 6 people have viewed your post…and 3 of them are probably bots.

Next post – how do I get people (other than my friends and family) to read my really interesting blog?  To be continued…


Nursing Associates – a few facts

The information in this blog was correct at the point of publication.

From time to time people ask me questions about the role of the Nursing Associate.  They forward tweets to me, or screenshots of Facebook pages, generally demonstrating confusion, or inaccuracies, or ambiguity about the role and they ask if I can comment.  I usually engage and try to be accurate, but I am also aware that there is confusing information out there, sometimes contradictory information even from authoritative sources, and it is not easy to get at the most up-to-date and accurate position.  I thought there was scope for a blog that sets out the current position – as far as I can ascertain it – so I’ve been in conversation with the Chief Executive of the Nursing and Midwifery Council (NMC) and this blog is a result of that conversation.

1 Nursing Associate education

Most current trainees preparing to be Nursing Associates are undertaking a two-year Foundation Degree (or equivalent).  These are pilot test programmes at academic level 5.  Whilst on these programmes trainees could accurately be described as Trainee Nursing Associates (TNAs).

The pilot programmes were developed using Health Education England’s (HEE) curriculum framework.  HEE established a two-year Nursing Associate training programme in January 2017 and these have not been approved by the NMC as they started before the regulation of the role.  The NMC has shared an early draft of Nursing Associate standards of proficiency, and it will consult on a further version later in the Spring of 2018, but the regulatory standards cannot be formally agreed until the new legislation is in place (see below).  Therefore the pilot programmes cannot be assessed for approval until after the legislation is in place.  The new legislation is expected to be in place around July 2018.

HEE is engaging with the NMC to support its pilot cohorts to meet the NMC’s required standards.  However, according to the Department of Health’s Nursing Associate consultation, the NMC will, where necessary, still have the power to insist on further education and training and a test of competence, if required, in order to protect the public.  Ensuring qualifications meet the required standards will provide assurance that all registered Nursing Associates are appropriately qualified and capable of safe and effective practice.

2  Nursing Associate Registration

There are two  main part to the NMC Register – Registered Nurse and Midwife.  In terms of Nursing, the existing Register is for Registered Nurses who have completed an NMC (or its predecessor bodies) approved three-year preparation programme (I know there are shortened programmes/pre-registration Masters etc, but for simplicity’s sake I am citing the usual route here).  Since 2013 entry onto the nursing part of the Register requires a Bachelor’s Degree from a University which has been approved by the NMC.  A Bachelor’s degree is at academic level 6 and normally takes 3 years of full-time study combined with a standard number of practice hours.  Entry on to the Register allows the use of the title ‘Registered Nurse’.  This title is protected in law.  It is an ‘offence’ to use the title Registered Nurse if an appropriate programme leading to registration has not been undertaken successfully, and it is an ‘offence’ to use the title Registered Nurse if one is  not on the appropriate part of the NMC Register.  More detailed information on the Register for Nurses can be found on the NMC’s website.

A part of the Register for Nursing Associates does not currently exist.  The NMC has to be the regulator in law before that new part of the Register can be created.  As stated previously, that legislation is not expected until July 2018.  Nursing Associates will apply to join the new Nursing Associate part of the Register when they qualify and can demonstrate that they have met the NMC’s standards and wider registration requirements.  They will not enter the Registered Nurse part of the Register.

The date of the required legislation is crucial.  I understand from the NMC that if the legislation is delayed, the Nursing Associate part of the Register may not open in January 2019 when the first 1,000 Nursing Associates qualify.  If the legislation is not in place, there will be no requirement for Nursing Associates to be registered in order to practise and they will be practising unregulated.  The title ‘Nursing Associate’ will only be protected when the new Nursing Associate part of the register opens.  I understand that there is constant dialogue with the Department of Health relating to this crucial timing.  Some information on potential transition arrangements can be found in the Department of Health’s Consultation document on the Regulation of Nursing Associates. Pages 18 and 19  specifically.

There is also some confusion over the title to be protected for the new role.  The title ‘Registered Nursing Associate’ with the post nominal ‘RNA’ is felt to be too close to the already protected title of ‘Registered Nurse Adult’ with the same post nominal of ‘RNA’.  The Department of Health has consulted on protecting the title ‘Nursing Associate (NA)’.  This will help to avoid confusion with Registered Nurse Adult.  However, this will not be known for certain until the Department of Health publishes the responses to its consultation in February 2018.

