Doctors and nurses


5:00 pm - November 21st 2009

by Paul Cotterill    


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If I hadn’t, a quarter of a century ago, in the heat of the moment, cast aside the class-based distinctions, built into the NHS rules, which said I must wait upon a doctor’s order in spite of what we both knew or didn’t know, that diabetic gentleman slipping into coma would have suffered brain damage. Perhaps he would have died. Class could have killed him.

I used to work as a nurse. One evening, I was just doing a last walk round the ward, checking on anyone I had particular concerns about, having a laugh with one or two of the regulars, making sure people were settled before the night shift nurses came on.

As I came to the bed of the gentleman who’d just been transferred over from A&E a few minutes before, it took me a second to work out something was wrong.

His pyjama top was soaked and for a second I looked to see if he’d dropped the water jug as he fell asleep.

But then it clicked. I grabbed a lancet and the blood test strip tube from my pocket and stabbed for blood, but even before the blood was on the strip I knew there was no sugar in there to change the colour; the sudden drenching of sweat could only mean he was in hypoglycemic shock and heading swiftly for coma.

One nurse was sent to the phone to fast bleep the House Officer – a sign that there was an emergency one stop short of cardiac arrest and that he was needed NOW – and another to the ward downstairs where I happened to know they had the 50% glucose solution we didn’t have in stock.

The house officer was there in seconds. It was his first few days, and it may have been his first fast bleep; he seemed dazed. Within seconds I had the 50% glucose from the nurse runner and was bleeding it through the giving set.

I needed him to give the verbal order for medication before I could legally administer – seconds counted now as any delay meant possible neural deficits if and when we got the guy round; you can’t live for long without some sugar in your blood.

The House Officer hesitated, and said he wasn’t familiar with the IV solution I was holding, ready to plug into the line and rush into the blood stream. He’d have to look it up, he said.

‘There’s no time’ I shouted. ‘It’s glucose! Just give the bloody order!’

The order was given, after a fashion. I would have started the drip anyway.

The glucose poured in, and I explained where we were at; that the gentleman was a late transfer, that I’d not read his notes yet, but that he was clearly an insulin dependent diabetic whose control had been upset by the events of the day; that he’d probably simply not been fed in A&E, who’d focused on the possible stroke rather than the existing issues, and that what was needed in these circumstances was fast glucose, the faster the better.

Next morning at 7am I entered the ward, and my first look was to the second bed on the right, where the gentleman sat upright, eating his cereal. He was fine, and good enough to wave me over and thank me for saving his life; I assume the night staff had told him where he’d gone to the previous evening.

Why do I remember this little incident to this very day?

Beacuse of the reaction of the House Officer in the days and weeks that followed.

I could sense, every time he was in my company, that he was uneasy. He became more formal, more ‘doctor-like’ in his relations with me. He was a lad not much older than me, maybe even the same age, but he needed to show – it seemed – that he was the doctor, and I was the nurse. He was never rude, but he became just a ‘little bit off’, the whole time.

It didn’t bother me much, but I wondered what had happened, and I grew to realize that just for a second, in the heat of the emergency moment, class relationships had been overthrown, and that he now felt he needed to re-establish the proper hierarchy.

There was no reason he should have known about 50% glucose, but that it was perfectly normal that I, as an experienced staff nurse, would do. What mattered, it seemed, was the convenient fiction that (male) doctors had the scientific knowledge of drugs, while (generally female) nurses took the orders, however adept they might be at making clear what orders they expected to be given on their ward.

Cutting across that, I suspect, was the fact that as a male nurse, and that I’d also transgressed a different, less clear line; that an older, ‘motherly’ sister figure giving an order like that would have been OK, that this would have been within the ‘order of things’, but that by my very masculinity of approach (I’m a big bloke and in those days I was built like a brick shithouse) I had denied him his dominant position, and that my continued presence around the ward continued to deny him that.

The NHS, at its very inception, had built into it a system of class inequality which stays with us some 60 years on, and which impacts negatively on the standard of care received by people benefiting from it; the NHS is a great institution, but that just as Labour MPs in the post-war government did, we should see it as a socialist project only just begun, not simply one to preserve in aspic.

