"You'll Never Make a Nurse"

Jan as a young nurse, Ayr, 1964

Jan Clyde is telling me about cycling through the Gorbals:

‘This was early 60s, the last days of gang warfare. Often there was trouble on the streets, and I remember feeling scared, but Sister would say, “Keep cycling. Look ahead. Don’t turn your head!” The thing is, they wouldn’t touch you because they knew you were there helping the community. They’d stop fighting to let you past.’ Jan laughs at the memory now. She was placed with the district nursing team in the Gorbals and would cycle out each day with her supervisor to attend the sick in their homes. ‘I had never seen deprivation like it. People had nothing – nothing but ten children – but they were lovely, and so grateful for anything you could do. The sister I had was terrific. I always say that I learned my complete basic nursing care from her.’

Jan is my neighbour on the Rosneath Peninsula. When we first met she’d just retired after more than forty years nursing in hospitals and the community. This year she celebrates fifty years a registered nurse. I told her that I was trying to write about nurses’ lives and she agreed to tell me some of her experiences.

Like many nurses I’ve talked with, Jan had close experience of illness in her childhood. Her father suffered the aftereffects of a severe fall at work, and became one of the first people to be given replacement hips. However, she credits her decision to become a nurse more to defiance than virtue. Jan, who has a flair for art, wanted to go into stage design, but her mother pressed her to get a ‘real’ job. The subject of nursing came up and her mother opined, ‘You’ll never make a nurse’ and that was it.

‘I was so naïve’, she says, ‘I thought it was all headaches and bandages. But I did take to it, and nursing has been good to me.’

Jan started nursing in an environment very different from today’s. Fierce ward sisters ruled and god help you if you were caught out, as Jan was, occasionally wearing nail polish or with too-high beehive hair or having a run in your stockings. The need for order was paramount. ‘But I liked the uniform, the stiff belt, the apron, you did take pride in it. It’s about respect, and having respect for yourself and your role. When they took the aprons away, and the caps, I just thought, I hardly feel like a nurse anymore.’

Working first at a hospital in Ayrshire, Jan was drawn to a surgical role. Having abandoned her early hopes of working in one kind of theatre, she spent seventeen years in another, as part of the operating team. ‘I like the drama, you see,’ says Jan, a light in her eye.  What she didn’t like was not knowing what happened to patients after they left theatre. Later, when working at a hospital in the Central Belt, Jan and other surgical nurses negotiated a system whereby the could visit patients in the wards to check on their recovery and talk with them. It echoes something I have heard from many nurses – the deep need to find out what happened next, what the outcome for ‘their’ patients was.

I can’t do full justice to Jan’s long career in a short blog post except to mention that she also ran an army medical centre, worked in a cottage hospital and spent the last fifteen years of her career as a practice nurse in a Glasgow community where she enjoyed the sense of continuity. ‘I was inoculating the children of people I had inoculated when they were small.’

Since retiring, Jan has re-connected with her creative ambitions and works as a textile and jewellery artist, but she remains a registered nurse and keeps in contact with former colleagues. Now her niece’s 19-year-old son has decided to enter the profession. ‘I tell him about life on the Nightingale wards and what is was like then and he looks at me as if to say, did you train with Florence?’

Jan is modest about her many skills and the thousands of people who have come under her care and passed out the better for it. At one point she uses the phrase just an ordinary nurse. I think that while the individual acts of nursing may seem ordinary to those that perform them, the accumulation of those caring acts over more than four decades is an exceptional thing.



Gorbals scene 1960s



Calling All Writers

sculpture: Bourrasque by Paul Cocksedge

Okay, not ALL writers. I’m interested in hearing from nurses (past or present) , based anywhere in the UK or beyond, who would consider contributing a piece of their writing to the blog. It can be a short piece of memoir, a poem, a story, and opinion piece. All I ask is that it is no more 600 – 700 words long and can fit (even obliquely) under the theme of ‘Nurse Stories’. You don’t have to be a published writer, just someone interested in reflecting your experience in words.

To start off this new section of the blog, I’m pleased to be including the work of some fine new voices here – Rosemary Mander, Deborah Ritchie and Corrienne McCullough – all individuals associated with Nursing Studies at University of Edinburgh. Just click on the ‘Writing by Nurses’ tab above to see their work.