In the same way as for Registered Nurses, the Department of Health will create an ‘offence’ – anyone calling themselves a ‘Nursing Associate’ who is not registered on the appropriate part of the register with the NMC will be committing an offence. This is an important point for individuals, and equally important for employers to recognise that they cannot use the job title ‘Nursing Associate’ for workers who are not on the appropriate part of the NMC register.  Further information on this can be found in the Department of Health’s consultation document on the Regulation of Nursing Associates. Pages 25 and 26 respectively.

The purpose of regulation is to protect the public.  It does this by approving standards of education and only allowing those who successfully undertake such education to be entered on to a register and to be able to use the appropriate title. Where titles are protected in law e.g. Registered Nurse, they cannot legally be used by someone who has not undergone such education, or someone who is not on the register – neither by an individual nor as a job title by an employer.  As a result, the public can feel confident that anyone caring for them who uses a protected title has undergone a specified period of education and continue to meet certain standards.

3 Additional information

A Batchelor’s Degree leading to registration as a Registered Nurse and a Foundation Degree (or equivalent) leading to registration as a Nursing Associate are different programmes, at different academic levels, leading to different roles.  A qualified and Registered Nursing Associate is not a qualified and Registered Nurse.  The Nursing Associate is a support role and the key areas of delegation and supervision are still being actively considered.  These areas will need to be clear by the time the NMC’s Council agrees the standards for Nursing Associates.  See the NMC’s draft standards of proficiency for Nursing Associates for some description of the major differences between the functions of the Nursing Associate and the role of the Registered Nurse. Page 5 specifically.

It may be possible for Registered Nursing Associates to progress to undertake a shortened Bachelor’s degree leading to registration as a Registered Nurse, but until the Nursing Associate standards of proficiency are published it isn’t possible to say how much of the Bachelor’s degree they would need to complete.  Entry onto a shortened Bachelor’s programme is normally at the discretion of an awarding higher education institution (University), following the assessment and mapping of the content of the completed FD (or equivalent) against the content of the Bachelor’s degree, bearing in mind that the two programmes are at different academic levels  i.e. they will differ in terms of breadth and depth of study as well as content.  Given that the Nursing Associate role is meant to be a ‘bridge’ between the Health Care Assistant and the Registered Nurse, it seems likely that there  will be some firm guidance on this in due course.

So, there you have it.  Some facts from an authoritative source that I hope will be helpful.  Please note that this blog is not my personal view, my opinion or a reflection of my own thoughts.  It is an attempt to set down some factual information.

I would like to thank Jackie Smith, Chief Executive of the Nursing and Midwifery Council for a frank conversation and for checking the information in this text prior to publishing.

Looking forward…



We are just into the new year and it’s high time I returned to the blog.  A very happy and peaceful new year to all of you.  I hope 2018 brings you all you might need to be happy.

Although I love the good wishes and the sense of new starts, I dislike the new year period.  I find it hard to feel hearty and celebratory as another year slips by, and as I get older, I realise more and more how sweet life is.  I’m not miserable about it, it’s just that the noise, the false bonhomie and raucous entertainment simply don’t appeal.  I haven’t stayed up to see the new year in for many years.  I ring around family and friends during the evening and then take myself off to bed as usual, looking forward to a new year in the morning.

When I was a child new year was a very traditional affair. The whole family (including one and a half sets of grandparents) would gather at home during the evening.  At a few minutes to midnight my father would discreetly exit the house by the back door and make his way to the front door, which would be ajar.  He would sing the chorus of a mawkish old music hall song, I think called ‘The Miner’s Dream of Home’ (see below*) and then walk though the house, in through the front door and out through the back, carrying coal, bread and salt. There would be much sentimental weeping, hugging and kissing and shouts of ‘Happy New Year’ and we would all gather on the doorstep to listen to the local church bells ringing  “…the old year out and the new year in…”.  It was like something out of bloody Dickens.  Dad would then go off to do the same at any neighbour’s house that didn’t possess their own tall, dark male.  My parents had been brought up in working-class families with Edwardian, if not Victorian, values and this was just one manifestation of them.  This was the nineteen sixties – it could have been the nineteen hundreds.  It’s maudlin influence has seeped down the decades leaving me with a melancholy apprehension and a life-long dislike of New Year.

