It’s not you, nursing, it’s me

Nursing was hardly my ‘calling’ in life, like it is for some people. Florence Nightingale didn’t appear to me in a vision, and angels didn’t fart into my ear at night, telling me to tend to the sick and diseased.
-Kristy Chambers, ‘Get Well Soon: My (Un)Brilliant Career as a Nurse’

When our high school careers advisers began pressuring us about our ‘future’, I was caught off guard. Between the start of year 12 and whenever the deadline for uni applications was, I’d somehow settled on nursing. My application receipt contained only two entries: a Bachelor of Nursing, or a Bachelor of Science, both at the same campus of the same university. The Bachelor of Science was intended only as a bridge to nursing, presumably because I didn’t set much store by my ability to achieve even the modest ENTER score required for nursing. The vague ideas of pursuing ‘something health-related’ had morphed, within perhaps a more practical part of my subconscious, into nursing. Nursing? No-one in my family was a nurse. I didn’t know any nurses.

I did have a moment of realisation on the first day of my clinical placement (what nurses of a previous generation would have termed ‘rounds’) in a hospital. Yes, a hospital. The fact that the majority of nurses were employed in hospitals had somehow passed me by. Hospitals were scary, labyrinthine, ominous places. Up until this point of my life, I’d largely managed to avoid them. I was tasked with helping a 90-something man who’d had a hip replacement to get out of bed and walk to the toilet. I’d never realised that ‘getting out of bed’ could constitute a major logistical operation for anyone, let alone one of the tallest men I’d ever seen. As with any daunting task, it is often helpful to break it up into smaller stages: “Ok, so, how about we swing your legs out that way…in that case, I’ll pull the covers to this side, watch there’s no obstructing pieces of furniture as the legs swing round, now I’ll just find your slippers, and I’ll just bring your walking frame to the side of the bed here… now as you go to stand up, remember to push down on the bed, and not pull on the frame else you’ll keel over…”

The student uniform soon became a millstone. A symbol of bumbling ineptitude. I’ve had the fortunate experience of being placed on ‘clinical review’ (sort of like a “lift your game – or else” shaming exercise. Like detention.) I’ve been so intimidated by a preceptor that my shaking hands kept dropping the IV line, and my already meagre credibility with it. I thought I’d hit a wall when, on the kids ward, I baulked at the idea of giving a 14-year-old autistic boy a sponge bath (and for the record, I have nothing against autistic people. At this stage, the idea of giving anyone a sponge bath had me in a cold sweat, much less someone barely 5 years my junior.) It was about this time that I started looking at a BA as a viable option. But the worst was yet to come. On my next set of rounds, I spent an inordinate amount of time crying in hospital corridors.

Aside from my own dwindling confidence, there were two other things I couldn’t get past. One was the strange hours nurses keep. Mornings in mid-winter are dark, cold, hostile things that rob me of the will to live. I don’t see the logic in dragging myself out of bed, only to go to work and open the blinds on people who are often equally ungrateful at being woken up so early. To this day, I find it an odd sight to walk into work of a morning to find people apparently well into a schedule of cleaning (What? That means you had to have got up even earlier than me? How is that even possible?!) The other was the smell. A hospital of any reasonable size belches forth a potent bouquet of chemical cleaners, acrid hand-sanitiser, and cafeteria stodge. I’m convinced this is only to mask the stench of disease. On my sleep-deprived, macerated senses, the effect is nothing less than nauseating.

