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We have recently opened a new research centre at Middlesex University, the Centre for Critical Research in Nursing & Midwifery.  The web site is just set up and is here.  We plan to start a blog to talk about our work and the ideas that motivate it.  We will post the link on this blog when we get it started. 

Its another case of ‘I thought it was just me’.  I’ve just received this succinct analysis of a rising pressure on university employees.  Sarah Stewart-Brown takes the words out of my mind. 

Dear Colleagues

I wonder whether you would consider signing this petition

At Warwick we are in a process of ‘restructuring’ based on the single criterion of grant income.  This method of making academics redundant is spreading across UK Universities particularly medical schools and is a significant problem for academic medicine and academic public health

It is clear that the use of the single criterion of grant income is spreading and is likely to be more widely used if it is not countered strongly now
This criterion is a potential threat to research led teaching because it makes the clear statement to those on research and teaching contracts that no amount of teaching can compensate for failure to deliver grant income
It is also puts a greater value on certain types of research than others – so biomedical research with significant infrastructure costs and costly RCTs are valued over cheap and cheerful public health research.  RCT methodologies are often not suited to the evaluation of public health interventions and approaches.  Highly impactful epidemiological research can be delivered without grant income if those undertaking it have a degree of creativity and a knowledge of available datasets.  It is often counterproductive for such public health academics to use their time pursuing highly competitive grant income rather than doing the research. 
It is also misguided.  Research income does not raise significant excess £££ for universities to use elsewhere.  A considerable body of research income -particularly funding for ground breaking innovative research which is too risky for risk averse research councils -still creates net costs for universities. 
And it is not a good way to judge the value of academics.  One of the associate profs at Warwick, a highly productive 4* epidemiologist who was also a skilled and highly contributing teacher and trainer was on the list of those to be made redundant.  He has just walked into a Chair Position as Director of a renowned research institute outside the UK
Thank you for any input you feel able to make – signatures to the petition will make a difference .  Please feel free to pass on to your networks as widely as possible
With best wishes
Sarah Stewart-Brown
Chair of Public Health
University of Warwick

Last week I was involved with selecting which papers will be presented at next year’s Royal College of Nursing international research conference (in Nottingham April 20-22).  The number of submitted abstracts was down this year from last at 297.  Last year we started to stream the papers by method rather than by topic, a change which caused some controversy.  We stuck with that again this time round.  I was curious to get some idea of what people were submitting, in terms of method, and had a moment in the proceedings to do a quick count, based on how we had allocated papers to the streams (see picture).  This is the result:

There were quite a few papers that could have been allocated to different streams.  We asked people to chose a methodological keyword for their submissions and where they didn’t we opened up the abstract to find out and usually it was possible to find this out.  So from this quick count it seems that the most common research approach identified was mixed methods and following that ‘thematic analysis’ – these were qualitative papers.  In fact qualitative research appears to dominate.  I notice there’s not a single experiment among these papers.  I was surprised.  I thought nursing research in the UK had moved away from this stereotype.  I didn’t get a chance to do the same with the 32 or so posters that we had accepted. 

The part of the programme that I was most interested in was the keynotes on the first and second days by Debra Jackson and Michael West, as well as Peter Carter’s response to Debra, dealing with the pressing issues of nurses working in the UK NHS.  Our intention for this conference was to try to address the so called nursing crisis head on rather than live in a parallel universe discussing frankly parochial interests. 

Debra has been studying and writing about resilience for many years.  Resilience is usually seen as a kind of hoped for quality in people who have faced and-in the oft repeated words-bounced back from adversity and grown.  Transferred to nursing work it is sometimes seen as the quality that separates those who remain at the bedside and deliver good care from those who become jaded and can no longer do this.  In my minimal reading about the topic I discovered that the word is used by ecologists, town planners and the military to describe and aim to design whole systems that can withstand or rather adapt to unexpected and catastrophic challenge.  The worst aspect of contemporary work on resilience is its translation into short training interventions that are design to improve or perhaps prolong individuals’ useful working life in tough and possibly dysfunctional environments. 

The dangerous thing when it is discussed and promoted by nurses and those researching them is the tendency to individualise.  Also it is a very short distance to the narratives of moral heroism which abound in nursing and were apparent in many presentations at the conference including, I thought, Debra’s impressive body of work with nurses.  In fact there’s a parallel heroism often going on in the form of the rescuing researcher whose intervention raises morale and saves the ward.  I have yet to hear a presentation of these kinds of intervention that does not end well with improvements on whatever is being measured.  And never far from these narratives is sentimentality about nurses and nursing work which was also not absent from these discussions in Glasgow.  The trouble with these moral narratives is that when things go wrong, as seems almost inevitable in a hard pressed system with a combination of political pressures, the public and politicians find it easy to also look for explanation to the same narratives but this time a narrative of personal moral failure – compassion deficit – rather than understanding that it is systems that are dysfunctional and possibly huge reorganisations that take up precious energy and time not helping. 