There is one part of those remembered evenings that I miss, however.  Do the church bells still ring in towns and villages on New Year’s Eve?  I haven’t heard any locally for many years, and I think the occasion is the worse for it.  I’ve always loved a proper ringing of church bells – two of my uncles rang at our local church and I would sometimes get taken along to practice evenings.  The rich, falling cadences of the quarter peals, the called changes like some arcane ritual.  It was enthralling.  Sadly, it seems to have been lost to shrieking and fireworks.  I’d rather sleep through it all and have the year fresh and new, ready when I wake.  And then the plans begin – there are seed catalogues to read, the latest Nigel Slater to cook my way through, theatre tickets to book for the whole season, the greenhouse to prepare, a book to properly start, garden shows…

Life is sweet, indeed.

*’I saw the old homestead and faces I love; I saw England’s valleys and dells.  I listened with joy, as I did when a boy, to the sound of the old village bells.  The fire was burning brightly – ’twas a night that should banish all sin.  For the bells were ringing the old year out, and the new year in.’

To be, or not to be… called a Nurse


This week the Guardian’s Health Professionals blog published a piece by Professor Alison Leary about the proliferation of titles in and around nursing and the issues that it raises.  You can read it here.  She has also published her research into this in more detail here.  The subject crops up regularly on Twitter and there have been reports on Professor Leary’s work in the popular nursing press.  In my own conversations with colleagues we talk about whether the time has come for the title ‘Nurse’ to be protected, so that it cannot be used by someone who hasn’t undertaken the required three-year Bachelor’s degree programme and be subject to statutory regulation.  Many people mistakenly believe  the title is protected, but in fact it is ‘Registered Nurse’ that has protection – but that isn’t the title in general and colloquial use.  There is also a view that protected title isn’t necessary – usually citing the view that no-one worries about Tree Surgeons or Drain Doctors or that if we protect ‘Nurse’ does this mean that Dental Nurses couldn’t use the title or Vet Nurses?  There is an exasperation about these comments that indicates that this is just nursing being ‘precious’ – again.

So, why is the proliferation of titles associated with nursing an issue?  First, for those who make the perfectly reasonable point that ‘no-one bothers about confusion between Doctors/Surgeons and Tree Surgeons or Window Doctors’ –  it kind of misses the point.  You are unlikely to meet a Tree Surgeon and a clinical Surgeon in the same garb in the operating theatre and therefore confuse them, and the same applies to your Drain Doctor – they are unlikely to be attending to you in a clinical situation alongside your physician. Similarly,  you would be unlikely to find yourself having to distinguish between a Registered Nurse and a Veterinary Nurse practising on a hospital ward (one hopes).

Professor Leary’s point is a more sophisticated one.  There are care support workers in clinical situations working alongside Registered Nurses,  with job titles that include the word ‘nurse’,  responding to being called ‘nurse’,  wearing similar uniforms,  and sometimes giving the impression that they can offer the same level of care and have the same knowledge and skill as a Registered Nurse.  This is a very different situation and obviously has the potential for misunderstanding and confusion.  Unless the difference between a Registered Nurse and a support worker is made very clear to the patient then there is a danger that the patient/client/vulnerable person or their relatives may make an assumption about the expertise of the person providing assistance.  Patients have to put their trust in the ability, the competence and expertise of those providing care and treatment, and a recognised, socially meaningful title plays a part in underpinning that trust.  Any lack of clarity is at best unfair and confusing, and at worst deceptive and dangerous.

Neither Leary’s article nor this blog is about attacking support workers and the important assistive work that they do, it is pointing out the ambiguity inherent in the NHS’s use of job titles which helps neither the support worker nor the Registered Nurse and may well confuse or mislead the people in their care.  Openness and transparency is the issue here, and ultimately patient safety.

Relax, refresh and renew…



When I gave up full-time employment in March of this year, I was looking forward to a change in lifestyle.  Six months later I am reflecting on that change and how it feels. It feels good.  I expected it to be a positive change – I had planned for it for a while – but I have been surprised at how comfortable it has been to slip the traces of routine, commitment, power and influence.  I still engage informally with my discipline and with the higher education sector and that’s enjoyable and interesting.  At first, I still got irritated about things and picked up old frustrations, but I find, over time, that the old issues are less significant to me and I am finding I let things pass by in a way I would not have done twelve months ago.  I am consciously choosing what to spend my intellect on, rather than reacting on auto-pilot to what I see.