It’s easy to get in touch – my 'nursingwriter' email address is on the top right under 'Our Project'. I look forward to hearing from you.

Professor Tonks

Tonks (centre) with some 2012 graduates

Josephine 'Tonks' Fawcett has been teaching in Nursing Studies since 1982 (‘Of course, I was a mere egg at the time!’). When you talk to students, Tonks’ name arises often – her humour, her habit of turning up during night shifts to visit her students, her perfectionism, her sayings. On first meeting, I was struck by her lithe energy and the individuality of her office – as much sitting room as workspace, with comfortable chairs, kettle ready for tea, and looking down from every wall and shelf, photographs and cards from past students and friends, an international web of nurses.

Tonks has just been awarded a Professorship at Edinburgh, providing an excellent opportunity to persuade her to submit to some questions.

One I have to ask – where did the name Tonks come from?

Well, I was the third girl from parents who really only wanted a boy. When I was born I was very dark, with ‘sticking up’ hair and my mother (a total blond) somewhat aghast, called me Tiddly Tonky. My eldest sister was known as Wimpy and my second sister Pepita (a mistake by my mother. She meant it to be Perdita) was called Pippity-Poppity-Poo, or Poo - though luckily that didn’t stick - and we once had a budgie called ‘Shivermetimbers’. It was all my mother’s doing; she was very creative with names! It wasn’t that Tonks was a pet name that stuck – it is simply my name’.

What for you is the core of nursing?

I always hope my students will see it as the caring understanding of each individual’s unique human response to the experience of illness (and health of course). Others would say communication – the heart of nursing. I would also add knowledge, always knowledge.

What achievements are you most proud of?

I am delighted by the professorship, and what I hope I can do with it, in a small way, as a catalyst for student learning. Also, Nursing Practice, the three editions of the book I co-edited with Margaret Alexander and Phil Runciman. (note: Nursing Practice was the first UK core textbook for adult nursing. The first edition was published in 1994. Grateful students refer to it as ‘The Bible’)

Who inspires you?

So many! My co-editors of Nursing Practice were, and continue to be, a great inspiration - Margaret for her energy and endless enthusiasm and Phil for her gentle ways and affirming understanding. Both are perfectionists. Also Annie Altschul, who was the nearest I had to a mentor (though she never called herself that) when I first started at the University of Edinburgh and who encouraged me to do my Masters in Nursing Education. I admired her capacity to be quite heretical at times in a way that only someone as respected as she was, could be; and of course all the wonderful students who go out into the world. So often when I write to them I find myself saying ‘…so proud of you’. They are an inspiration.  The patients also constantly inspire me with their courage and endurance and, again, my mother who taught me the value of resilience in the tough times and a little of how to ‘dare to be different’ - and to smile.

Which words or phrases do you overuse?

Gosh, probably too many. ‘We’ll get there’ a phrase so commonly said between nurses on particularly challenging days.  I give students lots of little phrases that I hope they will hold their heads like ‘Asepsis, Safety and Comfort’ –three all embracing principles of patient care and my three ‘Cs’ of bedside documentation – comprehensive, concise and (always)caring. And when the students first go on the wards and are nervous and a little unsure what to do, when everyone around seemed to be so confidently busy. I say, ‘Wash your hands, smile and circle the ward. Someone will need you’ Perhaps now I would be more likely also to add… find your wonderful mentor.

What was your first nurse uniform?

I first nursed on the degree course at St. Bartholomew’s Hospital (Barts) in London and the City University. My uniform had a wonderful cap, created from a large starched white square, an equally starched white apron, tight belt and detached collar with a brass stud that left a mark like a tracheostomy on your neck. I was smallish, and felt like I had been wrapped in a stiff white tube, but it really did give you a sense of yourself as a nurse and it somehow brought about a sense of mutual professional respect. The current universal uniforms, though necessarily serviceable, cannot have that ‘feel’.

Tonks (back row, centre) as a young nurse at Barts

Tell me one story from your nursing that sticks with you.

