Sunday, 22 August 2010

Breakfast, Misunderstandings, Men and the Origins of Nursing

Over the last three years I have had some interesting meal time conversations with some of the most remarkable and influential nurses in the UK and beyond. The Council of Deans of Health meetings have provided many of these opportunities. I was reminded this week of a breakfast I had at such a CoD meeting with one Anne Marie Rafferty. Anne Marie is the current Dean of the Florence Nightingale School of Nursing and Midwifery, King’s College, London.

She gained her qualifications at some of the most prestigious educational institutions in the world. Her research interests combine history, health policy and health services research. Not only has she written much in this area, but she has and continues to make an influential contribution to the development of policy across a wide range of areas affecting nurses and nurse education. By any measure she is an extraordinary person. I remember being impressed that over breakfast our conversation was entirely normal. We talked about shared issues we faced in managing our respective Schools, the state of nurse education as well as some personal conversation around families, what it was like to live where we did and so on.

Anne Marie was in the news last week. As part of the 100th anniversary marking the death of Florence Nightingale, Anne Marie reported upon why nursing is not a career choice that many of today’s young people would consider. In a study of 1000 18 year old students it was revealed that the modern-day nurse is misunderstood by the majority of youngsters. Many did not know nurses are authorised to give patients medicines and can also prescribe them. Other areas the students had misconceptions about were pay and career progression - just 6% knew nurses could earn up to £100,000, while only 25% were aware they could rise to consultant level.

However, some 20% of the students in the study (and they were studying different academic subjects), said they were more likely to opt for a career in nursing after hearing of the skills and opportunities involved. This was in a week that has seen many Universities experience problems in dealing with many more applicants for places than there are places available. In our School we have seen applications for nursing programmes rise year on year by 10% over the past four years. Next year we are predicting some 6000 applications for 680 places. However, some 70% of the students that study with us are 25+ years old and often have a family, and have chosen nursing following experience in other areas of work. Predominantly these students are female.

This last point is also interesting as this week the Nursing Times reported upon a survey undertaken with 84 acute trusts, half of which had foundation status. The survey revealed that male nurses are twice as likely to hold a top job in England’s leading hospitals. Men make up just fewer than 8% of acute nursing workforce, yet hold just over 11% of the Director of Nursing posts. This situation is blamed upon the ‘business ethos’ these roles involve which is said to deter women from applying or being picked for these top jobs.

I am not so sure. Partly I think the gender imbalance is due to women still being largely responsible for other roles in society such as bringing up children, and the realities of child care can make juggling the demands of such senior roles very difficult. I do agree however, with the view that has been expressed by Caroline Waterfield of NHS Employers Service who suggested that it wasn’t that there was a 'glass ceiling' for women, but rather that 'there isn’t a glass ceiling for men'. Interestingly, the study revealed that the gender imbalance was less pronounced among primary care trusts. But as PCTs will be abolished from 2013, this could lead to many senior female nursing leaders being made redundant.

Finally, given the Florence Nightingale anniversary celebrations, and the continued debate about nursing careers and gender imbalance at a senior level that in the first nursing school in the world only men were considered 'pure' enough to become nurses. This School of Nursing was started in India in about 250 BC. The Charaka states these men should be, 'of good behaviour, distinguished for purity, possessed of cleverness and skill, imbued with kindness, skilled in every service a patient may require, competent to cook food, skilled in bathing and washing the patient, rubbing and massaging the limbs, lifting and assisting him to walk about, well skilled in making and cleansing of beds, readying the patient and skilful in waiting upon one that is ailing and never unwilling to do anything that may be ordered.' An interesting thought as we prepare our new curriculum.