Are professional boundaries getting blurred - or are nurses finally shedding outdated, hierarchical constraints?

Nursing when Flo was a lass...

The nursing hierarchy in 1979, the year I started nurse training, was awful; but even then, people yearned for the good old days in ways which some readers may accuse me of doing, should they ever get to the end of this article.

The first year student was a life form one step up from a protozoon; the final year student was a demi-god who knew (almost) everything. Staff nurses, with fresh memories of pre-qualified status, were more willing to talk to you; but the ward sister was a full Olympian, who had her own fine china teacup, dined at a separate Sisters' table in the staff canteen, and was allowed to talk to consultants.

The use of first names in the presence of patients was taboo; should Sister hear it, you could expect a carpeting. During my training, there were several sisters whose first names I never learned (not that I would have dared use them...).

Being an annoying little so-and-so who couldn't see a convention unchallenged, I kept asking why we had this formality. The least helpful answer, back then, was 'because respect has to be earned'. (I've since come to appreciate that comment's profundity.) More thoughtful nurses talked about the need to keep oneself at an emotional distance from patients ('you're no good to your patients if you're off blubbing somewhere' sticks in my mind), and the value of a hierarchy where, in an emergency, there was no need to call a meeting and elect a leader.

Fast forward: some vignettes:

• a student nurse discussing, with a male patient, the emotional effects of her menstrual cycle
• a health care assistant talking with two qualified nurses about the shortcomings of a colleague, with no attempt at finding some privacy
• a trained nurse criticising, for the benefit of a student, the techniques employed by the nurse who had applied the dressing she was changing (comments which the patient couldn't wait to relay to the person who had originally done it)
• untrained staff answering the phone and dealing with queries for which they don't have the necessary knowledge - and then becoming indignant when upbraided, genuinely believing that they were freeing the nurse in charge to do more important things
• a belief among assistant care workers that any instruction from a qualified nurse, concerning a clinical issue on which they had recently had a four-hour 'professional update', should be treated as a suggestion, to be followed at their discretion
• a student nurse refusing to listen to an explanation of a patient's condition because 'she'd a lot going on'

I could give you a lot more of this, but I'm aware that I'm sounding like some old anti-progress curmudgeon, like the type who thinks that Wikipedia is a barrier to learning.

No, bad example, because I do believe that.

Whenever a student nurse or a new member of staff says 'this is a great place, everyone's so friendly', alarm bells go off. Where everyone is ‘besty fwends’, socialising regularly outside work, it's hard to break up cabals, and any criticism of a professional action leads to the 'accused' being surrounded by supporters saying 'you don't know what problems he/she is having'.

I realise that I'm sounding more and more heartless. I don't think I am; I just believe that there are necessary boundaries. I don't want to go back to the old days - for example (and this is from my own experience), answering the phone during a ward round, taking a message for the consultant, passing it on to the staff nurse, who passed it on to Sister, who then passed it on to the deity in a white coat, who passed the reply back down the line for me to deliver to the person hanging on at the other end. Those days were rubbish. 

But is what we've replaced it with really such a great improvement?

The first year student was a life form one step up from a protozoon; the final year student was a demi-god who knew (almost) everything. Staff nurses, with fresh memories of pre-qualified status, were more willing to talk to you; but the ward sister was a full Olympian, who had her own fine china teacup, dined at a separate Sisters' table in the staff canteen, and was allowed to talk to consultants.