One year later…

Writing on my other blog recently, I toggled through to this one and noticed that I haven’t posted on here for just over a year.  This surprised me, as I seem to be always muttering or chatting about nursing somewhere in my social media life.  I’ve been wondering why I haven’t blogged here.  Some of it is because I moved house last year and have been pretty busy doing all the things you have to do when you move house.  But that’s not all of it.  I haven’t been able to motivate myself to write about nursing.  More accurately, I haven’t been motivated to think enough about nursing to write anything.  I couldn’t raise the interest or the enthusiasm.

Reflecting on this ambivalence, I think it’s because nursing feels kind of ‘alien’ to me at the moment.  The rise of the ‘nursing family’ – a term I dislike and disagree with vehemently; the continuing overvaluing and subsequent hierarchical ordering of tasks – something I have never understood; the persistence of old systems and patterns of organisation – the same ways of working that I remember from 40 years ago, just renamed or shaped a little and hailed as innovation; a lack of voice – by which I mean wide-ranging and meaningful debate that is energising and challenging, new and unsettling, iconoclastic even.

I know some will say it’s all alive and well, but I can’t see it.  If it’s alive and well, it’s alive and well internally – facing in on itself, talking to itself, congratulating itself.  It feels diminished somehow, static, suspended.  Maybe it’s me that’s moving – moving on and no longer able to engage with what’s happening.  Perhaps.  Does anyone else recognise this?


In the last blog (scroll down to see) I talked about lists that crop up at this time of the year and shared some thoughts on some of those lists and the inclusion (or not) of nurses.   I also talked about a new list that was being developed – a simple list of nurses nominated by their colleagues and deemed to be outstanding in their nursing practice.  Nominations via Twitter closed on Christmas Eve and the list was publicised on Thursday 3rd January 2019.  And what a great pleasure it was to see people so happy to find themselves mentioned!  Having the respect and goodwill of one’s colleagues is a very fine thing indeed.

The complete collection is shown below.  These are not people with status -laden job titles, nor have they been previously recognised through other systems.  They are not (generally speaking) leading large organisations or national departments.  They are not well-known, some will be unknown to anyone except their closest colleagues and their patients.   We wanted to get beyond hierarchy and ask people to nominate nurses that they know well, maybe work alongside,  and who, for them, are outstanding.

The list is not hierarchical – it’s in alphabetical order by first name – and the person whose name begins with X, Y or Z is just as outstanding as the person whose name begins with A, B or C.  As I said in the last blog, it’s not in order of ‘outstanding-ness’ because that would be stupid.  It is not a list of ‘top’ nurses, or ‘the best nurses’ or any other kind of competitive adjective that might be applied.  Maybe ‘list’ is the wrong collective noun – people do love a hierarchy, even when one isn’t intended!  The nurses on the list were nominated by friends and colleagues who respect them and want them to be recognised.  Of course these aren’t the only outstanding nurses out there – but they are the ones we got told about and we’re happy to let them know that other people think they’re great.  Maybe this can be an annual extra Christmas present for 100 people!


You can see also see the full list here and the twitter wall of nominations.

Congratulations to this particular group of outstanding nurses and Happy New Year!

Calling prospective RCN Council candidates…

My last blog (scroll down) was in the immediate aftermath of the RCN ‘no confidence’ vote.  Council had retired to consider its next actions and I reflected on what had led me to agree with the vote.  Last week Council announced that they would be standing down (with some caveats), and a new Council would be elected as soon as practically possible.  There was a little flurry of media activity and then, in the wider world at least, life continued.

Most of the media I’ve seen has concentrated on the nurses’ pay deal as the reason for the vote of ‘no confidence’ in the leadership of the RCN.  Whilst the pay deal was doubtless the trigger for the vote, many people (myself included) came down on the ‘no confidence’ side because of a much broader dissatisfaction with the leadership of nursing’s professional organisation.  As candidates begin to put themselves forward for the ‘new’ Council, I’d like them to pay attention to the reasons why I (and others) voted for change.  I have summarised those reasons below, and I would like to see Council candidates, whichever ‘constituency’ puts them forward, at least recognise these and commit to addressing them in their election statements. They include:

  • a perceived diminishing of the RCN’s function as a professional body e.g. it doesn’t do enough informing/debating the wider issues facing the profession, protecting and championing the role of the Registered Nurse, engaging with the mainstream media on issues other than union representation and terms and conditions
  • failure to engage its wider membership – some 400,000 members – illustrated by the very low turnout for elections and other important votes over a long period of time. Less than 4% for the no confidence vote and often less than that for elections to governance groups
  • an organisational structure that is modelled on an out-dated trade union model of ‘branches’ and ‘reps’ that many members find off-putting, not reflecting modern multiple channels of engagement and not adequately content-driven
  • perceived conflicts of interest, e.g. unable to champion the primacy of the Registered Nurse because it also counts health care assistants/nursing support staff among its members; difficulty in promoting the development of the profession as a whole because it has a major function to protect the interests of individuals – and what may be good for the profession in the long-term may not seem good for individuals in the short-term.

These issues are important to members who see nursing in an increasingly challenging position – inadequate articulation of the unique value of the Registered Nurse, dilution of the workforce, antipathy towards higher education for nurses, an image that is stubbornly resistant to the recognition of the changes and developments in the modern profession, a disaffected workforce creating retention problems for employers and safety issues for patients – and our professional body failing to effectively challenge and articulate these.  

A successful ‘no confidence’ vote was an historic moment in the life of the College, and now that the dust has settled a little, meaningful dialogue with members is needed to move forward.  The feelings that led to the vote won’t be satisfied by a new Council – elected through the same mechanisms as the old, and subject to the same modus operandi – smiling out of headshots and making aspirational statements.   As more and more nurses have graduate education and post-graduate thinking skills, they will not be satisfied with old thinking and old ways.  They’ve been taught to challenge, to push beyond the status quo, to learn & act on evidence.  They’re used to multi-channel, content-driven communications.  They want to pick & choose, not take what they’re given.  Traditional thinking, traditional expectations and traditional organisations are not going to cut it for them – inside or outside the profession.  They are looking for a ‘voice’, and not finding it where they should.

So, prospective candidates – I’d like to hear some thoughts on how you might tackle the bullet points above.  And if it sounds feasible, and creative, and responsive, then maybe, just maybe, someone will be elected on a turnout bigger than 3.47%.

Times of trouble…

Today the Royal College of Nursing held an Extraordinary General Meeting (EGM).  You can read about it here and you can also read both sides of the argument from a link on the same page.  A recording of the debate will be available shortly on the RCN website.  I couldn’t go to the EGM but I did watch it streamed live.  I’ve also been openly supportive of the resolution that was proposed:

“We have no confidence in the current leadership of the Royal College of Nursing and call on Council to stand down”.

Briefly, the resolution was sparked by the feelings of disappointment and anger when the pay deal that the RCN negotiated for its members wasn’t quite what they had been led to believe. The furore resulted in the Chief Executive/General Secretary standing down from her post and the College instigating an independent review of what had happened to cause such a breakdown in communication and understanding.  You can read that review here too.  Some people thought this should be enough.  Some didn’t and felt that accountability for whatever happened was likely to be more widespread than one individual.  Hence the resolution.

Today the vote on the resolution was held and the results were:

For the resolution: 11,156

Against the resolution: 3,124

So the resolution was carried and the Council should stand down.

I voted in agreement with the resolution.  I’ve been open about my views on the subject on social media.  I’ve also been open about my broader concerns about the College.  For example, it’s my view that the College does less than it could do to develop and support the profession as an entity.  It is a Trade Union and much of what we hear from it is related to that part of the College’s business – representation, terms and conditions, supporting individuals.  The structure of the College follows a Trade Union model.  The language of reps, and branches, and elections and votes turns me off.  I think it turns a lot of people off – see below for what I think is some evidence of that.

The communication to members is through these structures and from what I hear from friends and colleagues, rarely gets beyond those who attend branch meetings, or who are involved ‘reps’ or union activists.  In today’s nursing world sophisticated communication strategies that use multiple channels are needed.  Keeping the noticeboard up to date is really not going to cut it.  And communications should be easily two-way.  I don’t see that.  Finding agendas and minutes is a struggle.  In fact, to date I haven’t found any minutes, just meeting ‘reports’ – sanitized and reduced notes without even the members present being recorded.  I shouldn’t have to search to find information that I have a right to see.  It’s not transparent.  These are symptoms of a management that want to keep knowledge as power.  Or that’s what it says to me.  Others may find it perfectly acceptable.