Maybe, as a newer type of nurse goes through its newer type of training, challenging class rules is good for the NHS as a whole.

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About the author
Paul Cotterill is a regular contributor, and blogs more regularly at Though Cowards Flinch, an established leftwing blog and emergent think-tank. He currently has fingers in more pies than he has fingers, including disability caselaw, childcare social enterprise, and cricket.
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Reader comments


A very believable tale. I’ll bet the month was August. My wife has many – very similar – stories. She much preferred casualty where the Doctors had to “bloody well listen” to the Nurses, than theatre, where the nurses were treated like the Doctors’ hand-maidens.

Of course I’m a teacher, so there’s my street cred gone !

The new system doesn’t strike me as an improvement. Basically, it means more levels of the medical hierarchy have been reserved for the middle classes. People shouldn’t be forced to study for a degree before they start saving lives if that is what they want to do with their life.

Nick @2: I think by ‘new system’ you may mean the training of nurses within higher education (rather than hospital-based schools of nursing) towards a degree rather than to the diploma (though both still conferring Registered General Nurse status). In fact this shift to Higher Education has been taking place since 1992, when Project2000 was inititiated, and last week’s announcements about the end of diploma training are merely a conclusion to that shift (and one that has already been reached in Scotland).

The notion that degree training is ‘new’ has been happily propagated in the media and blogosphere by people like Melanie Phillips (who believes it is a product of ‘ultra-feminist’ orthodoxy, no doubt with the connivance of ZaNULiebour), and by Iain Dale, whose ignorance was at least corrected by some of his readers.

Having said all that, I do indeed think there are significant problems with the shift towards HE.

In fact the piece above is the first of two. The second will set out how ‘professionalism’ in nursing – a perfectly valid aspiration in itself – was co-opted in the late 70s/early 80s (and brought about Project 2000 in 1992) as a means to perpetutate the class divide within the NHS workforce through a ‘divide and rule’ strategy which in the longer term has resulted in the ‘middle-class’ nursing hierarchy you rightly identify (closely linked historically to the Royal College of Nursing and its efforts to undermine/bypass a growing shift to trade unionism).

This ‘new’ hierarchy is now separated off, by its own design, from a Health Care Assistant workforce on much lower levels of pay and with much lower staffing ratios than the ones we were able to secure in the 1980s (not least through our trade union militancy).

” last week’s announcements about the end of diploma training are merely a conclusion to that shift (and one that has already been reached in Scotland). ”

Also in Wales.

Well thankyou for reinforcing my view that the NHS is full of hard working medical staff working in a very poor system – but god forbid one proposes reform.

Nick, they’re now required to study for an extra year (before they were required to study for two years, now it’s three). I don’t see a huge problem with that, and if that means nurses are going to all become middle class by virtue of attending university… hold on, I don’t think that’s how class works anyway.

I’ve heard many stories about new doctors being totally clueless and taking dangerous actions – which a nurse would have warned them against – when alone with a patient. Sounds like doctors are thrown in to wards with too little prior practical training – maybe joint training sessions for doctors and nurses on practical, basic issues which they both ought to know about, would help? Both educationally and to break down that “class wall”. I dunno, it’s just an idea.

7. Richard Blogger

18 January next year it will be 35 years since I was admitted (conscious, apparently that was unusual) to a children’s ward and diagnosed with juvenile diabetes (latter called insulin dependent diabetes IDDS, still later called type 1 diabetes; the name changed over the years). By the time I was discharged I had been shown how to inject myself (I couldn’t face it for another 5 years, my Dad did it for me) and rudimentary advice on food (basically I was told that the answer to the “does he take sugar?” question was always “No”).