In the first few months I was keen to keep up with former colleagues and accepted invitations to meet.  More recently I find that I am looking for personal value in relationships, rather than ‘keeping in touch’ for reasons that are often unclear if I stop to examine why something is in the diary.  This has surprised me.  I am a gregarious person and enjoy the company of others, but new people are cropping up in my life and although they do not replace old friends, they are gently easing aside former acquaintances.  And I find it is increasingly easy to distinguish between friend and acquaintance in a way that I hadn’t previously.

I knew when I gave up employment that I would want to continue to make a contribution somehow.  I have been surprised by not really knowing what that means.  For example, I put myself forward for a couple of things that I thought would be interesting – they were the kind of things that you would probably expect me to be interested in – but as time went on I found that actually, I couldn’t raise that much enthusiasm. That puzzled me for a while and I thought that perhaps my energy was low, but slowly I realised that they felt like ‘ought to’ rather than ‘want to’ and I recognised that actually, I just didn’t want to.  This is one of the benefits of not working that takes a little getting used to.  You don’t have to do what you don’t want to (except for necessary chores, of course, and going to the dentist etc).  I still don’t always say no soon enough, but that’s coming too.  I still work and I’m still available, but in a much more focussed way.

I am spending time and brainpower on the things that I promised myself I would – the garden, writing, cooking, my remaining family, reading – and I’m about to enroll on a Masters in Research in History.  The MRes is not something I was planning but it presented itself to me through a conversation with a friend and I thought, ‘why not?’.  And throughout the excitement of finding a course that suited me, the tedium of the application process, the novelty of being interviewed before acceptance, I have maintained an enthusiasm and curiosity about studying again that has delighted me.  I am really looking forward to it.  And to being a student for a while.  The thought makes me smile.

I’m sure the next six months will bring more changes – and more choices.  I love the intellectual freedom, the physical freedom and the lack of obligation.  Who knew it would be so good?


Think about nursing’s image, then think harder…


In the last year or so I’ve written a bit about inappropriate images of nurses in the media and elsewhere.  Inappropriate in my view because they depict nurses unprofessionally, or as objectified or over sexualized, or grotesquely parodied.  Each time, I’ve been congratulated and berated in equal measure.  I’ve been called ‘brave’ and a ’stupid, stupid woman’ (and worse).  I’ve been thanked and also accused of having a ‘sense of humour failure’.  No matter.  What does matter to me is the profession of nursing and its future.  I’m a nurse, and I care very much about how my profession is presented to and viewed by the public.  Not least because that public image underpins society’s trust in nursing, it’s view and value of nursing, and because society’s view influences the view of decision makers and Government.  And there are some important points that need to be made to counter some of the negative views put forward.

*Firstly, there’s nothing wrong with being seen as attractive and sexy – as long as it doesn’t become one of the most common public images associated with your profession. ‘Sexy nurses’ are a persistent fantasy – a well-know high street and online lingerie shop sells a ‘Naughty Nurse’ outfit that is very popular.  It’s right next to the Naughty Maid outfit.  And the Naughty Air Hostess.  I couldn’t find a Naughty Doctor, Naughty Lawyer or Naughty Engineer outfit.  In fact, it seems that the Naughty costumes are largely associated with jobs that are traditionally female, as nursing is.  Does it matter?  Well, it matters to me to see the profession used as shorthand for unintelligent, submissive, or sexually dominating, available females, or pantomime-dame-parodied as if there was something intrinsically amusing about a profession that concerns itself with the health and well-being of the population.  And I know it bothers other nurses, many of whom won’t speak up because they don’t want to be seen as strident, or shrill or prudish, or any other of the tedious adjectives applied to women who say they don’t like their profession being seen in this way.

*Secondly, objecting to these portrayals isn’t about nurses ‘losing their sense of humour’ or their ability to have fun.  It’s about pointing out the danger of ‘disparagement humour’ – when prejudice/sexism/racism is delivered in a joke.  When disparaging remarks, or a demeaning image, is presented ‘in fun’ it discourages criticism of the discriminatory message, because it encourages the receiver to accept that message as the norm.  There is research from the USA that has found that repeated exposure to disparaging jokes creates a greater tolerance of future discriminatory events in those who are already prejudiced.  It’s called ‘prejudiced norm theory’.  So, if the jokes aren’t called out for what they are, they’re repeated, and they become more and more acceptable, and it becomes more and more difficult to challenge them.  Does this seem familiar?  There is a big difference between nurses knowing how to have fun, and nurses being made fun of.  I think many nursing leaders need to understand this.