But back to the vote.  The RCN has more than 400,000 members.  That’s a lot of people.  Do you know how many members voted in this really important vote on the very essence of the RCN’s practices?  Less than 4%.  In fact 3.74%.  This isn’t unusual in RCN elections. In the recent elections for the Professional Nursing Committee – the Committee that is supposed to reassure members that the College is more than a Trade Union – the committee members were elected on about the same turnout, or less in some cases.   It also appeared that getting the right strategic skills and experiences brought to that Committee at a crucial point for the College were secondary to following a Trade Union election model; and that employment, age, and geographical location were more important.  It was disappointing.  And it said to me, that nothing was changing here.  New committee, old thinking.  Less than 4% turnout for important elections and votes.  An organisation that can’t engage, or even interest, more than 4% of its membership in these fundamental activities is an organisation that is failing its members.   What I heard from the EGM today was the RCN promising to reach out to its members.  All well and good, but first, it needs to take a long, hard look into itself.

I’ve been a full member of the RCN for 42 years.  45 years if you count my student days and  I want this organisation to work for me and for others like me.  These days, I work for myself.  It’s very liberating.  But I still want to belong to a professional body that champions my profession.  That gets itself into the mainstream media.  That is a ‘voice’.  For example, I expected at least a blog from the RCN on the implications for the profession and it’s value to national policy-making when the CNO stepped down into a part Regional Nurse role.  I would have liked to see an exploration from the RCN on the background to the CEO of the NMC standing down and a broader discussion on the regulator and how it protects the public and also protects the profession from itself.  I expected outrage that Trainee Nursing Associates won’t need to be supernumerary when they are supposedly learning in practice.  But the issue that exercises me more than any other – is the absence of a strong, authoritative RCN voice drawing attention to the dangers of diluting the workforce.  The danger of undermining the contribution to patient safety of the Registered Nurse.  Why aren’t they quoting chapter and verse of the research on RNs and safety/mortality/recovery, and getting that talked about outside of the profession?  I don’t understand how the College can stand square behind the primacy of the Registered Nurse when it also has an obligation to promote the roles of members who are not Registered Nurses.  I think that’s a serious conflict of interest.  And these things are why I got involved in this vote.  I thought – hoped – it was a catalyst for a whole range of dissatisfactions to be raised; and some of them were raised at the EGM.  And I’m raising them again here – for what it’s worth.

No CNO, no CEO of the NMC, no CEO of the RCN, and RCN Council vilified by (some of) its ordinary members.  Some would say this means that at a really troubling time for the profession – dilution of the workforce, failure to regulate advanced practice, substitution of RNs, antipathy towards higher education for nurses – there is no visible leadership.  I disagree – because for quite a while now I haven’t looked to these roles for leadership.  They are too embedded in Govt, employers and established systems to ever take an independent stand, to speak against the status quo, to be awkward.  I look for other voices, other influencers, other opinion leaders, independent thinkers, independent minds.  A professional body, more than anything needs independence.  Independence from Govt, from party politics, from employers, from factions.

But on the other hand, I really want a renewed RCN to be a voice and to show leadership for the profession as an entity, not just seeming to represent a group of workers with employers, or fighting the government, no matter what political shade it is.   My vision for that renewal is entirely predictable, I want the trade union activity and professional activity to be separate – completely separate.  So that the professional body can champion the profession, without fear or favour.  Because sometimes, what might be in the best interests of the profession in the long-term, may not be in the best interests of individual professionals in the short-term (another significant conflict of interest in my eyes).

So, stream of consciousness over.  As usual, this is meant to encourage you to think a bit harder about this, a bit further than the vote of no confidence, and the pay deal.  I’m not asking you to agree with me, and I’m not saying I’m right or that my take is the only one.  I’m just putting my worries out there.  Catharsis.  And, I hope, stimulation.

Who’s who continued…

Just a couple of blogs back I was thinking about the lack of 20th century figures who are well-known to the profession for having an impact on its development.  It seems to be quite a serious gap in our history.   The blog, and a subsequent editorial in the Journal of Advanced Nursing, has piqued the interest of a few people and I think we have the makings of a serious project to try to address this vacuum in some way.  We have conducted one short survey aimed at Nursing departments in the UK; we are going through the results of that and will write about it soon.  As things progress, you will be able to keep up to date with it here.