Unfortunately no one told us how to prepare the syringe. It was a glass syringe and I was given five reusable needles, a plastic pot and a big bottle of surgical spirit. The vague instructions were to sterilise the syringe and needles by boiling and then storing the syringe in the pot immersed in alcohol. My mother methodically boiled the syringe and a needle every morning. That is, until our GP (who also didn’t know what to do) put us in contact with a family who had a diabetic child and they explained that it was only necessary to boil the syringe and needle once a week – the alcohol kept the syringe sterile in the pot. I remember returning to the ward after a week for a follow up appointment and my Dad asking a nurse if it was OK for me to have saccharine in my tea. She said that I wasn’t allowed anything sweet. The level of awareness amongst clinicians about diabetes and how to live with it was very poor 35 years ago.

Paul, I am glad for that man’s sake that you were there, you clearly know the signs and what to do, but as a diabetic I have been given lots of bad advice from both doctors and nurses. Finding the clinicians whose advice you can trust is difficult. As a patient I am too meek to challenge the clinician’s advice, regardless of whether the clinician is a doctor or nurse: they have the training, I merely live with the condition. The clinician usually does not accept my observations and insists that the only way to treat diabetes is their way. I am not sure if this is a “class” issue, but it certainly shows a lack of care being “patient centric”.

8. the a&e charge nurse

Very enjoyable read, Paul.

Personally I doubt if the original architects of the NHS would even begin to recognise today’s £100billion beast which now provides services for organ transplantation, fertility treatment, gender re-assignment, HIV, etc (not to mention the anxious army of of swine flu neurotics or ambulance callers).

The role of the nurse has certainly changed dramatically from those ‘Carry On Doctor’ days.

Nurses now prescribe independently
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4133743
And are being pushed into pseudo-medical roles – the so called ‘noctor’ or ‘quacktitioner’
http://www.nmc-uk.org/aArticle.aspx?ArticleID=82
Nowadays nurses even teach clinical skills and personal development in medical school.
http://linkinghub.elsevier.com/retrieve/pii/S1471595303000362

In fact a long running debate has raged across the medical blogs for several years with many respected docs (and indeed nurses) claiming NuLab have been responsible for ‘dumbing down’ health – others claim that these (nursing) developments have been long overdue, and have merely maximised potentials within the largest sector of the clinical workforce?

As you know this subject has kicked off again with the news that nursing is to become a graduate only profession – even the irrepressible Melanie Phillips has felt compelled to make a pronouncement on the matter (sniggers).
http://www.spectator.co.uk/melaniephillips/5532246/nightingale-must-be-turning-in-her-grave.thtml
Doctors may boast a higher quota of toffs but the ‘genie’ seems to be well and truly out of the nursing-lamp.

So yes, I suspect a new type of nurse IS already emerging, but the profession’s inherent conservatism (with a small c) still tends to baulk from the political issues you have raised.

I trained as an RMN from 1968-1971. Then I did my shortened SRN training from 1973-75. like PC I diagnosed hypoglycaemic crises, resuscitated people, and so on. But you don’t have to go to university to learn that sort of knowledge or have permission to apply it. It was all in the traditional course. In fact, 6 months after starting our training we were de facto in charge of a ward at night, with on-call back-up from a senior nurse. Later, aged 29, I did a degree in Russian and Linguistics. Back in nursing in 1997, I did an MA in Health Sciences. It was ludicrously undemanding.
Nursing is primarily a vocation. You can’t teach people to care, it has to be there already. When I was in hospital briefly some years ago, it wasn’t the professionals who responded, and their increasing grandiosity showed. It was the untrained auxiliaries who exuded care, who dirtied their hands, showed compassion and sympathy. One of the best nurses I ever knew, Kaz, was an untrained auxiliary, who couldn’t even pass the entrance exam to study nursing, and so left the job. If Joe Bloggs wouldn’t get out of bed, despite all the cajoling, entreaties, threats of sanctions of all the trained nurses with their specialised training in social skills etc., you called Kaz. Ten minutes later Joe Bloggs would be sitting at the table eating his breakfast, or having a (now forbidden) fag with Kaz. The patients adored him. He was a natural. And I’ve known others as gifted, yet completely unacademic. By all means give some people a more advanced training, but call them nurse technicians or something, and call the auxiliaries “nurses”. And you’re virtually back at square one: when I did my training nursing had long been two-tiered, with SRN/RMN’s versus SEN’s.

