While on a bus recently I overheard a conversation between two older females. I was not really listening but a line one of them said caught my attention. It was: “I don’t understand why nurses need a degree to care, surely it’s a vocation?”
At this point, as steam came out of my ears, I wanted to go over and correct them about this and explain why nurses need a degree but for my sanity and the peace of everyone on the bus, I decided against it. Instead, I sat there quietly grumbling to myself for the rest of the journey.
This overheard conversation reminded me of a previous one; a time when a family member was in hospital and another commented that the nurses “don’t stay with our relative but just come in, do something, then leave”. I responded with, “no nurses have been in yet”.
“Nurses are highly qualified professionals, assessing patients, delivering treatment and therapies, implementing and coordinating interventions“
My relative looked at me in disbelief at my stupidity and said, “one has literally just left the room, are you blind?” They had not – it was a healthcare assistant, which I pointed out. I then explained that in the time I had been there no qualified nurses had been in the room. My relative was astonished as she thought the several members of staff she had seen were nurses doing nursing tasks, but they were not, they were healthcare assistants.
These two accounts make me think that the nursing profession has an identity crisis. The public do not seem to know what nurses do, what we are – and this is a problem, our problem.
I am not going to try to define what nursing is and what we do, others much cleverer and more knowledgeable than me have tried (and in some cases, failed) to capture that. But I know what we do not do and I know what we are not. Some members of the public think nurses sit there holding the hands of their patients going “there, there” and mopping brows, or simply undertaking basic tasks, so no wonder those ladies on the bus wonder why we need a degree to do that. As explained by Aubeeluck et al (2012), “nursing is a well-known profession… [it] is so much in the public eye there are general perceptions in society of the work nurses do”. It seems to me that these perceptions are wrong – very wrong.
Nursing needs to move away from the terms ‘caring’ and ‘care’, as they are outdated and misleading. They give the wrong impression about what we do. Nurses do not care in the manner that the word is understood by much of society – they deliver high-quality (in some cases, not all) health services. Nurses are highly qualified professionals who are assessing patients, delivering treatment and therapies, implementing and coordinating interventions. We are leaders and we are educators.
While we use terms like ‘care’ to describe what we do, the public continue to misunderstand what we do and what nursing is. If we improve our image and make it clearer what nursing entails, this could help when it comes to negotiating better pay and conditions – does the government (past and present) really know what nurses do? Does the government think we simply care?
By being clearer on what we do, it could also help with recruiting the right people to the profession and reducing attrition, because people will better understand the profession they are joining. One dictionary definition of care is “the provision of what is necessary for the health, welfare, maintenance, and protection of someone or something” (Oxford Pocket Dictionary of Current English, 2018). Is this really what nurses do? It seems to me to be too basic; the aspects covered by healthcare assistants maybe, as in the example earlier.
The definition further expands into the realms of ‘caring for’, implying some sort of emotion and ‘looking after’ – again not what nurses do.
Caring roles are valued – I am not undermining those jobs or the people who do them – but we need to differentiate between a carer and a fully qualified, professional nurse.
The Nursing and Midwifery Council’s Code of Practice (2018) uses the word ‘care’ throughout, but many instances refer to what the patient receives, as opposed to what the nurse delivers. When talking about what nurses, midwives and nursing associates do, it states ‘practise’, not ‘care’. Is this an intriguing difference or simply semantics?
Should we adopt a different term then, and drop ‘care’ from our language? How about simply using ‘nursing practice’? This covers the broad range of roles and applies to all fields of nursing. I am open to other suggestions, but I feel we should move away from using the term ‘care’.
Justine Barksby is associate professor – head of division, learning disabilities and mental health, Leicester School of Nursing and Midwifery, De Montfort University
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