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Saturday, July 2, 2022

The burn-out hero: why bedside nurses shouldn’t be valued for being martyrs

In 2020, we saw windows glued with rainbows, hospitals flooded with donations and NHS workers were routinely described as heroes. While the risks faced by healthcare workers during pandemics have been linked, perceptions of self-sacrifice in nursing are not new. In fact, he has long outlined the nature of the role.

With the commercialization of care work in the 19th century, in a society where a woman’s role was defined by care, nurses were considered married for a job. Like military or monastic life, nurses were not only expected to face hardships without complaint, but were also accepted as part of your life’s service.

As E. Glover wrote in a letter to the Nursing Journal published in 1903:

A good nurse can never be compensated by money, she must be paid … but her work must be something better, something higher, and I might add more pure and pious than the common commerce of today.

If medicine has long been viewed as a professional specialization, nursing has been sidelined as a philanthropic business – and undervalued.
Welcome Images | Wikimedia, CC BY

The rights of women and workers have come a long way since then. Yet the roles, job autonomy, and even pay of bedside nurses are still defined by the assumption that, as naturally compassionate individuals, they must use parts of themselves to care for others. Must be ready to give up.

“Bedside nursing” refers directly to patient care and includes registered, aide and auxiliary nurses in many settings. Most work day and night shifts and are not paid above band six (at which level, you can earn a maximum of £39,027 when you have more than five years of experience). Above that, you move into management or become an expert businessman.

During my 15 years working at the bedside, I have experienced burns to hundreds of ward employees. My doctoral research into ward-based care delivery reveals how bedside nurses are particularly vulnerable to distress and irritation. Such tensions are only compounded by hero narratives.

The Enduring Ideal of Nursing as a Calling

The historical division of employment by gender and class underlies a hierarchy of labor within modern health care systems. Despite performing the most patient care and being subject to the highest risk, bedside nurses occupy the lowest clinical pay band.

Medicine has long been considered a professional specialization. Nursing, in contrast, was seen as a profession. It is rooted in the idea that caring work is altruistic, and caring is a disposition – not a skill.

This traditional demarcation between treatment and care, followed by continued efforts by regulators and unions to cement nursing as a skilled profession, has directly led to the devaluation of patient care and bedside nursing.

Prioritizing clinical and life-promoting treatments, the fundamentals of health care – observation, hygiene, nutrition and comfort – have been framed as fundamentals and, therefore, are least valued. It is defined by a pay structure that financially rewards employees in the role of nine to five, moving away from bedside nursing and having the greatest direct impact on patient care outcomes.

A Nurse In A Green Bush Holds A Poster Demanding Better Pay.
In August 2020, nursing staff protested in front of Downing Street demanding a pay hike.
John Gomez | Shutterstock

This disinvestment does not reflect either the need or demands for bedside nursing. It is physically and emotionally laborious work, and there is a price to be paid. Cross-workforce studies show that nurses across the board are unquestionably more at risk of post-traumatic stress disorder, anxiety, depression, alcohol dependence, self-harm and suicidal thinking.

While research has shown a link between increases in mental health disorders among employees and peaks in COVID admissions, it has less to do with the trauma of COVID-specific care, as it is increasingly counterproductive of being over-stretched and under-resourced. does effects.

This was most eagerly felt beyond the COVID critical-care wards, pooling resources I had visited for the first time.

How care of rations hurts patients and staff

During the first wave I was redeployed to a COVID high-dependency unit, taking care of critically ill patients. It left me stunned, stressed and upset. But nothing prepared me to return to an empty and overburdened oncology ward for a second wave.

There, patients were neglected because we were unable to adequately meet their needs. It was there – and not in the COVID wards – that I felt unsafe, that I saw more medication errors, longer waits, inadequate levels of basic care and limited lifesaving interventions.

When needs are unlimited and resources are limited, patients face humiliation, loss and neglect. How bedside nurses prioritize who gets their time and attention is the basis of my research. I have found that the process of denying care to some in order to provide others – what specialist care calls “rationing” – has a seriously detrimental effect on bedside nurses.

A Nurse In Protective Gear Sits On The Floor In An Empty Corridor.
COVID has seen nurses across the world go beyond their limits.
Alberto Giuliani / Wikimedia Commons, CC BY-SA

Healthcare rationing is a human rights issue and not being able to provide good care is a significant cause of distress. In contrast to policy and macro-level rationing, where institutions are ultimately held responsible for effective neglect, in which rationing results, care rationing shifts the ethical responsibility onto the caregiver.

Nurses must bear the burden of deciding who will feed their food while it is hot, who will be covered in dirty sheets and who will be left to die. To try to mitigate these injustices, they tend to be early and stay late. They leave food, they work through the brakes, and they get burned.

I am currently working with the International Public Policy Observatory on a rapid evidence review showing that poor mental health care among the NHS staff is placing a heavy operational burden on it. This comes at a significant financial cost.

While statistics on nurses’ mental well-being and its wider impact draw much-needed attention to the topic, surveys and reporting may not do justice to the reality of working in an under-staffed, under-resourced, and over-staffed NHS ward . They cannot adequately express the physical, emotional and mental stress that bedside nurses endure.

As long as the role continues to be devalued and as long as bedside nurses are held to an impossible standard, this will not change.


On Friday 17 June, the Conversation’s partner organisation, the International Public Policy Observatory, is hosting an online event to launch its rapid evidence review on the wellbeing and mental health of NHS staff. Speakers will include Dr. Steve Borman CBE and Professor Dame Carol Black. Sign up for this free program here.

World Nation News Desk
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