The essence of nursing — kindness, empathy, compassion — at risk

Cushla McKinney reviews The Language of Kindness, by Christie Watson. Published by Penguin Random House.

After 20 years as a nurse in the British NHS, Christie Watson is leaving medicine to pursue a literary career. But in a final act of the generosity that characterises the job to which she has devoted much of her life, she has taken the time to share what it has taught her. In The Language of Kindness, which falls somewhere between memoir and manifesto, she offers readers insights into an essential but undervalued profession and provides a blunt assessment of the way in which decades of political decision-making have compromised the heath system in general and nursing in particular.

Although she touches on nursing history and theories of practice, Watson relies primarily on her own experience to illustrate the values that define the profession: kindness, empathy, compassion, and the promotion of dignity in the face of illness that robs the patient of all privacy.

What emerges is a picture of a vocation that falls somewhere between art and science, requiring skills that can only be learnt through doing. A good nurse must be able to calculate complicated dosages on the fly and spot changes in a patient’s condition too subtle to be detected by mechanical monitors. She (and it is still primarily a female profession) must keep the horror of cleaning an incontinent patient from her face and to spend time listening to or holding someone as they grieve despite a growing backlog of other tasks.

She must know to keep a child still during a  lumbar  puncture, and to be able to translate scientific language into something a husband, parent, wife can understand. She has to recognise when to dissuade doctors from unnecessary treatment, and how to convince them intervention is necessary now; and to do it day after day regardless of whatever else is going on in her life.

It is a job that takes a heavy emotional and physical toll —  compassion fatigue, back injury, depression, PTSD and substance abuse are all too common side-effects of days spent caring for others —  and one that can  be sustained only by drawing on the altruistic impulse that draws nurses to the profession in the first place.

These stresses are exacerbated by workforce and funding shortages that mean nurses are unable to provide properly for their patients. And although Watson does not say directly why she is leaving the profession, I suspect it is partly because she believes that changes such as the devolution of basic physical care to unqualified and lowly paid healthcare assistants and the reliance on nurse-practitioners to fill the role of junior doctor (without the associated wage costs) have isolated the nursing from its nurturing core.

Despite its political messages, The Language of Kindness is also an intensely personal book and one that celebrates compassion in all its forms. Watson shares the trauma of observing her first birth and death, how treating hundreds of abused and neglected children spurred her to adopt her son, and what she learned from watching her own father being nursed through his final days of life. I was left with a deeper understanding of and appreciation for the work that nurses do.

While  New Zealand’s healthcare crisis is not yet at the scale of that faced by the NHS, it is a timely reminder that society can be judged on how it treats its most vulnerable and those who care for them. It is a message we ignore at our own risk.

- Cushla McKinney is a Dunedin scientist.

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