why bedside nurses don’t have to be martyrs to be appreciated


In 2020 we saw windows plastered with rainbows, hospitals inundated with donations and NHS staff regularly described as heroes. While linked to increased risks faced by health professionals during the pandemic, notions of self-sacrifice in nursing are not new. In fact, they have long sustained the nature of the role.

With the professionalization of care work in the 19th century, in a society where the role of women was determined by the care giving, nurses were considered to be married to work. Like military or monastic life, nurses were expected not only to endure hardships without complaint, but to embrace them as part of your life’s work.

As written by E Glover, in a letter to the Nursing Journal, published in 1903:

A good nurse can never be compensated with money. She must be paid … but her work must be something better, something higher, and I may add that it is purer and more sacred than the ordinary trade of today.

A scene in a 19th century hospital ward, in black and white.
While medicine has long been seen as a professional specialty, nursing has been sidelined — and undervalued — as an altruistic profession.
Welcome images | Wikimedia, CC BY

Women’s and workers’ rights have come a long way since then. Yet the role of bedside nurses, job autonomy, and even salaries are still governed by the idea that, as naturally compassionate individuals, they should be willing to sacrifice parts of themselves to provide care for others. .

“Bedside nursing” refers to direct patient care and includes registered, associate and assistant nurses in a range of settings. The majority work day and night shifts and are not paid above band six (at which level you can earn up to £39,027, if you have more than five years of experience). Above that, you go on to management or become a specialist.

In the 15 years that I have worked next to my bed, I have seen hundreds of neighborhood employees experience burnout. My PhD research on departmental care distribution shows how bedside nurses are particularly vulnerable to stress and burnout. Such tensions are only exacerbated by hero stories.

The Enduring Ideal of Nursing as a Vocation

The historical distribution of employment by gender and class supports a hierarchy of labor within modern health care systems. Despite providing the most patient care and being the most at risk, bedside nurses occupy the lowest clinical reward classes.

Medicine has long been considered a professional specialty. Nursing, on the other hand, was seen as a vocation. This is rooted in the idea that care work is altruistic and care is an attitude – not a skill.

After this traditional separation between healing and care, the continued efforts by regulators and unions to strengthen nursing as a skilled profession have unfortunately led to a greater devaluation of direct patient care and bedside nursing.

With diagnostic and life-enhancing treatments as a priority, the fundamentals of health care – observation, hygiene, nutrition and comfort – are considered the foundation and therefore the least valuable. This is determined by a reward structure that effectively financially rewards staff for transitioning from bedside nursing to a nine-to-five role, despite having the greatest direct impact on patient care outcomes.

A nurse in green clothes holds up a poster demanding better pay.
In August 2020, Nursing staff for Downing Street protested against demanding a pay rise.
John Gomez | Shutterstock

This divestment reflects neither the need nor the demands of bedside nursing. It is physically and emotionally demanding work and comes with a price. Cross-workforce studies show that nurses across the board are undoubtedly more at risk for post-traumatic stress disorder, anxiety, depression, alcohol dependence, self-harm and suicidal thoughts.

While research has shown an association between increases in staff mental illness and spikes in COVID admissions, this has less to do with the trauma of COVID-specific care than the increased ill effects of overwork and under-resources.

This was felt most strongly outside of the COVID intensive care units that pooled resources, something I saw firsthand.

How rationing causes care in patients and staff?

During the first wave, I was transferred to a high-dependency COVID ward, where I looked after patients who were critically ill. This left me shocked, stressed and upset. But nothing prepared me for my return to an exhausted and overworked oncology unit for the second wave.

There, patients were neglected because we were unable to adequately meet their needs. It was there — and not in the COVID wards — that I felt unsafe, witnessed more drug errors, longer wait times, inadequate levels of basic care, and limited life-saving interventions.

When need is limitless and resources are finite, patients suffer humiliation, harm, and neglect. How nurses at the bedside determine who gets their time and attention is at the heart of my research. I’ve found that the process of refusing care to some to provide it to others – what experts call “rationing” care – has a serious adverse effect on bedside nurses.

A nurse in protective clothing sits on the floor in an empty hallway.
COVID saw nurses around the world push their boundaries.
Alberto Giuliani/Wikimedia Commons, CC BY-SA

Rationing health care is a human rights issue and inability to provide proper care is a major cause of suffering. Unlike policy and macro-level rationing, where institutions are ultimately held accountable for the effective neglect that rationing results in, care rationing shifts moral responsibility to the caregiver.

Nurses must bear the burden of deciding who gets their meals while they’re still warm, who’s in dirty sheets, and who’s left alone to die. To mitigate these injustices, they get up early and stay late. They skip meals, work through breaks and get burned out.

I am currently working with the International Public Policy Observatory on a rapid review of evidence showing how poor mental health among NHS staff places an overwhelming operational burden on the service. This entails significant financial costs.

While statistics on nurses’ mental wellbeing and its wider impact bring much-needed attention to the subject, surveys and reporting cannot do justice to the realities of working in an understaffed, under-resourced and overstretched acute NHS ward. They cannot adequately convey the physical, emotional and mental stress nurses have to endure at the bedside.

As long as the role itself remains devalued and bedside nurses are held to an impossible standard, this will not change.

On Friday 17 June, The Conversation’s partner organisation, the International Public Policy Observatory, is organizing an online event to launch the rapid review of evidence on the wellbeing and mental health of NHS staff. Speakers include Dr Steve Boorman CBE and Professor Dame Carol Black. Register here for this free event.