General Secretary of the RCN Peter Carter was at the conference and gave a response to Debra’s paper.  He focused on nursing shortages and there is some hope that staffing levels are at last being linked to patient care and safety by governments, though there is still a strong sense of victim blaming to be found in some of David Cameron’s speeches about nurses and the idea of performance pay related to compassion demonstrations.  But I found his comment that compassion can’t be taught less than helpful, partly because of the same view that it is innate qualities that determine what happens in the NHS and partly because one or two researchers gave impressive accounts of projects based on specific cultural changes that did appear to have the effect of improving patient care.  And I think these kinds of initiatives are a much better bet than our current efforts to weed out, during recruitment, people ‘without compassion’. 

there’s an interesting initiative from a group of UK academics who have set up an ESRC-sponsored series of seminars discussing the role of the social sciences in nursing education and practice.  They are http://socialscienceandnursing.com/

Last week I went to the London School of Hygiene and Tropical Medicine’s Health Services Research Unit 25 year celebration.  CPNR (Centre for Policy in Nursing Research) was set up within the HSRU with funding from the Nuffield Trust and founded in 1995.  Apart from this there’s not much on the web about the work we did there.  However, here’s a reunited picture of (L to R) Jenny Stanley, MT and Anne Marie Rafferty. 

My book, Nursing in Context: policy politics profession has just been published by Palgrave.  For more details from the publisher, have a look here:
The RCN Library are organising an event on 28th November in Cavendish Square to launch it. 
There’s so much to say about nursing at the moment.  Given the impossible pressure that the NHS is under now, nursing scandals seem entirely predictable and it seems that no one, possibly not even nurses themselves is particularly motivated to change things radically.  Nursing is, for the moment at least, a relatively cheap profession which seems prepared to do dirty work and take responsibility when things go wrong.  What governments and hard-pressed managers could want more? 

Attending Congress always comes as a shock if you are used to the more measured deliveries of research conferences.  Congress centers around a series of either debates, where there is a vote which determines the RCN’s priorities for the year, or discussions.  But the debates are not what you might imagine from the debating society at school or university.  Out of Aristotle’s three modes of persuasion, Congress features far more pathos than ethos or logos.  Almost every contribution from the floor, with exceptions, is a first person account where depth of feeling is the credential for truth and persuasion.  In fact about one third of all speakers show audible signs of emotion, it is not unusual for speakers to break down and many tell the audience that they can barely talk for the strength of their feelings.  One particularly emotional debate was about obesity.  Nearly all the speakers who made it up to the front started their talks by admitting they were morbidly obese, many were in tears, and many, both men and women, pledged to lose weight by next year’s meeting.  One very young speaker was obviously not overweight and told a story of her own struggle with an eating disorder.  She broke down and a colleague, I presume, came up from the audience, put her arm around her and encouraged her to breathe deeply and finish.  She got a standing ovation and there was not a dry eye in the house, including mine.  The webcast can be found here item 15. 

Another debate posed the question about hospital patient relatives helping their relative to eat.  Some delegates argued that it was important that qualified nurses did this.  One nurse spoke about the immense sense of pride he had after helping an elderly man with dementia to eat his lunch.  Although unable to speak the man gave a smile of appreciation.  This was an argument for nurses to be engaged in this kind of activity.  This contribution articulated a sense from many speeches from the floor that nurses’ own emotional gratification was the driver and justification for their work. 

Over decades in research and conversations I have seen many nurses take up the position of victim, with the sense that their moral orientation and service ethic makes them vulnerable to exploitation by managers and government alike.  The 2013 Congress seemed to encapsulate this in almost every speech.  One powerful first person account was delivered by Austin Thomas, Lead nurse for the GB Paralympics team.  He’d had a major motorcycle accident and he talked about his experiences of receiving poor nursing care while seriously ill.  He was careful not to blame individuals and talked about poor training and lack of time.  He finished his talk with a poem, as other speakers did.  The last lines are reproduced in the daily bulletin for Wednesday’s events: ‘At times I felt you let me down, and the profession I love too.  But how are you to care for me, when no one cares for you?”  This received a standing ovation and obviously spoke for many present.  I remember that Isobel Menzies suggested that nurses could feel a deep envy for the care that patients were authorised to receive but which they felt deprived of. 

Its impossible to say whether Congress 2013 was more pained, more emotional than previous years, happening in the aftermath of the Francis enquiry and government response which many considered unfairly treated nursing.  But I have had similar feelings at Nursing Standard’s Nurse of the Year, that these large scale celebratory events are shot through with a clearly apparent pain.