Facing the Crisis

The crisis in Nursing is multi-faceted, though the facets are dynamically and intimately connected. Central to the whole problem is the crisis in patient care. The increase in serious complaints about nursing care is only the ‘tip of the iceberg’. Smaller failures are rife, and cause patients a great deal of suffering and distress as well as possibly slowing their recovery and prolonging their stay in hospital. Failures in patient care also distress nurses and are a not-insignificant factor in a more public aspect of the crisis: the heavy loss of experienced nurses from the hospital service and the difficulty in recruiting and retaining good students. In the end, the responsibility for the quality of nursing care lies with nurse-managers.1 It follows that if nursing care is poor one should look to how managers are functioning. It seems that ward-management has deteriorated since the ward sister, who was not a ‘manager’ — just ‘ran’ her ward — provided better patient care.

I gave a paper forty years ago to a group of Health Service professionals who were heads of units. I began by saying “I am going to address you today as managers”. That opening evoked a wave of outrage. The audience thought of themselves as caring professionals and dissociated themselves from managers who, in their fantasies, were ruthless, inhuman and authoritarian. Such a remark would not provoke outrage today. Being a manager is commonly explicit, and consciously accepted. But the dislike of being a manager has not gone. It is expressed more subtly and insidiously, but nonetheless effectively. It seriously interferes with managers committing themselves to their task, and performing well.

Subtle socially-structured defences seem to have grown up that contribute to this situation (Menzies-Lyth 1988). There is confusion and vagueness about the role and functions of a ward manager. I have tried many times to elicit some clear description, and have singularly failed. I think this is deliberate, if unco