Sunday, 23 April 2017

Like a Virgin? I don’t think so: Nursing a need to develop a more authentic self

Yet again I travelled to London on a Virgin train where it was impossible to connect to the wi fi. Its a situation I find extremely frustrating. When I got to Euston (which did have free wi fi) my in-box was overflowing with the emails and messages I could have responded to earlier. I had begun to feel like Billy No Mates. When I later complained to Virgin Trains, I was fobbed off with absolutely facile excuses, which I found very patronising. It was not a particularly authentic and helpful customer service - but perhaps this was another secret not learnt at the Business School

I was in London to participate in a Nursing Midwifery Council (NMC) Thought Leadership Group. The group has for the last 18 months, been developing new standards for the education and preparation of nurses. It has been an interesting experience. The group is made up of representatives from across the 4 nations of the UK, and is composed of student nurses, clinical practitioners, researchers, services users and educationalists from all fields of practice. We have met on a regular basis in developing, challenging and refining each standard.

The new standards are aimed at ensuring that graduate nurses will be fit to practice and fit for purpose in 2025. Being ‘fit for practice’ and ‘fit for purpose’ has been a long contested concept. Attempts at both understanding what they might mean and how they might be measured have led to many reforms in the way nurses are educated and trained in the UK. Indeed, the work of the Thought Leadership Group is in part a response to public and political perceptions that the current standards underpinning nurse education today do not ‘produce’ nurses fit for either practice or purpose.

The NMC, defines fitness for practice as: being fit to practise requires a nurse or midwife to have the skills, knowledge, good health and good character to do their job safely and effectively’. It is a definition that reinforces their Code, which has been in force since March 2015. It sets out what nurses need to be able to demonstrate in order they can: prioritise people; practice effectively; preserve safety; and promote professionalism and trust. It is a good piece of work and something the group referred to as we developed each educational standard.

One area the group spent a great deal of time over was the notion of the authentic nurse. This was an idea that reflected the notion that the nurse as a person had to be credible, even though they might at times be fallible and human in the choices they made. So could a nurse who smokes really be authentic in promoting healthy life style advice? For me the answer had to be yes. The authentic nurse is someone who is able to draw upon their life experiences, and psychological capacities (such as hope, optimism, resilience and self-efficacy), and has a high degree of emotional intelligence. It is these attributes and insights of self that enable individuals to become truly authentic. 

In this sense the authentic nurse understands that they may have the knowledge (what happens when someone is having a coronary) and the knowing (how such knowledge should be used in providing treatment and care) but its in responding to the not knowing (how an individual is experiencing the heart attack) that is critical. So for me, authenticity arises from harnessing the knowledge and knowing, and that space in between - not knowing - in providing person centered care. 


Unfortunately at last week’s meeting we returned to this debate for rather sad reasons. We had received some early feedback that the term credible nurse (I lost the argument to use my preferred option of authentic) and it was suggested we revisited this element of one of the standards, as a nurse who was obese could never be credible. Now nearly 60% of men and women in the UK are either overweight or obese (as defined by a BMI over 25 and 30 respectively) – and we rank 3rd behind Iceland and Malta for having the highest rates of obesity in western Europe. 

Of course some of these people are going to be nurses, and whilst being obese is perhaps not a health promoting state to be in, it doesn’t follow that they maybe any less credible as a nurse than any other person. It is a rationale and response similar to the reductionist one dimensional view that Virgin Trains provided me regarding there being no wi fi on the train. I hope as the new standards go out for wider consultation in a few weeks time, that the responses we receive from the profession and the public are a little more authentic in their challenge.