@6: Nick, they’re now required to study for an extra year (before they were required to study for two years, now it’s three). I don’t see a huge problem with that, and if that means nurses are going to all become middle class by virtue of attending university… hold on, I don’t think that’s how class works anyway.”

No it doesn’t, the 2 year State Enrolled course (which was practical based and very limited, academically and promotion wise) was phased out with project 2000 c. 1992. The 3 year Registered Nurse course has always been the mainstay of professional nursing.

Registered Nurse Spider.

Or you remind him of his own inexperience and that makes him uneasy in himself. Perception and subjective viewpoints are amazing, aren’t they. Nice to see you make it in to a baseless attack on the “class”of doctors.

12. the a&e charge nurse

[9] Care is a priceless commodity – even so responsibility for it seems to be increasingly delegated to the state or other agencies?

If we look at trends over the last 50 years we see more and more oldies being placed into institutional settings, increasing numbers of children in ‘day care’, while fewer and fewer people die at home (now just 18% of the population).
http://www.gsttcharity.org.uk/pdfs/gomes.pdf

But there are already significant dropout rates:

http://www.timesonline.co.uk/tol/life_and_style/health/article6920871.ece

Great post Paul!

Interesting post, Paul. Though it’s also worth mentioning that just as there’s a class divide between doctors and nurses, there’s a similar one between nurses and healthcare assistants.

As for the reactions of Mel Phillips et al towards nurses having degrees, I’m a degree nurse (passed with first class honours) and I’ve always gone to great lengths to ensure I’m not too posh to wash/too clever to care/insert Daily Mail slogan of the day here. Quite frankly, if I swanned onto the ward acting like I’m above piddling things like hands-on care, then the HCAs would have me for breakfast.

There are many problems with nursing care at the moment (abysmal nurse: patient ratios on NHS wards, reams of paperwork landing on our desks, a global shortage of nurses, greater concentrations of older and sicker patients on the wards due to an ageing population etc, etc) but nurses having degrees is not one of those problems.

I honestly can’t believe some of these responses. Great post? Is it because this guy is saying what you want to hear about class divides (as true as they may be) that you’re taking a baseless anecdotal story as proof of systemic problems?

After discussing this post and reading it again the only thing I can take away from it is this:

A nurse effectively bullied a doctor in to making a decision they had no information about. I’m not suggesting here that in the situation the nurse did not know it was the right course of action, but the nurse had not explained why the decision was needed to be such until AFTER administration. A doctor was being forced to take the word of nurse they did not know nor knew they could trust, and it’s supposed to be purely a class or experience thing that explains the uncertainty they had?

If the order had been the wrong one to give who would face the consequences? The doctor.

And we’re all just supposed to buy that the reason that the guy was “off” after that was a fear of losing hierarchical control and being intimidated by a “brick shit house”? Has anyone asked the doctor why he was more formal after that? Couldn’t at all be that a big bloke completely made an arse out of him and his pride was hurt and that he is embarrassed…breaking down in this case the ability to form an informal relationship immediately or in the long term? Just as viable a situation but perhaps not in tune with the story that we all want to hear?

If I got shouted at by anyone in my first week of work it would take a hell of a long time for me to get on to anything other than strictly professional terms with them unless they came and apologised. Paul, did you ever apologise for the manner in which you may have addressed him in the heat of the moment? Did you ever try to break down the class divides you hate so much? I’m hoping you did and that there is more to this story.

17. the a&e charge nurse

[16] ‘A nurse effectively bullied a doctor in to making a decision they had no information about’.

If this did happen, Lee (although that is not the sense I got from the anecdote) it is only because Paul was aware that untreated hypoglycemia leads to brain damage, and therefore felt compelled to put the interests of the patient above all else?
http://stroke.ahajournals.org/cgi/content/abstract/17/4/699

In a perfect world adequate medical support would be available for junior doctors but there are ALWAYS instances when the experience of a nurse is required as well.
I think this pattern is unlikely to change (in hospitals) for x2 reasons;
*increasing ‘specialisation’ – this had led some to accuse hospital doctors of being ‘partialists’ because they only look after the kidney, eyes, or gut, say, rather than the global medical needs of the patient (the consultant pathway is now set only 2 years after qualifying).
*NuLab have validated roles that nurses have ALWAYS provided informally (see 8).

