Reuters: "New Generation of Nurses 'Too Posh to Wash'"

May 10, 2004 -- The lead of a Reuters article dated today and written by Tristan Jones is disturbing: "A new generation of nurses who are 'too posh to wash' are threatening traditional nursing practices by refusing to perform basic tasks," according to a statement by Beverly Malone, the leader of the UK's Royal College of Nursing (RCN) at a recent conference. The piece identifies what seems to be a significant issue, but it does not provide the necessary balance or depth, particularly in failing to explain the real importance of many of these "basic tasks," during which skilled nurses perform vital assessments of their patients' conditions that can mean the difference between life and death.

The 400-word piece focuses on the "debate" at the nurses' conference as to whether nurses "should focus on treatment and technical nursing, leaving their caring role to less qualified health care assistants." In this case, "caring" is apparently defined as "core activities like washing people's feet or backsides"--an absurdly limited view, since virtually everything nurses do, from providing emotional support to high-tech interventions, can be described as "caring." The story notes that the proposal to make this shift in nursing focus was expected to be soundly defeated (and it was). In discussing the issues surrounding the proposal, the piece quotes Malone and other nurses to the effect that the higher status of women in society has apparently led to a "significant minority" of younger nurses and students who feel that it is beneath them to provide basic "holistic care" or to "do the bed pans," even though, according to a nursing sister in South Wales, "that is what nursing is all about." Another nurse is quoted apparently criticizing newer nurses for their inability to grasp "the deep philosophical concept that carrying someone else's [stool] is a privilege;" this obviously sounds facetious, but the nurse seems to have been serious. The piece does not include a reaction from any of the "new generation" of nurses in question, and it should have.

In any case, the article appears to have missed a critical point about this type of "basic care." Whatever the importance of providing holistic care in order to be a full service care giver upon whom a patient can truly rely, providing this type of care allows nurses to make a range of critical assessments that can mean the difference between life and death, or between a quick recovery and a slow, difficult one. Since nurses operate as the constant surveillance system safeguarding patients' health, they must have sufficient patient contact to collect detailed, accurate information first hand. Unlicensed personnel probably do not know that clammy skin is a sign of shock, or that certain bowel conditions can signal life-threatening problems that require timely action. Thus, many feel that nurses should consider very carefully before relinquishing care tasks such as bathing and taking vital signs or assuming physician functions, and that nurse staffing should be adequate to ensure that nurses have time for these critical assessments. Of course, there may well be nursing tasks that can safely be shifted away or streamlined through technology, but if great care is not taken, patients may well pay the price with their lives.

The article shows some awareness of the important discussion to be had about the workload of nurses, delegation, and the duties and qualifications of allied health care staff. The author reports that the "RCN estimates that some 20 percent of junior [physicians'] work could be shifted to nurses and over 12 percent of nursing work given to health care assistants." But the piece does not discuss the critical issues noted above.

Finally, while the story reads as though this "refusing to perform basic tasks" issue is the central one being addressed at the RCN's conference, in fact the conference--which was the 2004 Annual Congress--had 27 other agenda items, including violence and staffing levels, palliative care, and care of substance abuse in general care settings.

See Tristan Jones' article "New Generation of Nurses 'Too Posh to Wash'" from the May 10, 2004 Reuters news service.