Not including my training, I’ve been looking after older people for just under five years. I think in that time I’ve grown more impatient. US Comedian Greg Behrendt suggested that getting old involves (reluctantly) admitting new words into your vocabulary, such as ‘ointment’. Because they are often the ones applying the stuff to back rashes, or dry legs, nurses are perhaps uniquely placed to appreciate the sheer number and variety of salves, balms and other preparations. In my more impatient moments I have often cursed this tyranny of minor difference; irritated skin folds call for a different unguent to the one for your backside, which is different again from the environment between your toes…

When I reflect upon the status of nursing in the 21st century, it strikes me that nurses are caught between a rock and a hard place: between doctors and managerial prerogative. There is a disjunct between the autonomy you have been made to believe is your right, and the autonomy denied to you on a daily basis, particularly in the traditional hospital context. In the late 1950s, trainee nurses at Melbourne’s Alfred Hospital were bound to a Code of Ethics which specified their attitude to the doctor thus: “a nurse must be loyal to the doctor at all times and do every thing in her power to maintain the patient’s faith in him.” (Blergh. Someone get me a bucket!)

Nursing Despite the entry of more men into the profession in recent decades, still 90 percent of employed nurses and midwives in Australia are female. And while their numbers have been on the increase, women comprise only 36 percent of doctors. The female nurse/male doctor stereotype endures. If this was going to be a problem, I should have addressed it earlier, because the years since I was spat out as a newly-minted nurse have coincided with my embrace of feminism. I’ve had difficulty reconciling myself to a role that, in many respects, is as manifestly subordinated as it was in the ‘50s.

Aside from the thorny issue of gender, I bristle with the many injustices I see happening around me. Nurses face discipline for medication errors caused by doctors’ bad handwriting. Nurses cop the brunt of patients’ physical and verbal aggression as part of their daily working lives. The nurses union fights tooth-and-nail over decades to improve the remuneration and working conditions of its members, only to have conservative governments attempt to sweep it all away. Suffering individuals are denied appropriate end-of-life care due to doctors’ laziness or fear of litigation.

Where their values and life experiences are concerned, nurses as a group are not easily categorised. There are nurses who believe in God, and strive to deliver care that is more spiritually attuned, and there are nurses working among the less privileged who understand that notions of the ‘sanctity of life’ are a western indulgence. There are nurses who think the earth is flat. There are nurses with sidelines in hair and beauty, or shower screens. There are nurses more akin to business managers, earning upwards of $100k a year, and there are nurses at the coalface, who must do more with less.

And yet, amongst the working class, nurses are not really exceptional. Nurses, like other working people, get home tired. Nurses spend (or waste, depending on how you look at it) time in transit to and from work. Nurses think about the loved ones they’ve left at home, or what loved ones out in the world might be doing at this very moment. Nurses get restless or just plain sick of their jobs, and long for a change. Nurses have mortgages. Some want to change the world: one life at a time, or millions of lives at a time. Nurses find all sorts of rationalisations for why their work doesn’t fulfil them like it should, or why they choose to work ridiculous hours, or back-to-back shifts (the 9 hours between finishing a ‘late’ shift and starting a morning shift, is apparently sufficient to achieve a restful sleep. I say, not possible.)

Nurses often see the people in their care at their most vulnerable, and this is not always a privilege I have felt deserving of. Away from TV screens, in the course of our ordinary lives, our eyes are confronted with few compassionate or selfless acts for non-kin. When I transitioned from university to the workplace, I was fortunate to be steered by a couple of forthright mentors, and one day I recall hovering impotently in a corner of the room, while my two senior colleagues attended to a dying man. As he slipped in and out of consciousness, they swooped on his bed, making him more comfortable in a tender, unhurried, intuitive way that I’d never encountered before. In that moment, I realised: this is what it means to care, unconditionally.

Next year, nursing and I are going to spend some time apart, while I follow a different muse for a time. For better or worse, nursing is part of me. I will no doubt look back on my nursing days with an odd mixture of embarrassment, pride and cynicism, before concluding that they are somehow precious. But I suspect this is not so much a full-stop, as a pause, because I have the urge to croon hopelessly, “We’ll meet again, don’t know where, don’t know when…”

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3 thoughts on “It’s not you, nursing, it’s me

  1. Dear Meave,

    I just logged on for the first time and love this piece you wrote about nursing! It struck such a chord.