The media is awash with stories of doctors who came a cropper after ignoring the advice of nurses and it has been suggested that these poor decisions MAY have been linked to some of the power games that Paul alludes to?
http://www.independent.co.uk/life-style/health-and-families/health-news/doctor-guilty-of-killing-intensive-care-patient-1548027.html

http://www.bio-medicine.org/medicine-news/Sheer-exhaustion-makes-a-junior-doc-u2019-kill-a-patient-21-13495-1/

http://www.dailyecho.co.uk/news/4326945.Woman__87__choked_to_death_after_doctor_gave_her_pills_despite_warning/

I certainly accept your points about the importance of communication but I will leave you with this final thought – one of the perennial criticisms leveled at doctors is that they do not always LISTEN and because they don’t listen sometimes bad things happen.

My hypothesis is that doctors regard themselves (as a profession) as the brightest of the bright and come to believe that they simply know best – in the majority of cases I’m sure they do know best but every now and again a catastrophe arises because they are guilty of poor communication.

This was certainly the case when a relative of mine died – his parents knew the initial diagnosis simply did not stack up (and tried to communicate this) but several members of the medical team did not listen, or ignored concerns until it was too late.
Maybe if a ‘brick shithouse’ like Paul had been batting for them things might, I repeat MIGHT, have turned out differently?
http://www.bio-medicine.org/medicine-news/-u2018Drunk-u2019-Doctors-Misdiagnosis-Proves-Fatl-19455-1/

@Lee

I think you’re probably right that other issues such as personal pride may be involved as well as/instead of things like social class and professional turf.

Is there a class divide between doctors and nurses? I don’t doubt it. This is a bit of a generalisation, but if you go into the canteen of a medical school you’ll be able to easily distinguish the medical students and the nursing students by the differences in clothing, haircuts and accents.

Though before nurses get into too much inverse class snobbery, it’s important to remember that the same issues of class and professionalism exist between between nurses and healthcare assistants. Many a newly-qualified staff nurse will have had a similarly chastening experience at the hands of an experienced HCA. I know I did.

@13

Trofim, the issue of student nurse drop-out rates is more complicated than depicted in that Times article.

As the article says, drop-out rates vary wildly between the universities – my university’s drop-out rate was far lower than some of the very high figures mentioned at some unis.

From what I’ve heard on the grapevine, those with the very high levels of drop-outs tend to be those universities who’ve engaged in a mad rush to put bums on seats in order to secure funding, and as a result wind up taking on students who were never really up to it in the first place – and then they promptly drop out because they’re simply not capable. I’d say this is the problem rather than the supposed “elitism” suggested by the Times.

Either way, the pass mark for a nursing student essay, even at degree level, is 40%. If they don’t pass that then they get two attempts at a resubmission before they’re asked to repeat a module. Anyone who doesn’t have the intellect to achieve this shouldn’t have peoples’ lives in their hands, quite frankly.

The main reasons for drop-outs on my nursing course were financial, especially for mature students trying to juggle a family and a mortgage. Behind that was people who dropped out due to illness or pregnancy. Academic standards came behind those other issues.

zarathustra @ 15:

Re class:
when I was training in the early seventies, there was certainly a class difference, but this gradually became blurred. I’ve certainly been attended to by doctors with clear demotic accents. At the end of my working life in an out-of-hours psychiatric emergency team, the professional difference was barely tangible, but then, psychiatry is generally more democraic. But I do think that many nurses now seem to want to model themselves on the characters in TV medical series, see, for instance, Holby City, where the nurses spend most of their time advising doctors where they’ve gone or might go wrong. You’ll see the occasional non-speaking extra in the background doing the menial nursing. But what’s this about docs and nurses having distinguishing clothes and haircuts? I’m intrigued to know what this entails.

