23 January 2018
Michael Traynor, Middlesex University
I woke up last Tuesday morning to the BBC’s headline story that 3000 more nurses left the NHS than joined last year – and that many of those who are leaving are young – under 40 (http://www.bbc.co.uk/news/health-42653542). Not surprisingly the CEO of the Royal College of Nursing commented on the story saying that many nurses leave because they feel that with current poor levels of staffing they cannot deliver the standard of care that they believe is needed by their patients. They feel there is ‘no alternative than to leave’, she said. I am pleased that this is happening.
I recently wrote a book called Critical Resilience for Nurses. In it I voice unease at the recent promotion of resilience in nursing. Some nurse leaders and researchers along with, I imagine, many politicians are grasping at the straw of resilience as the NHS falls apart due to a series of policy decisions on the part of our current government. Resilience is a characteristic way of getting individual nurses (and others) to feel some personal responsibility for invidious system problems—on top of the responsibility they already feel to provide decent care for their patients and clients. Many nurses have been naively drawn onto the bandwagon of resilience believing that it can help individual nurses in some way, usually to stay at the bedside a little longer.
One of nursing’s worst tendencies is to cope. Or rather to acquiesce to gradually increased pressure and falling standards. I believe that policy makers and managers have come to rely on this professional ‘flexibility’. Under immense pressure themselves, they end up exploiting it. In my book I encourage nurses to join together to inform themselves about the causes of the specific problems they face—and do this in detail to avoid the possibility of critique turning into complaint, which too often is unproductive. Doing this can place them in a good position to influence and resist. If this strategy fails then I suggested that leaving the service could be a positive action, not the sign of weakness and failure that so many studies of resilience assume. If enough nurses refuse to work in a toxic system, governments and policy makers are forced to respond as I believe is happening today. That the government response is good for the NHS, its users and employees is far from certain so nursing’s professional bodies and trades unions need to work to influence the nature of that response. But for me, the promotion of resilience is part of the problem. Leaving, painful and costly as it is, could be part of the solution.