History: Radical nurses

Nursing Conversation Starter written by Elaine Maxwell

Politics determine policy and in a public funded health service such as the NHS, politics are extremely important. If nurses want to influence policy, they must hold their noses and get involved in politics. Whilst this can and does happen at a local level, there is a noticeable absence at national level. In 2013, the transfer of the Chief Nursing Officer from the heart of Government in the Department of Health into NHS England, an arms length body, left the profession one step removed from central politics and policy making. Whilst there were a number of voices raising concerns, the profession largely stood by and let this happen in a way the medical colleges would not have permitted if the same had been suggested for the Chief Medical Officer.

Political activism is a contentious issue for many nurses. The NMC Code of Conduct requires nurses to use best evidence (section 6) and provide leadership to make sure people’s wellbeing is protected and to improve their experiences of the health and care system (section 25) . The evidence suggests that structural elements such as income and education are major determinants of health and this would suggest the nurses should be campaigning on behalf of their patients. Many nurses are concerned about doing this, because of another part of the code that requires registrants to ‘make sure you do not express your personal beliefs (including political, religious or moral beliefs) to people in an inappropriate way’ (section 20.7). So should nurses be political or not?

Nurses have, at times, been galvanised to action around their terms and conditions but even that has waxed and waned. The Radical Nurses Group (RNG) was set up in 1980 ‘by and for nurses because of the dissatisfaction so many of us have about so many aspects of our jobs’. Although (or perhaps because) it was deeply political, it was not a trade union and had an uneasy relationship with the established trades unions. It was grounded in feminism, had no constitution and not even a set of aims and objectives, seeking to ‘co produce’, although that term was not used. RNG explored the politics of being a nurse; staff shortages, sex roles and stereo-typing in nursing, nurses roles, especially in relation to doctors and lack of emotional support for nurses. One of the founder members, Jane Salvage, wrote a highly influential book ‘The politics of nursing’ which still resonates today. Ultimately the group failed to engage a critical mass of nurses and the group disbanded around 1990.

Concerns about terms and conditions and about the supply of nurses dominate any political discourse involving nursing. This is clearly important and raising this up the political agenda is paramount, but as a profession is it enough to focus our political action on ourselves?

As the Royal College of Nursing emerges from a year of existential navel gazing, it has the opportunity to recognise the inevitably political nature of a profession that seeking to improve both individual and community health. Focusing on the impact of nursing practice on our patients and clients means lobbying for the social conditions that determine health. Nurses know at first hand as well as through the evidence that long-term conditions are more common in people from lower socio-economic groups and that housing affects health.

Nurses are afraid of speaking out individually because it may be career limiting and so we must come together as a collective voice, not as a trade union that focuses on the people who do nursing but as a professional voice advocating for our patients. If we truly advocate for patients, we must go where the evidence takes us and that means we must be political about the environments people live in.