There are so many but probably one that has stayed with me from my earliest days as a qualified nurse at Barts was the day of the Moorgate tube disaster, when an underground train crashed into Moorgate station. I ‘grew up’ that day. I had only been a staff nurse for less than eight weeks, and at 8a.m. was preparing patients for surgery. The phone rang and the nursing officer (as they were called at that time) said ‘Are you ready to receive the disaster victims?’  Within two hours the whole ward had been re-organised. I saw the very best in people that day. Everyone pulled together, the nursing officers relinquishing administration priorities and literally ‘rolling up their sleeves’. One of our ‘firm’ surgeons particularly comes to mind, working in the darkness of the disaster tunnel to amputate a trapped woman’s foot. As well as the horror, it brought out amazing capacities in people. There was one young woman, a social worker, who had been badly crushed. We cared for her for six months but, in the end, could not save her. 
We can do so much more now.

Dancing Nurses Vanquish Evil

Add caption

No self-respecting blog about nursing and culture (and possibly they number more than one) could ignore what happened on Friday night. The Olympics opening ceremony boggled eye and brain. It was an ambitious attempt to re-imagine what British things were worth celebrating without recourse to forelock-tugging, corporate branding or celebrity glitter. Some crass mouthbores slated it as socialist. As if there was some sinister bias revealed in the motto that ringed the stadium before the appearance of Tim Berners-Lee - THIS IS FOR EVERYBODY.

At the centre of the pageant was the unexpected partnering of children’s literature and the NHS as represented by 800 puff-sleeved dancing nurses and dozens of ecstatically bed-bouncing children. The dark spirits of Lord Voldemort, the Childcatcher and other fictional villains were driven back by co-operative goodness and some airborne Mary Poppinses. And they weren’t hired actors pretending to be nurses; they were actual nurses and other healthcare workers who had volunteered their own time to rehearse weekend after rainy weekend. To learn exits and entrances and jitterbug kicks for the joy or satisfaction of just taking part. Watching it was to zigzag between thinking, this is madness and this is brilliant.

The reasoning behind the juxtaposition was that J.M Barrie, author of Peter Pan, gave all the rights for the work to Great Ormond Street Children’s Hospital, and it was fitting too that his words were read out by JK Rowling who has passed a great deal of her wealth on to projects such as a new research clinic for neurodegenerative diseases at Edinburgh’s Royal Infirmary. Literature is good for your health.

Removing healthcare from the day-to-day and setting it in this fairytale wonderland, addressed to the whole world, allowed us to see it for a moment in a new light. I mostly consider myself immune to the emotion of national spectacles, if not downright repulsed. The Jubilee, for example, had me running for the literal hills.  Yet I found myself vulnerable to the sheer optimism and egalitarianism expressed by ceremony writer Frank Cottrell Boyce, one of the creative team behind the ceremony.

But maybe I’m coming down with a case of age-related tenderness.  I’d be interested to hear what others thought about those dancing nurses. Chuffed or queasy?

nurse performers return home post-ceremony 

An Art?

Gabriel Orozco 'My Hands are My Heart' 1991

Last week I attended a study day for intensive care nurses and AHPS (yet another acronym to digest – for those who don’t know, it stands for Allied Health Professionals - physiotherapists and speech therapists, for instance)

At lunchtime I got talking to some experienced ICU nurses. We’d been discussing a presentation we’d been given about agitation in ICU patients, and how careful monitoring of sedation levels was needed to find the right balance between wakefulness and unconciousness. As I understand it, sedation that is too deep can hold back a patient’s recovery, while too little can make it difficult for a patient to tolerate the invasive breathing tube, not to mention the various lines, drains and cannulae.‘Of course,’ one woman remarked,  ‘A lot depends on the nurse.’

When I asked what she meant she said that older or more experienced nurses were more likely to have developed strategies to calm a patient. Really good nurses had the ability, she said, to create a tranquil atmosphere, just through the quality of their presence. ‘Are you saying it’s an art?’ I asked. ‘Yes,’ she said, clear as a bell, ‘It’s an art.’

It is so much easier to talk about clinical techniques, about monitoring and measurements and checklists than it is to talk this way, about art and intangibles, how nursing can work on a level that I can only, godless heathen that I am, describe as spiritual.