Thirdly, the pressure on nurses to ‘just get over it’ has been around forever.  I don’t want to get over it, I want to change it.  If there is anyone reading this, who is not aware of nursing’s history, then please, go and find out about it.  Its route to professionalism has been nearly two hundred years of struggling for improvement and change.  For example; gaining acceptance as a job for women other than gin-soaked semi-criminals or religious orders (a nineteenth century cliché, but it will do for starters); for the most basic training in the care of the sick; for regulation and registration in order to protect the public from the untrained and incompetent; for recognition as something more than a doctor’s helper; for recognition as a profession in its own right; for formal education in line with other similar professions; for a career structure that rewards skill and knowledge; for better pay – all of these are linked to a battle for respect.  Every step hard-fought and hard-won in the face of political prejudice, societal norms about what women – and men, come to that – should and shouldn’t do, can and can’t do, and sexism and gender constraints.  And  in the twenty-first century there are still those who think nurses don’t need to be educated to the same level as other health care professionals, that a warm heart and a cool hand are all it takes, and that as long as they hand over a few quid they can patronise and make fun of nurses.  And if that sounds angry, then yes, I’m angry.

*If a profession is subject to decades of  low recognition, innuendo, and lack of respect, then should we be surprised if sections of society and government are dismissive about its worth or importance?  Or if that societal disrespect turns into an impact on its terms and conditions and how well it does when the government resources are divvied out?  Should we also be surprised that a profession so closely associated with females and constantly associated with female sexuality does not attract and retain many men? Or that the many bright, intelligent men and women who do go into nursing can become disillusioned to find themselves not worthy of more respect – in terms of recognition for the job, in terms of career, and, of course, in terms of pay – and so they leave?  To use the cliché, it isn’t rocket science to see that a century or more of this kind of broad societal disrespect will have an impact, and will be a factor in people avoiding nursing as a career – the number of men in nursing hasn’t increased above 10-12% for years – or discouraging their kids from going into nursing or leaving the profession itself.  It’s naïve to say that the public’s understanding of nursing fed by media stereotypes has nothing to do with the nursing crisis – that the shortages are only about poor pay and poor resourcing.  That may be the end point, but the low pay and poor resourcing have their roots way back in that insidious lack of respect for ‘women’s work’ and a continuing lack of understanding of what modern nursing is.

At the moment there is a big national campaign by the Royal College of Nursing – ‘Scrap the Cap’ – to lobby the Government to remove the 1% pay cap nurses (and others) are subject to and pay them what they are worth to society.  And there’s the rub.  When some elements of society see nurses as cheerful, hard-working young females happy to give their all for the love of it; others see them as something to make fun of, mock or denigrate; our own professional organisations and leaders don’t make a strong, consistent stand against disrespectful representations; and some nurses collude because they think it’s ‘affectionate’ or funny – don’t expect any Government to be falling over itself to treat nurses as the serious, highly educated, knowledge-based professionals that they are.



American nursing campaign website  ‘The Truth About Nursing.’ This is a fantastic website, full of resources and I’ve used their stuff in this blog, marked * because they make great arguments.   If you don’t know it, take a look.

Thomas E. Ford and Mark A. Ferguson (2004) Social Consequences of Disparagement Humor: A Prejudiced Norm Theory Personality and Social Psychology Review 8 (1) 79-94, http://tinyurl.com/9gwl48f.

Girvin J (2015a) Editorial: the public understanding of nursing – time for a step-change? Journal of Clinical Nursing 24 (23-24) 3341-3342

Girvin J (2015b) Guardian Health Network blog site. 14th September 2015

Girvin J, Jackson D, Hutchinson M (2016) Contemporary public perceptions of nursing – a systematic review and narrative. Journal of Nursing Management 24 (8) 994-1006

Twitter thread on low value of women’s work and caring.

