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The vocation of nursing

This was going to be a blog about a meeting.

On Friday Public World had a lunch meeting with Buurtzorg’s Jos de Blok and members of the four neighbourhood nursing teams that we are currently supporting to introduce the Buurtzorg approach to health and social care here in the UK.

We were excited about bringing the teams together and the meeting didn't disappoint, with the women, and man, easily relaxing into an open conversation about the challenges and rewards of their journeys so far. They demonstrated a passionate commitment to giving high quality person-centred care, and to bringing the self-managed way of working they have seen in the Netherlands here, intact, and true to its principles. It was inspiring.

But deeply troubled by the events of Saturday night in London, my thoughts are on values, and the shared humanity that the attackers on London Bridge departed from. The acts in London and in Manchester are traumatising because most of us simply cannot comprehend the impulse that drives a man to such atrocious violence against unknown people that he has decided to hate. The people who committed the brutal and disturbing attacks in London and in Manchester are extremists also in the sense that they are at the ugliest extreme of the spectrum of traits and behaviours that humans are capable of.

So I sat down to write this blog on a sunny Sunday, in a way, to cheer myself up and to remember the other end of the spectrum. The desire to care for the other. The capacity for empathy that requires no shared personal history, religion or race, and that is so innate that newborn babies show distress when they hear the cries of another infant. Seeing another in pain and wanting to help. Compassion and a willingness to give of ourselves to try to make things better.

While community is created by the fact that people in all walks of life behave in these ways every day, it is the profession of nursing that gives fullest expression to these values and behaviours in working environments. And there was a natural solidarity in that fact on Friday, evident in so much of the sharing and discussion.

The stories from the first UK neighbourhood nursing team inspired by Buurtzorg were motivating for us all. One of the team members spoke about a patient who was housebound with a long term condition, whose family had started to avoid her because of the grumpiness that resulted from her frustration about her declining health. While ensuring that she got the care her GP recommended, the nurse also started to get to know the family, and she described how with support the sons were able to take responsibility for some of the routine care tasks:

"A lot of people want to help their loved ones, but they feel that they don't know how. If you hold their hand and support them the first few times, they gain confidence and can get more involved in providing care".

A nurse under the pressures that are standard in our overstretched district nursing system doesn't have the time to get to know the family and friends around their client. In contrast, the neighbourhood team, which organises it's own workload, has the freedom to invest in developing these relationships and leveraging the support that helps to meet the clients care needs independently, and supports improvements to their well-being and relationships.

The benefits of holistic person-centred care that is the primary aim of the Buurtzorg approach are not just felt by patients. The nurse described how as the relationship developed, it was possible to get the woman to leave the house for the first time in months to visit a tree in a nearby park that she had planted several years ago:

"If you see the look on that lady's face; it's just transformational, so motivating."

That is the reward of nursing. Knowing that you have made a difference to the person you are caring for in a way that is far richer and more meaningful than the hurried response to immediate medical needs that is all many district nurses find possible if they are to get through their daily case load.

An organisational model that focuses on time and task rather than people as full human beings, and austerity budget cuts, have combined to increasingly squeeze the caring out of nursing. Gender analysis identifies caring as traditionally women's work, and perhaps it is no surprise that this fundamental characteristic of nursing is not valued and defended within a health system where a business school mindset has come to wield significant influence.

Both the older people who depend on public services, and the nurses who work in them, are suffering. Another of the nurses at the launch, who has set up a social enterprise to introduce the Buurtzorg approach in her area, described how she and her partner stay in touch and provide support to a couple of former colleagues they describe as "broken". Unable to give the care that they know the vulnerable people they see each day need, these nurses are suffering from depression.

When Jos and his colleagues speak about their experience in Buurtzorg, they often describe how the model of self-managed teams with a small back office which is there not to manage but to support, frees nurses to nurse. Over the course of the last ten years, it has become clear that not only does Buurtzorg score higher than other community nursing providers in terms of client and workforce satisfaction, but that the model is also a better use of resources.

It is time for change. The vocation of nursing is motivated by compassion and empathy, the best of what makes us human. The trust and responsibility that the Buurtzorg approach invests in nurses is something they rightly deserve.

  • Julie Porter is an associate consultant with Public World, working on our partnership with Buurtzorg Nederland to bring its model of care to the UK.
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