In the third blog of her ‘6 Cs of nursing’ series, Clare Price-Dowd, senior lead for evaluation and patient experience, explores what courage means to her.
I remember my first day of nurse training; I was absolutely petrified as the bus pulled up outside the Queens Medical Centre in Nottingham. Finding my way through the very long corridors to the school of nursing to meet others in my group, I had this perception that they were all going to be so much better than me and so much more experienced (like they’d all done some secret cadet nursing). But I actually found that everyone else was feeling the same.
Courage to extend your craft
After the initial six-week preparation, what struck me on my first day on the ward was that patients couldn’t differentiate between me with my hat with no stripes on or my experienced colleagues. To them, a nurse was a nurse. Didn’t they see me quaking in my boots as I walked onto the ward for the first time?
And then there were the ‘firsts’. No amount of injecting an orange in training school is going to prepare you for the moment where you first stick a needle into a patient’s leg. Then there’s the first dressing you do, the first changing of a naso-gastric tube… All of those things take nerve and the personal courage to believe in your tutors and the people that have trained you to do a good job.
Courage to stand up for what’s right
There are lots of different sides to courage. There’s something about getting rid of nerves to enable you to develop into a good nurse, but as you qualify and progress, courage takes on a whole new meaning. It evolves from being about you and what you can do to how you advocate other people and how you stand up against what’s not right. There’s evidence to say that when we’re in a situation we don’t agree with, we can do one of two things: become professionally socialised and take on some of those bad behaviours (we saw this in the Mid Staffs report) or risk ourselves professionally and become a whistle blower. You wouldn’t think that doing the right thing would put you in jeopardy of being ostracised or bullied yourself, but standing up and holding people to account of what is right is a very courageous thing to do. The nurses who’ve done it throughout history certainly haven’t had an easy ride.
Courage to do difficult things
There’s a courage that goes with the professionalism of nursing. There are instances throughout every nurse’s career where you have to do something really difficult that you know is going to cause distress. It might be breaking bad news, it might be telling someone that there really is nothing left that can be done for them, or that a routine test has revealed something worrying. As nurses this is something we have to do. We’re the ones often thought to be the best communicators and most able to cope in those types of situations. You might be absolutely quaking inside as you tell somebody something they’re dreading hearing, but you put on that professional face and you do it. I heard a nurse colleague once describe it as taking one for the team. Sometimes that courage comes from you doing it yourself rather than passing it on to somebody else.
Last year my husband was really ill. For a period of time I knew that something was seriously wrong but I put on that brave face: “It’ll be fine”, I told him: “The doctors know what they’re doing, the surgeon knows what he’s doing – you’ll be kept safe.” But inside me I thought ‘What if something goes wrong?’
Sometimes the flip side of being a nurse is that you know both sides; that things sometimes don’t go as planned, so that blind faith in everything being okay is stripped away. Courage for me at that time was maintaining a happy face and saying everything that my husband wanted to hear. But it was also having the courage to actually say “I’m scared too” despite everything. It was saying goodbye to my husband at the operating theatre’s clean and dirty line where I couldn’t go any further, then completely losing it and dissolving into floods of tears having being the courageous one for all that time and realising that I couldn’t be courageous any longer. (By the way, everything was fine and my husband is fit and well, thanks to the amazing care that he got.)
However senior you are, I don’t think that need for courage ever goes away. I’m no longer a frontline nurse but I still use my nursing skills every single day. Now in a leadership position, my courage is often called upon to have a difficult conversation with somebody, maybe about something they could do better.
I talked last time about the different types of bread my line manager used to describe me as. I was either having a ‘white sliced’ moment or an ‘artisan loaf’ moment. Sometimes if the lowest common denominator has become the norm, we need to have that courageous conversation about how we can improve standards, because ultimately, we’re all here for patients.
Sometimes being courageous is as much office-based as it is ward-based. We might not have direct hand-on patient care here at the Academy, but the leadership we develop manifests across the system and impacts on staff and patients every day. One of the golden threads of the Academy is to develop standards of leadership, so they are manifest in the people that we’d want looking after us and those we love the most.
And finally, we see immense courage displayed by our patients and carers. We have no idea how some of them manage to remain cheerful and upbeat when they are so poorly and coping with some of the most difficult situations.
They are the real role models for courage.