As a result of the early conversations we have already had a number of suggestions to consider, and as always, social media has been an interesting source of names.  Social media conversations were also useful in helping us to think about the questions we wanted to ask those who lead nursing programmes.  Will our suspicions – that large numbers of student nurses are not being taught the history of their profession or about the many influences on its development – be confirmed?

The names we are hearing informally come mostly from the latter quarter of the 20th century and are predominantly female.  Historical male figures seem to be an equally closed book.  It is sad to think that some of today’s young men thinking of joining the profession may only be able to relate to fictional characters – Charlie Fairhead or the other bloke that used to be in The Bill – when it comes to significant male figures in nursing.  At least Nightingale and Seacole were real.  All good reasons to be getting on with what seems to be a very necessary project.

So dig around in your memories, oral histories, local archives.  It’s a fascinating process and between us we will uncover or rediscover nursing luminaries for at least one more generation.  And, by the way, in terms of men here are a few starters to consider.  Try looking up Bob Tiffany, Trevor Clay, Phil Barker or Alan Pearson.

Disagreeing well…

Like many of you who read this, I often take part in nursing related discussion/debate on Twitter.   I join conversations about nursing on Twitter almost every day, and have been doing so for some years now, and have been interested to see how things change and develop.  It’s still a great place to mix with nurses from many different work contexts and interests, but recently I have noticed something that gives me pause for thought.    Nothing dramatic, just an increasing awareness of some reactions to nursing debates on there.  Any regular user of Twitter will be familiar with the wide range of comments that appear on timelines: from the kind and supportive, to the vitriolically opposed and everything in between.  If the subject is controversial or popular, then often feelings run high.  Most contributors are polite, some people are often amusing and sharp-witted, sometimes there’s sarcasm or irony, occasionally people are a bit rude, or personal.  But generally speaking conversations are interesting, enlightening, amusing, informative and annoying in varying degrees.  A bit like a conversation anywhere, really.

What does concern me a little is when the ‘professional’ word raises its head.  As in ‘that’s not a professional way to react’ or ‘that’s unprofessional’, sometimes stated directly, more often an implication  – usually when there is disagreement or dislike of someone’s point of view, or turn of phrase, or vehemence.  It’s said as a rebuke, and is a serious allegation to make if we understand what being a professional is.  Disagreeing with someone isn’t unprofessional.  Disagreeing strongly with someone isn’t unprofessional.  In fact, one of the characteristics of being a professional is the ability to question and challenge and disagree.  A former boss of mine used to say that one of the benefits of higher education is that it teaches us ‘to disagree well’.

Having spent part of my nursing career in academia, I’m used to having my views challenged.  Not just my views, but my thinking, my writing, my proposals, my ideas, sometimes my right to be contributing at all!  Robust discussion is a part of academic life.  Mostly it’s good-natured, frequently blunt and to the point, occasionally it’s a bit hurtful, and it’s challenging.  And rightly so.  It’s how thinking is refined, arguments developed and theses defended.  It can be very critical, but it’s rarely meant to be personal.  On the occasions when it feels personal it’s usually a prompt to step back and examine whether there is any truth in the remark.  An academic’s life is an argumentative one.

As nursing becomes a predominantly graduate profession, nurses will operate more and more within an academic framework – critical appraisal applies to clinical signs as well as evidence, marshalling a rational argument applies to advocacy as much as debate,  challenging practice as important as challenging ideas.  Dissent and questioning accepted as healthy and welcomed as tools of reflection and improvement, even if they occasionally (slightly) hurt our finer feelings.  Professionals give and take criticism and challenge as much as giving and taking praise and reward.

So, I get a bit concerned when I see ‘unprofessional’ used as a veiled insult, when what someone means is ‘that’s a bit sharp’, or ‘that’s unacceptable to me’ or just ‘I really don’t agree with you’.  Twitter is a great place to exchange views, to contact other nurses  and to share etc. but it isn’t a formal group.  It doesn’t have invited members, everyone isn’t like-minded.  Even if they have joined the same conversation.  That’s the point.

Twitter is an open space and sometimes we forget that.  It’s not a professional space with boundaries and rules and expectations of behaviour.  Participants are not in any sort of hierarchy.  That’s the joy of it, and also the problem with it.  It can’t be manipulated and moulded into some sort of reflection of a workplace, it can’t be ‘professionalised’.  It is uncontrolled.  I like it for those very characteristics.  It is more often a breath of fresh air than cause for a sharp intake of breath.



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!