Having specialist knowledge and skills doesn’t necessarily justify why nurses should have a degree. My first job, in 1963 was as an apprentice compositor. What’s a compositor? See here:

http://www.localhistory.scit.wlv.ac.uk/Museum/printing/printers/wilkes/wilkes03.htm

This was a highly skilled job entailing specialist knowledge and techniques, requiring a whole 5 years of weekly day release. Doesn’t mean I should have had a Degree in Printing, though. But I did get a lovely document, my indentures, signed off with a sealing-wax stamp at the end though.

Lee @16: I’ll start my round of responses with you as you are most questioning of the validity of my class-based interpretation.

First and foremost, you are right to say that from the way I’ve (necessarily) briefly set out the story it could be interpreted as simple bullying on my part.

There isn’t room in this type of anecdote for much background – that actually we’d already worked together for a while, that we got on reasonably well at a time when there was a cultural shift on the ward towards first name terms between doctors and nurses and a greater level of informality, and that as soon as the brief shouting was done there was a return to calm explanation and agreement on the course of action; I honestly can’t remember whether I offered an explicit ‘sorry I shouted’ but I certainly don’t remember any immediate sense other than that I’d acted urgently (how urgent this was in the context of the actual biomedical situation, we’ll never know, because I couldn’t know how exactly the guy had been in that state). To the best of my knowledge, I genuinely don’t think the doctor felt he had been bullied, but yes what I am suggesting is that over time he felt the legitimacy of his authority had been undermined and, yes, I am suggesting a class-based explanation for the way he reacted over time. That is, as I’ve said, why I remember an otherwise relatively day-to-day incident (an emergency, but not in fact an emergency) very well.

The other key point to make is that this is a story from a quarter of a century ago. The reason I recount it now is because this is the first in a couple of posts planned about the way the expression of class divisions has changed over the last twenty five years. Back then, in a large London teaching hospital, the class distinctions and the way they were acted out on wards up and down the hospital would gobsmack a younger generation. This was still a time when senior medical staff trained in the 1950s would quite happily reduce nurses to tears on the ‘grand tour’, insulting them over anything they considered to be a minor indiscretion in ward administration or even ‘deportment’.

Commenters above are right to point out that nursing has moved a very long way since then in terms of the way its professional status is recognised, with (as noted) senior nurses now involved in medical school training, for example.

What Zarathustra point out above though is entirely correct (and a focus of my second post). This professionalisation of nursing has come at the cost of a new class division between trained nurses and those who actually do the nursing as we once conceptualised it – the Health Care Assistants.

The point therefore of this post, ancedote that it is, is to set out the case that the NHS, even since its creation when the hospital consultants lobbied and won key concessions that allowed them to retain their major priveleges, has been the subject of class (and gender) inequalities, which shift in their expression over time, but which are institutionally designed to divide and rule the workforce overall and now result in a marginalised and exploited workforce of HCA (and cleaners etc.).

I’m interested in your suggestion that my anecdote is ‘baseless’. The base for my anecdote is my own experience, and that is perfectly legitimate. You will see from several commenters above that this experience chimes with that of several others who trained/worked as nurses in the same kind of period, and several of them go on to record (anecdotally) how things have changed since then, especially with the development of a new ‘two tier’ nursing workforce.

Just on a point of detail about who would have taken the rap had I acted without a verbal order then confirmed in writing, and if that had been the wrong decision. That would have been me, and I would have been struck off. It is likely I would, in the 1980s, have been struck off in such circumstances even if it was the right thing to do if the doctor had chosen to report my actions in a way designed to ensure that.

Trofirm and Zarathustra and A&E nurse @various

Thanks for your contributions. As I’ve tried to set out briefly to Lee in my comment back above, but you all set out better, the way class divisions are expressed in the NHS has changed significanlty over the last 25-30 years.

My concern about the ‘degree-ification’ of nursing (and a concern that many of us have held since the 1990s) is that, courtesy of what in some ways is a legitimate aspiration to professionalise nursing, the profession’s bodies (RCN, UKCC-as-was) have sold out the wider body of the NHS workforce. Nowhere is this more strongly evidenced than in the RCN’s mid 2000s’ attempt to ‘define nursing’ (http://www.rcn.org.uk/__data/assets/pdf_file/0008/78569/001998.pdf) where there is an attempt to put clear blue water between the ‘profession’ and those who do much of the actual nursing.