‘Aut delectare aut prodesse…’*


As a regular follower of Anne Cooper’s blogs, I enjoyed her recent ‘fantasy party guest’ post.  Not necessarily a list of people with whom to paint the town red, but a list of colleagues and others that she enjoys learning from and with, and who inspire and motivate her in her professional life.  At the end of the blog Annie exhorted readers to draw up their own list and to share it.   So, here are the people I would like to attend my own ‘salon’ to talk nursing, past and present.  Unlike Annie – I haven’t restricted my list to people I know personally and not all of them are, ahem, alive.  They are, of course, in no particular order.

Professors Debra Jackson, Trish Davidson and Nicky Cullum – all fierce nurse believers, strong in thought, word and deed.  Always a joy to listen to and talk with, full of energy and optimism.

Debra, a single-minded, action-oriented powerhouse of a Prof, it was my great pleasure to appoint her to lead the Institute of Nursing, Midwifery and AHP Research at Oxford Brookes University.  One year in, when I retired as Dean, the Institute was well established and she was consolidating connections locally and globally.  She had already achieved more than I expected.  Relentlessly energetic, I have never met a more single-minded person.  An amazing woman.  She’s also a great mentor, a good laugh, and a brilliant storyteller.  I love her.

Trish, arguably one of the most powerful women in nursing today,  presiding over the Johns Hopkins School of Nursing in Baltimore, has had the kind of career one dreams about.  A globally recognised researcher, leader, manager, teacher she is the stuff of nursing legend.  I have met Trish just once, but have read her work, listened to her speak and followed her achievements with awe.  To see someone who is a significant influence on nursing right here, right now – just look to Trish Davidson.  Respect.

Nicky, I got to know through the Council of Deans UK.  Down to earth, no nonsense, straight-talking Head of the Division of Nursing, Midwifery and Social Work at the University of Manchester.  Frighteningly intelligent, not easily impressed, and reassuringly irreverent, I count myself lucky to be an acquaintance.

These three would lead a conversation about nursing scholarship that would set intellectual sparks flying.

To challenge and question, I would invite Elaine Maxwell @maxwele2 and Alison Leary @alisonleary1 .  Always interested, engaged and incisive, they would remind us of our need to be politically aware and our obligation to always seek for evidence – robust and valid evidence.  Smart, funny and clever, unafraid to prick the pompous and deflate the self-important they would keep our feet on the ground whilst our heads were in the air.  Invaluable contributions.

Dr Ann Ewens @AnnEwens would be round the table.  Ann has just taken up post as Dean of the School of Health and Social Care at Staffordshire University and prior to this worked with me for a while as Head of Department at Oxford Brookes University.  Ann is one of the few people I know who really does turn absolutely every experience into a learning experience.  Many times when working together I have been aware of Ann quietly listening and processing, asking questions and clarifying, challenging and provoking and then utilising what she has gathered and synthesised into her academic practice.  A voracious learner, a pragmatist with a huge capacity for resolving the complex and awkward, and a delight to spend time with, I can see Ann just ‘hoovering up’ everything she was hearing and filing it away for future reflection and use.

My invitation list would also include Virginia Avenal Henderson (1897 – 1996).  A legendary figure in 20th century nursing, how could any nurse of my generation not want Henderson round their fantasy dining table?  The woman who gave us the most enduring definition of nursing…‘the unique function of the nurse is to…’ etc.  and stressed the importance of patient self-determination at a time when being a passive recipient of care was the norm.  A profound influence on nursing world wide, Henderson is, in my view, the 20th century’s Nightingale.  I would sit at her feet.

Given the discussions we have today about the title ‘Nurse’, the importance of regulation and rights of the public to expect those Nursing them to actually be Nurses, I would welcome a conversation with Ethel Bedford Fenwick 1857 –  1947.  Mrs Bedford Fenwick campaigned successfully for a longer education preparation for nurses (three years), for a nationally recognised qualification (State Registration) and the regulation of nurses through a professional register, the latter in direct opposition to Florence Nightingale who was against what she saw as the ‘professionalisation’ of nursing through registration.  It was Bedford Fenwick’s view that the biggest issue facing nurses and the general public who might need their attention was that anyone, with any or no training, could call themselves a nurse.  Oh, how we would talk into the night about this!  What Bedford Fenwick experienced in opposition to her plans, is so very similar to the arguments we see today around Registered Nurses and supporting nursing roles.  Bedford Fenwick thought she had achieved safeguarding and protection of the title “Nurse’ when the register came into being in 1919.  Sadly, despite campaigning for thirty years, we now know that she didn’t do enough.  There is some fabulous reporting on Mrs Bedford Fenwick’s battles and the chaotic debates around nursing summarised here.  It’s rather depressing to see how history repeats itself.  I would lift Ethel from her grave to spin around my table, which she would surely be doing at the current professional issues in nursing.

