sacrifice of nursing, The

Mental Health Nursing,  May 1999  by Beard, Paul

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At this year's CPNA conference held in Edinburgh in April, PAUL BEARD, new to a post at Broadmoor Hospital, was invited to give the Mental Health Nursing address. His paper considered the ways in which organisations, politicians and society have, for diverse reasons, coerced nurses and nursing into fundamental sacrifice. Mental Health Nursing 1999; 19, 3: 1923

In January this year, I signed up for something quite different. Despite advice from many quarters to the contrary, but with encouragement from some, I took up the position of executive director in one of England's three high-security (special) hospitals, Broadmoor, where I am now responsible for patient care services and the leadership and development of nursing.

During the months leading up to my new venture the word 'sacrifice' took on a certain significance. Some, but not all, of my closest friends and advisers said: 'How could you sacrifice yourself in this way, or indeed your career?'

I never thought of Broadmoor in these term. A 'calling' perhaps, but surely not a sacrifice. In the months I have been in post, I have been filled with humility by what I have seen. If anything I feel a sense of privilege and honour to have such responsibility invested in me. But as the complexities and realities of what I have taken on unfold, I see daily sacrifice in the form of compromise and pragmatism in response to shortages of resources, especially nurses. I'm not, however, suggesting that compromise and pragmatism are in themselves bad - it depends on what gets lost (or sacrificed) in the process.

This word sacrifice troubles me, not so much for its religious connotation, but more in respect of its relationship to nursing quality and morale. Searching through some old dictionaries at home, I came across a definition which offered me an insight into a possible link between sacrifice and nursing. It is taken from a I958 edition of the Universal Dictionary and it states that sacrifice is: `To give up, surrender, suffer to be injured, destroyed, or lost, in order that something else may be gained or improved, or for the sake of another person.' Using this as my working definition I proceeded to construct this paper which I have entitled: `The sacrifice of nursing.'

This concept of sacrifice of nursing may involve the personal sacrifice nurses may have to make in order to be a nurse, or the way in which nursing or nurses can be sacrificed politically, institutionally or by society. In order to understand this concept, I should define what nursing is. To do this justice, however, would require at least one paper in its own right. Therefore, for the sake of brevity I will draw upon the work of several nursing pioneers and scholars. For example, a recent article by Alison Kitson,1entitled `The essence of nursing', cites Florence Nightingale and Virginia Henderson as perhaps the two most influential thinkers of modern nursing. Taking Henderson's definition, which is still probably the most widely popular definition, nursing is as follows: `The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, skill or knowledge, and to do this in such a way as to help gain independence as rapidly as possible.'

Mental health nurses may not see the relevance of Henderson's definition, so I offer an additional reference point that encapsulates the very essence of nursing, both in the wider spectrum of nursing and in the context of mental health nursing, in particular. This is the classic book, Interpersonal Relations in Nursing, by the late Hildegard Peplau, first published in 1952.2 Peplau's thirst for `watching' led her to stress the importance of the interpersonal relationship between nurse and patient. By implication, Henderson and Peplau's basis for nursing requires close work between nurse and patient. Therein lies potential for personal sacrifice on behalf of the nurse who, faced with lack of resources, sacrifices nursing principles for pragmatism and survival.

This transgression from principalism can result in the sacrifice of self. The term `emotional labour', made famous by Pam Smith in her book, The Emotional Labour of Nursing,3 has resonance here. Her book, based on the findings of a study of student nurses' experiences of being socialised into nursing, was influenced by the writing of Hochschild,4 who described how airline cabin staff were able to maintain a calm, caring and comforting exterior, despite the deplorable and emotionally demanding conditions under which they often worked.

Pam Smith's study used face-to-face, in-depth interviews with nurses to examine some of the differences between their professional and personal lives, and the potential interplay and impact that one had on the other. This interplay has, as yet, not been fully researched. However, Smith's examination of nurses in clinical practice settings, listening to what they said, suggests that there might be a secret ingredient which could enable nurses to cope more successfully with emotional work, thus avoiding burn-out and, in the context of my paper, reducing the possibility of sacrifice.