Trofim @ 20

But what’s this about docs and nurses having distinguishing clothes and haircuts? I’m intrigued to know what this entails.

Medical students tend to dress in a quite consciously middle class way – button-down shirts, tank tops, short-back-and-sides haircuts for the boys, sensible long hair for the girls. Nursing students tend to dress more casual – jeans, trainers, t-shirts, fashion logos, whatever spiky hairstyle happens to be flavour of the month at Toni and Guys.

This gets a bit blurred once they qualify, as the nurses will be in uniform from then on. That said, I work in psychiatry where we don’t wear uniforms. As you say, psychiatry tends to be more democratic than the rest of healthcare, but even so the medics tend to wear a suit and tie (or, failing that, at least a smart shirt) while the nurses tend to dress as casually as the dress code will allow them to (or, if they’re on night shift and there’s not many managers about, more casually than the dress code says they’re allowed to.)

I once knew a nurse who was on her way to run a parenting class at a child and family clinic, and she got pulled up by the clinical director for wearing jeans. She patiently explained to him that there was research evidence that attenders of parenting classes feel more comfortable if the instructor dresses casually.

She said to me afterwards that she was glad that he didn’t ask to see this research evidence, as then she would have had to make some up.

24. the a&e charge nurse

‘Class’ in the health workforce is undoubtably a legitimate concern – but I suspect it is even more of an issue for patients?
The simple fact is class kills or maims – the research evidence bears this fact out time and time again.
http://www.sochealth.co.uk/Policy/inequalityNHS.htm

Ricahrd Blogger @7:

As I’m sure you now know, the understanding of diabetes has moved on a long way from those dark ‘no sugar in his tea’ days, which at this remove seem remarkable (given the extent to which my highly sporty IDD nephews stick away the sugar to avoid going hypo). Those were dark days, relatively speaking.

My piece, as I’ve set out above, was a piece of history, and it’s important to recognise that overall there has been huge progress in the NHS and that staff are much better equipped and trained than they were 35 years ago notwithstanding some of the concerns both I and other commenters above set out about how workforce divisions have led to the marginalisation (and poor staffing ratios) for some staff at the bottom of the pile. Recognising that does not, much as Mark M @5 would love it to, mean that the NHS is rubbish and needs ‘reform’, whatever thay means, but that there are still challenges to overcome for a socialist health service.

“In fact this shift to Higher Education has been taking place since 1992, when Project2000 was inititiated, and last week’s announcements about the end of diploma training are merely a conclusion to that shift (and one that has already been reached in Scotland).”

It was wrong then and it is wrong now.

27. the a&e charge nurse

[26] ‘It was wrong then and it is wrong now’.

Enigmatic, Nick, very enigmatic – care to say more, I mean isn’t this a bit like saying drugs are, err, ‘bad’?


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    hierarchy. Thoughtful, useful piece RT @libcon Doctors and nurses http://bit.ly/69F60h

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    'Doctors and nurses' http://bit.ly/69F60h Wasn't expecting this personal memory to get edited for move to @libcon, but heh ho…Also at TCF

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  8. Liberal Conspiracy

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  10. Lee Griffin

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  11. Mandy Elliott

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  12. Christina Cox

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  13. BMJ Group blogs: Journal of Medical Ethics blog » Blog Archive » Nursing by Degree

    […] at Liberal Conspiracy, this is a point made wonderfully well by Paul Cotterill: it’s well worth following the link and reading the whole thing.  But, as an appetiser, […]

  14. Charlotte Badger IV

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    Social comments and analytics for this post…

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  16. David Block

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  17. Kathy Herbert

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  18. Gerardo Medina

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  20. Gerardo Medina

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  21. Claire Butler

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  22. Gender vs. Class: the case of nursing (Introduction) « Though Cowards Flinch

    […] personal story about class difference in the NHS 1980s, which was kindly edited by Don Paskini for publication at Liberal Conspiracy and attracted a good deal of, mostly supportive, […]





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