In my reading I come across accounts by individuals who have suffered life threatening illnesses and who write about the importance of certain subtle interactions to their recovery. Richard Selzer, an American surgeon and writer receiving treatment for Legionnaire's Disease in an ICU wrote of the skilled nursing care he received, calling it ‘transformative’. He describes being carried back to bed by a male nurse after a bath as the moment when his ‘molecules rearranged themselves’ ‘It is the true moment of cure,’ he writes.

David Rier, an Israeli sociologist, was admitted to an intensive care unit with a virulent form of pneumonia. Unusually for an ICU patient, he was alert or semi-alert much of the time and the notes and observations he made provide an insight into patient experience in the ICU that is rare in its thoroughness and which changed his own thinking about medicine. In his fascinating account, he credits a large part of his recovery to the atmosphere of the ward.

“The staff’s cheerfulness, and the personal attention they lavished on me, gave me a strong sense of security. As mentioned earlier, this conviction that everything was under control and would turn out all right remained with me through most of even the most critical phase of my illness. But given my weakness, not even the staff’s smiles and attention could have sustained this security had they given me the full, discouraging story they were giving to my wife,” Rier is of the opinion that at his most ill, bad news would have killed him.

“These points are crucial” he writes, “because I am convinced that this cocoon of optimism helped save my life.”  David A. Rier The Missing Voice of the Critically Ill (in Sociology of Health and Illness vol 22, 2000)

The non-clinical aspects of care – human interaction, empathy, encouragement, nurture – are often referred to as ‘soft skills’. It’s not a good phrase. Within a society so devoted to the hard and fast and innovative, it is belittling and dismissive. Yet what evidence there is points to these intangible exchanges as essential to recovery and healing.

In the Surgeon's Hall

The Playfair Hall

After visiting the Anatomical Museum here at the Medical School, I went to see another important collection three minutes walk away. This is the Surgeons' Hall Museum. Before you reach the pathology specimens in the main hall, a classical, galleried space designed by William Playfair, you pass through displays devoted to the history of surgery, detailing the many advances made by surgeons in Scotland, such as Joseph Lister, who pioneered the first antiseptic, and James Simpson, who revolutionized surgery through his discover of the anaesthetic properties of chloroform. Obscure feelings of gratitude wash over me.

I‘m browsing the lit display cases when a handsome notebook catches my eye. Bound in what looks like rich brown leather, glossy, with elegant gold writing tooled into it. I lean in close and read, Burke’s skin pocket book– and have to take a step backwards, my covetousness turned sour.  Burke and Hare, the notorious 19^th century murderers are an integral part of the history of medicine in Edinburgh. And here is Burke’s death mask beside the little book. I have already seen his skeleton displayed in one of the glass cabinets at the Anatomical Museum in the university.

Burke's skeleton © Hugh Pastoll

William Hare is not here. Having testified against Burke, he was given his freedom. Knox, the surgeon who bought the bodies of those they murdered, is not here either. Burke was hanged and then publicly dissected, and souvenirs were made from some of his remains. The treatment of Burke’s body reflects the offense that his crimes caused to humanity, but more particularly the harm they caused the medical establishment. The continued display of his remains in these venerable institutions does have the air of an object lesson.

There are no women in evidence in the Surgeon’s Hall, other than as specimens. The portraits and photos are all of eminent men, men who pushed forward our knowledge and proffered solutions to much suffering. The process of healing and care of the sick, however, consists of more than technical solutions, and I find myself wondering how such an elusive, tender process could ever be captured in a display of objects and photographs. The world of care – the ordinary and transformative acts of bathing and nourishing and clothing – has no museum.

Although women are not commemorated in the Surgeons' Hall, the work of a woman has brought me here. The writer Kathleen Jamie wrote a magnificent essay on the Surgeons' Hall in her book Findings. It is the best thing I have read about places like these, places that call forth all kinds of competing emotions.

‘Dr. Barclay was a man who could take up a tiny scalpel and flay, most delicately, the corpse of a small child until nothing remained but arteries and veins running to and from their destinations. The result hangs here in a glass closet. Around a small skeleton the blood vessels swarm stiffly, and the skeleton is arranged with arms uplifted, as though at play. For a while, in this room of still and suspended things, we must suspend judgement.’ – from ‘Surgeons' Hall’ Kathleen Jamie © 2005

I urge you to read the full essay, it is a beautifully structured, thoughtful piece of writing and manages to find an equilibrium between the seeming cruelty of this slicing and probing and the motivation that spurs it.

