Identity Crisis

Jessica Parkhouse is a third year student nurse at Kingston University. She spent three weeks undertaking her elective placement with the CNMAR in August this year. These are her thoughts.

In my late teens I managed to come to terms with the possibility that I perhaps might not become a world-famous actor, filmmaker, or a generic somebody, who inexplicably saves the world from all its woes in some non-descript way. This was a sobering realisation, and amidst the terror of not knowing what to do with my life, I landed in nursing. So, there it was, the renowned “identity crisis” that is so commonly experienced at that age. Done and dusted. I’m becoming a nurse, so that’s who I am now. Life: sorted. But since then, I’ve heard a startling rumour; people continue to have identity crises throughout their whole lives.

I was speaking with a nurse recently, who described the historical role of the nurse as the “handmaiden” of the ward. This is where I began: unwaveringly sweet, willing to do anything and everything and obeying every command. I’d established this attitude as a petrified healthcare assistant who was simply attempting to avoid catastrophe. As I was assigned to a bewilderingly heavy ward, I was eternally grateful any time somebody would tell me what to do – because surely, I wasn’t going to do anything awful under their instruction? I thought I could skate by and collect my paycheck by simply completing tasks and following instructions, masking my constant sense of impending doom with a beaming smile. However, working in auto-pilot mode in that kind of chaos isn’t as sustainable as I had hoped. The ward sister there – A.K.A the greatest ward sister in the world – took me under her wing and encouraged me to trust my clinical judgement more and kept reiterating that I wasn’t as massively incompetent as I wholeheartedly believed. Working more closely with her, I started to form my own opinions on care, develop my professional skills and I established the foundations of my clinical identity. “Now that I’ve mastered the art of caring, my nursing degree will be a breeze,” I naïvely concluded.

Student nurses get a very unique perspective on healthcare. Stepping into new nursing areas, being supernumerary, and having to apologise for merely being allocated to shadow someone gives you a good amount of space to critically analyse the inner workings of a clinical setting. Having the chance to reflect on the ideal practice I was first taught -from the aforementioned greatest ward sister in the world- and compare it to other areas was a wake-up-call. It feels slightly taboo to address this, but I believe a decline in the standard of care is only a human response to the persistent adversities one might face in an understaffed ward in the depths of a winter flu crisis. Sometimes standards slip, bad habits form, morale drops, and the patients become a secondary priority. However, sometimes practice becomes harmful and distressing for patients and protocols dangerously get swept under the rug in exchange for a solution more convenient. Unfortunately, I’d seen this textbook bad practice in one particular setting.

Once spring had sprung and the winter flu crisis was leaving the headlines, I left the hospital and headed back to university, putting the negative experiences of my placement on the backburner. The nursing degree presents an array of modules, one of which never interested me: ethics. What could I possibly learn from that? I’m nice and friendly – isn’t that all there is to it? Nonetheless, they take attendance at our lectures, so actually attending is mandatory. Flickering my attention between the lecturer and my plans for dinner that evening, I tuned in to a sentence which elicited an unexpected paradigm shift. “As a nurse, you have a duty to protect the public.” Cue identity crisis 2.0. ‘Alas, I really am going to have to become a grown-up and take some sort of action.’

I gave an account of my experiences to my lecturers and they gave me endless support in taking it forward into a proper report. Advocating for the patients, giving them a voice, giving my colleagues a voice and amplifying my own voice was at the same time both frightening and empowering. There we go though, report filed. I did my duty. I can regress to my former carefree 21-year-old persona and relinquish any scary responsibilities. However, no matter how supportive everybody in the hospital and my university was, simply expressing my opinions and experiences to one unit was never going to bring about the change I was hoping for. I’m sure the majority of nurses, student nurses, midwives and AHPs reading this can recall similar experiences: noticing glaring shortfalls, inefficient protocols or damaging practice. And I’m sure many of us have made such complaints or even formal reports. And yet, I’m sure we still see the same issues happening in the same areas and affecting the same people. Despite putting myself on the line and reporting what I’d seen and what I felt went wrong, not much had actually changed, and that was deflating to say the least. Any previous sense of empowerment that I’d gained promptly disappeared, leaving me with a sense of injustice and pessimism, and almost reverting to the “handmaiden” role I’d once been so comfortable in. Cue identity crisis 3.0. I’m getting tired of this now.

As nurses, midwives and AHPs, we are normally at the centre of the patient’s journey. We see their good and bad days, we understand their problems, we get to know their relatives and we are essential to the multi-disciplinary team. We see how everybody’s input truly affects the patient. I can’t vouch for the other professions, but I know nurses are opinionated, outspoken and powerful. And yet, we don’t get listened to as much as we’d want. When I enquired about a placement with the CNMR, I didn’t delve too much into my reasoning, I just felt compelled. During this placement, I began working with the CNMR team on a report evaluating the efficacy of implementation of the new trainee nursing associate role into UCLH. To be working towards illuminating the greatest uncertainties of a pivotal new role was enlightening. Hearing different individual’s experiences with trainee nursing associates, reviewing the literature and starting to produce a report on the findings, highlighted the key areas of success, the main issues to focus on, and gave the fleeting opinions of my colleagues some substantial backing. Very quickly, I learnt that this was what I was searching for – a voice, but this time, it wasn’t my voice on its own, it was the many voices of my colleagues all banding together.

I feel that the nursing profession itself is in a sort of identity crisis. I feel sometimes we all function as singular units and forget the power we have all together. We are the majority, yet we are too scared to speak up for fear of retribution. For a workforce -not so secretly- understaffed and over-worked, we are too weary to rock the boat. When your working day is primarily about keeping your head above the water, how are you expected to navigate the ship towards a new horizon? More pragmatically put – where do you find the time and energy for ‘making change’ when on some of your 12 hour shifts you only give yourself 20 minutes for lunch in order to get everything done? Positions in which a clinician can have a day or two set aside each week for research are few and far between, and this is consistently highlighted as a rudimentary issue. Nurses, midwives and AHPs are the perfect investigators for the NHS’ most fundamental issues, because we see a myriad of patient encounters with the entire multi-disciplinary team and hear everything that goes on in a ward. I truly believe that research is the conduit for our voices to really make the changes we want, and I think it’s important for Trusts to meaningfully encourage research engagement and propagate these opportunities.

Our NHS is a beacon of exciting innovation and this is a direct result of research. Going forward from this placement, I will continue to embrace the power of research, and attempt to instill that empowerment into my colleagues. I will stand proud on the most stable looking chair in the staff canteen and proclaim: “We are no longer the ‘handmaidens’ of healthcare: we are leaders, we are team-players, we are carers, we are clinicians, we are academics, we are investigators and we are change makers.”

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