Nursing has had more peaks and troughs than a bar of Toblerone

THE received wisdom is that any minister who goes up against nurses is a lone lemming, headed over a cliff.

That for Mary Harney to talk about nurses shovelling cups of tea into themselves at regular intervals was an own-goal. That for the INO to vote no confidence is a deadly strike against her.

Nurses are perceived as being — in image terms — impregnable. Everybody loves them. Saying anything against them is akin to stabbing Bambi in the gizzard.

All of which assumes that once a profession has a good image, that good image stays forever. It ain’t necessarily so. Professional popularity has more peaks and troughs than a Toblerone, and the troughs can last longer than the peaks.

At the beginning of World War I, to be a soldier was the highest aspiration possible. The Allied soldiers in WWII were regarded as heroes: this WAS their finest hour. Then came radical change in public perception. Today, American soldiers wandering around Duty Free in Shannon Airport don’t expect passers-by to grasp them warmly by the hand and wish them well. Nobody does. The role is at best nuanced, at worst, negative.

Nurses didn’t always have a great image. Just a couple of centuries back, they were seen as one small step above women working the streets. Then Florence Nightingale did a makeover on the profession’s image and reality.

She created standards, protocols, systems. Systems like visiting the sick at night. In that dark hour of terror before dawn, her nurses walked quietly through the wards carrying lanterns. The image they presented was the first step in branding a profession: she herself became known as the Lady with the Lamp. The next step in branding was to put her women in identifiable uniforms, a step elaborated by individual hospitals, who extended the brand.

Nurses were there at the moments of terror and humiliation. They had practical skills that made a difference to patients: while a doctor would poke a syringe into your arm until you were black and blue, a nurse could find a vein in 30 painless seconds.

The very fact that nurses were less qualified made them more human. They could explain your condition to you in terms you understood. Above all, they were physically present in a way consultants were not. The consultant did rounds at dawn.

The nurse was there all the time, ready to sit down and let you talk. Hence the strongly branded image of nurses, up to now. Nurses would be ill-advised to believe that will continue forever.

A number of factors have come into play which are already denting the public image of nurses, the single most important of which is the nurse’s station, that off-putting glassed-in coven of paperwork. It sends a message that record-keeping is more important than people. (Cynics suspect that half the time the nurses inside it are talking about their kids or their new boyfriend, but cynics always think the worst.)

In A&E, the work stations create a focus which makes patients feel impotent and ignored. When I spent a night in A&E with a relative recently, the trolley wasn’t the problem. The trolley was just a smallish bed on wheels with rails up the side to prevent the patient falling out. The patient, in this case, was concentrated on sucking oxygen through a mask and wouldn’t have cared much if he was in a hammock or a swingboat.

The patient’s relatives — me and my son — were much more aware of and bothered by external factors, like the drunks in the area. They puked. They fought. They swore. They woke the sleepers and bothered elderly people. Enda Kenny’s weekend Árd Fheis speech suggested those rowdy time-wasters should have been in a drunk tank of minimal comfort, overseen to ensure they wouldn’t snuff it from alcohol poisoning, and charged a fortune when they sobered up for wasting medical time. It’s difficult to argue with him.

At one point, the night we were there, my companion — not the patient — did a wander through A&E.

“You know something,” he said when he slid back in through the curtains to the cubicle. “This is the first time I’ve become The Enemy without doing anything wrong. The minute I went out there, every staff member I met hated me. Didn’t meet my eyes, for fear I’d ask them something.”

HE WAS right. The staff may have been doing a great job, indeed, probably WERE doing a great job. But communication was way down their list. The priority was getting back to one of the work stations with charts and lists hanging in front of it. Never mind the patients, get the paper-work right. They were a care team, and demonstrated it by clustering together in a corner and looking daggers at anyone who went near them.

When I raised this later with management in a different acute hospital, I got two answers. The first was that the care teams were too busy to communicate. Wrong. A five minute circuit by one of the team to say “Here’s what’s happening, here’s how long before X-ray, here’s how you’re doing,” would have been possible. A considerable body of research indicates that regular communication reduces tension and that the more optimistic and informed a patient is, the better their outcome is likely to be. Avoidance of eye-contact and hope that patients will just shut up, lie there and not ask questions is just bad medicine.

The second thing management said was that it would be great to have what the Americans call “candy-stripers”; unpaid volunteers who can wander A&E offering a willing ear, a comforting hand to hold, a sandwich or a cup of tea. Aaah, I said, but Bertie’s right, we’ve lost the spirit of volunteerism? No, came the response. We could fill A&E with willing helpers. Except for Health and Safety regulations and trade unions. Never mind the patients, the regulations and job-demarcations are more important.

Last week the Minister for Health refused to pitch up at the INO national conference and they called her a political coward. Big headlines, because everybody loves nurses. Big impact? Not necessarily. Mary Harney isn’t a coward. Like her, dislike her, believe she’s to the right of Attila the Hun if you will, but she’s not a coward.

Her absence, however, did give the INO a fabulous free run, in the course of which one of their spokespeople, on radio, hit a surprisingly bum note. She seemed to be saying that nurses should get paid more, simply because some other care group reporting to them were doing financially better. A small-minded position, at best. But then the interviewer asked her about wage rates and she said she didn’t have them in front of her.

Post-interview, the text messages to the programme unanimously ticked her off for not having the figures to hand. Once upon a time, the image of the nursing profession would have halted that negative reaction at source.

That’s a small but significant warning for nurses: don’t assume invulnerability based on past public perception of your profession.