Jamie quotes an 1863 book by the Edinburgh physician John Brown, entitled Rab and his Friends. The story features a rare early description of a surgical operation on a woman with breast cancer. The author asks the reader’s forgiveness for the young medical students who he describes jostling eagerly for places at this spectacle:

“Don’t think them heartless…they get over their professional horrors and into their proper work, and in them pity as an emotion ending in itself, or at least in tears and a long-drawn breath, lessens – while pity as a motive is quickened and gains power and purpose. It is well for poor human nature that it is so.”

What Nurses Wear

“Nursing is made up of little things; little things they are called, but they culminate in matters of life and death” Florence Nightingale

I have become all too aware of the breadth and complexity of nursing today. With some 57,000 nurses and midwives working in Scotland – in hospitals and within communities, not only practicing care but advocating, researching and teaching, I look for points of connection, those little things that catch my attention and provide a way in to writing and thinking about nursing today. Writing too is made up of little things, an accumulation of words where everything can turn on a small, telling detail.

child's nurse costume

Lately I’ve been thinking about what nurses wear. The design of nurses’ clothing has always been driven by a certain functionality yet when you compare nurse uniforms of 100 years ago to the current uniforms being adopted in Scotland, the changes are radical, boggling even.  It’s not just about the development of easycare materials, but reflects a literal loosening up of the constraints that working women were subject to, and more particularly the roles that nurses occupy.

painting by William Hatherell ©IWM (ART 5234)

Around the time of the first world war, many nurses wore long white veils and floor length gowns and aprons. It’s no accident that they look like nuns, it’s a deliberate reference to the origins of organised nursing within the convent hospitals of Europe. Over the years the veils got shorter, and sat in elaborate shapes on the top of heads. The white aprons remained too, making nurses visual sisters to maidservants and waitresses. 

from the 1970s TV series, Angels

Capes and big belts lasted into the seventies, but in the last couple of decades, we have seen a shift to the simple, androgynous ‘scrubs’ type of clothing influenced by the US. By the end of 2012, all nurses in the NHS in Scotland will be wearing the uniforms modeled below, with different roles and hierarchies denoted only by subtle colour coding. The impetus behind this is to help patients identify who is who, but from the outside perhaps it’s not that obvious. The materials and cut are chosen with regard to washability and hygiene rather than aesthetics. That much is obvious.

new national uniforms © Scottish Government

In my posting about nursing in Malawi, you’ll see that nurses there, as in many developing countries, still wear caps and dress-like uniforms, but in North America and Europe, skirts and hats have disappeared. If you go to buy a nurse outfit for a child, however, it will have a little white hat, as well as a blue dress and apron, and assorted accessories – a stethoscope and upside-down fob watch. If your child is a boy, you won’t find a male nurse costume. Popular imagination is on a time lag as regards what a nurse looks like.

Male nurses never wore little white caps. For a while they looked like dentists. This new simplifying of the uniform is also a way of acknowledging that things have become more egalitarian –nurses may be male or female, surgeons and health care assistants can be dressed similarly, and increasingly care is delivered by teams of differently skilled people working together –ideally with the patient as the focus, not the internal hierarchies.

This is Elsie Stephenson in a photo taken during her nurse training in the 1930s. Elsie went on to be the first head of Nursing Studies here in Edinburgh. Her outfit is so crisp, so constraining at chin and neck and waist it practically makes me itch to look at it. The neatness of a nurse's uniform in that era was an outward manifestation of the discipline and attention to detail that were seen to be central to a nurses’ being. That and an unquestioning obedience. It wasn't so different to being in the army.

Scrubs, on the other hand, are clothes that you can throw on and not think about. But it does make me wonder if anything is lost in this casting off of the traditional idea of what a nurse looks like. And I'm interested to know - does anyone have nostalgic feelings for the nurses’ cap and uniform or is it a case of good riddance and don't look back?