Sunday, 8 March 2009

How nurse got worse

Out canvassing in South Leicestershire I met a mental health nurse who was about to lose her job to an assistant without any qualifications. Her managers thought it would be cheaper, which it would.
But it would probably be a much worse experience for her patients, who instead of getting someone who is well informed and qualified and understands their condition will get a "nice person" who knows nothing and may be able to "signpost them" - most likely in the wrong direction. Why do we think that if you are looking after people you don't have to be skilled? I heard Sarah Kennedy, a community psychiatrist on the radio, talking about how different it was when you went into someone's home. She had cooked for her patients, and even sung to them - she's a singing psychiatrist. If it is not beneath a psychiatrist it should not be beneath a nurse.
And it is not just in mental health The public said they wanted more policemen on the street so we invented PCSOs (because policemen do more important things); midwifery assistants have been asked to do midwives' jobs (without any training) though hospitals are realising it might be dangerous; nurses don't feed patients - because that is not "qualified enough", even though without being fed you die.
In the area I work in we have a whole range of people called anything from family support workers to parent support advisors and it is impossible to know from their titles whether they have had three days' training or three years and so impossible to know whether you would trust their advice. We have seen in social work the danger of not having good enough people on the front line with the authority to make decisions about the most difficult and dangerous families.
We have ended up in a position where although we have great public services, the first person you meet or have dealings with whether you are giving birth, being treated for a mental illness, or dying is probably the worst ambassador for that service and the least qualified to help you.
I am not sure why this is the case - but probably a combination of things. There has been an erosion of the authority of these people and their jobs - most marked in the police and various forms of nursing and other "caring jobs". Teachers and doctors have protected their professions well. Yet I suspect it was part of a trend to upskill those jobs, so part of the same movement which said that nurses had to have a degree, or that street policing was only for the least able policemen.
Creating a career structure meant pushing people who were any good into "management". Of course this was a movement meant to help women. But we misunderstood what we needed to do: it was not about getting able women out of the "caring" bit, but about valuing the "caring" bit more.

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