    You’ve raised so many issues for today’s nurses to grapple with. I fear, though, most nurses choose not to grapple. They come in, do their jobs, often go home exhausted – mentally as well as physically – without spending much time thinking about how their work and working environments could be shaped and improved. I can’t blame them – often, I do the same.

    Like you, I think, I was horrified as a young trainee to find myself actually doing nursing – it was never in my plan. I didn’t really have a plan. I am also disturbed to learn that you were victimised by more senior staff who were supposed to be ‘teaching’ you. Those people are perpetuating something done to them, rather than remembering it, and trying to break the cycle.

    Reading your piece, I was reminded how little has changed in nursing in the 30 years or so since I trained, spent years away from it, and then came back to the job. I’m afraid that says something about nurses, their personality types (or a general ‘type’), and about a workplace which is 90 per cent women. Nurses can be analytical, but conservative and compliant. They can allow themselves to be worked hard, leaving little time or energy to question the way a faceless ‘management’ expects things to be done.

    In the hospital environment, nurses are at the bottom of the pecking order, with only a small say over a system where they carry huge responsibility but have little authority. I think, in general, nurses are valued only as the ‘worker bees’ rather than the closest and most constant link in the care chain to the patient.

    I loved the wide-ranging piece you wrote, and the skilful way you drew so many threads together. Congratulations! Keep going! I have a feeling 2013 will be a pivotal year for you.

    • Thanks for your comments Rose!
      I understand that the start of this piece (the opening quote notwithstanding) comes across as rather serious, and the tone is a bit ‘woe is me’. I think the passage of time has allowed me to appreciate that perhaps I was a bit oversensitive when I started out, and to laugh at myself.
      That being said, I do think the problem of nurses’ ‘eating their young’ needs to be addressed. Perhaps it speaks to the pressure that nurses working in busy clinical environments feel. They are responsible for delivering complex care for multiple patients, at the same time as initiating new nurses into the profession, and it is hardly surprising that they often don’t feel adequately supported to meet all these demands.
      It’s eye-opening that you feel not much has changed within nursing in 30 years, despite having shifted to a completely different model of training, the growth of the ANF and the gains made industrially in that time.

  2. Hi Meave,

    I should have qualified the statement about not much having changed in nursing in 30 years. In some ways, a great deal has changed. There are new tests, terms, procedures, and equipment, but the basic principles of bedside care haven’t changed that much. (Lucky for me!)

    Unfortunately, though nurses now have a much better formal education, I feel the status of nurses and the culture in nursing hasn’t changed a great deal (and the continuing victimisation of trainees bears out the second). It’s as though any sign of ‘weakness’ has to be weeded out, and that the idea of workplace bullying has not penetrated the very traditional working environment that endures in hospitals.

    It’s true that significant industrial gains have been made. But during the recent EBA dispute with the Victorian government, I made a cursory comparison of education and wages in the police force, with those in nursing. Nurses do three years of tertiary education before being paid anything. Police qualify as constables and earn wages after only 12 weeks in the job. And you guessed it, a constable starts out earning more than $52.000 p.a. – far more than a graduate nurse!

    According to what I’ve been able to find out, a first year associate nurse unit manager earns about $62K. At just the second rung on the police ladder, a leading senior constable now earns nearly $75K. That’s still a lowly rank – after that comes sergeant, sen. sergeant, inspector, chief inspector, and more.

    When asked, the nurses’ union said they could not mount an industrial court case based on equal pay principals – that was only possible in situations where there was no history of collective bargaining. And in the latest EBA negotiations in Victoria, police did much better than nurses, and achieved a much quicker result.

    Despite the complexity of our work, the life and death situations we often deal with, and the possibility of ending up in the Coroner’s Court, nurses are still underpaid and under respected.

    Sorry to go on. I’ll go back and read more of your blogs – I thought your nursing one was entertaining, beautifully crafted, and well expressed.

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