I think the above eight women would make for a fascinating dinner table conversation.  Who wants an invite?



‘A salon is a gathering of people under the roof of an inspiring host, held partly to amuse one another and partly to refine the taste and increase the knowledge of the participants through conversation. These gatherings often consciously followed Horace’s definition of the aims of poetry, *”either to please or to educate” (“aut delectare aut prodesse”). Salons, commonly associated with French literary and philosophical movements of the 17th and 18th centuries, were carried on until as recently as the 1940s in urban settings.’ Wikipedia.




#50shadesofHey (acknowledgment of the # to P Darbyshire!)


I have written on these pages and elsewhere about the public understanding of Nursing and the issues that this may lead to for the profession and for those who need access to it.  Some of that has been polemic in the general media (here), editorial aimed at the profession (here), and research into contemporary perceptions of nursing (here) in order to try to find out if views are changing.  The research revealed that there are indications that the perception and image of nurses and nursing in the USA is a positive one, whilst in the UK there is still a struggle to move beyond traditional and often denigratory images.  Although there is some evidence of strong public trust, this does not generally appear to be born out of an understanding of nursing work and impact; rather it appears to stem from the respect held for the traditional, more sentimental stereotypes of selfless young women, cheerful, hardworking and overworked.  Nursing in the UK knows that it has an image issue and recently the Chief Nurse for England announced work on addressing this.

It is one thing when the popular media portray Nurses in an unhelpful way, but in the last few months there have been at least 2 inappropriate portrayals of  Nurses by employers, which is both disappointing and troubling.  The first, an advert recruiting Nurses that showed a group of young women in uniform, presumably Nurses, grinning at the camera, whilst another lay across a trolley, kicking her legs in the air.  It was, I think, meant to show ‘the fun side’ of Nursing.  It resulted in a Twitter surge of anger and, to the Trust in question’s credit, was quickly taken down and an apology made by the Chief Executive for any disrespect shown to the profession.  The second incident was more worrying.  This was an advertisement produced by a professional marketing company, that portrayed Nurses in arguably both sexist and disrespectful terms – again, under the excuse of being ‘a bit of fun’.  You can judge how amusing they are here .

There was disapproval voiced on social media, with many Nurses (and others) expressing their distaste for an advert that was seen, variously, as ‘crass’, ‘ill-judged’, ‘sexist’ and ‘disrespectful’.  The Trust in question had little to say, other than an approximation of the ends justified the means (yes, really, see below) and the Trust’s Head of Education and Training was quoted as saying: ‘This is without doubt is (sic) the most intelligent, inventive and creative campaign I have seen anywhere within the NHS and it has worked a treat’.

I looked up the Trust Board because I was interested in the gender split.  It’s here, if you’re interested too.  It seems that no-one recognised that the adverts could be seen as sexist and demeaning to a highly educated and knowledge-based profession.  The entertainment value of demeaning Nursing is clearly identifiable from the research  literature mentioned above, and hostile or sexist interpretations of Nursing are frequently seen and used as amusing entertainment.  ‘Just a bit of fun’ and ‘it’s a bit of banter’ are worn-out and discredited excuses for what has become known as everyday sexism, and these adverts, for me, fall well into that category.  It is all too easy (and lazy) to use images and references to Nurses and Nursing that demonstrate a clear lack of respect, often arising from denigratory stereotyping.

Gender prejudices are alive and well in public images of Nursing, and these prejudices are evidenced in portrayals of Nurses characterised as sexual playthings, beautiful young and sexy, defying danger to find romance – all resonant in these adverts.  The statement that ‘it has worked’ and that the end justifies the means serves only to demonstrate how deeply seated these damaging stereotypes are, how normalised in some thinking, how unrecognised as offensive, even when tongue-in-cheek.  It’s one of Nursing’s biggest issues professionally and it is deeply troubling that employers should exploit this as a recruitment tactic.

Post script – 24 hours after the offending ads hit Twitter and three hours after I posted this blog the Trust put out this statement on Twitter.