A nurse’s story: what it takes to do the hardest job of all
Award-winning novelist and keynote speaker at this years RCN congress Christie Watson says nurses are in dire straits and in desperate need of support. Her account of a 20-year career in London hospitals captures the terrible, hidden beauty of nursing
In her new book, Christie Watson set out to do something that sounds simple, but isnt: I wanted to describe the job of nursing. As Watson sees it, nursing is bigger, more complex, more demanding than any other profession. It is very hard to put into language because it is metaphorical, it is quite abstract. It is not just one art, it is all the arts it is everything all at once.
With medicine you can talk about disease processes,...
Award-winning novelist and keynote speaker at this year’s RCN congress Christie Watson says nurses are in ‘dire straits’ and in desperate need of support. Her account of a 20-year career in London hospitals captures the terrible, hidden beauty of nursing
In her new book, Christie Watson set out to do something that sounds simple, but isn’t: ‘I wanted to describe the job of nursing.’ As Watson sees it, nursing is bigger, more complex, more demanding than any other profession. ‘It is very hard to put into language because it is metaphorical, it is quite abstract. It is not just one art, it is all the arts – it is everything all at once.
‘With medicine you can talk about disease processes, pharmacology, scientific bases; in nursing you have to grapple with kindness, care and compassion. It doesn’t seek to be medicine, it’s something much more unique.’
The Language of Kindness: A Nurse’s Story drops the reader into Watson’s life and walks, or more accurately sprints (there is a propulsive energy to this tale) through her 20-year career in nursing.
‘Nurses know what nurses do, and won’t be shocked’
You start out with the gullible 17-year-old student, hilariously duped by a mental health patient posing as a senior nurse, and end up with the expert resuscitation officer who has been immersed so often in others’ suffering that she fears she has lost the capacity to feel anything at all.
There are pauses along the way to consider the history, ethics and politics of nursing, which provide an intellectual spine to the book’s ruminations on the nature of the profession. But there is nothing dry or academic about The Language of Kindness.
‘You can tell a nurse by their way of being – it is somewhere between matter of fact and extremely kind’
Watson is an award-winning novelist. She uses her skill as a writer of fiction to deliver an extraordinary charge to real life events (identifying features carefully concealed). None of this should hold many surprises for other nurses, particularly those who work, as she did for most of her clinical career, in paediatric intensive care. ‘Nurses know what nurses do, and won’t be shocked,’ she says.
What they may feel is a sense of validation, because someone has dared to bring to public view the hidden world of nursing. Not just the intense joy and heartbreak – the toddler dying from sepsis who survives and thrives; the nine year old, paralysed from the neck down, who weeps for his old life – but the messy, funny, exhausting everyday reality that lies between these extremes.
No turning away
In one scene, Watson struggles not to retch while cleaning a woman who is covered in faeces: ‘Gladys has every type of stool described on the Bristol scale, all at once. There are lumps, blobs, ragged edges and the liquid has spilled over the incontinence pad, up her back and onto the pillow. There are flecks of green in her hair.’ The nursing team’s compassion is vividly felt but so too is Gladys’ distress and shame, her humanity and individuality as she drifts in and out of memories of a friend she is longing to see.
One of the achievements of The Language of Kindness is that it doesn’t spare the reader: you cannot read about Gladys and look the other way, there is no feeling sorry for her from a safe distance. Watson pulls you in close: ‘One day I might be Gladys. You might.’
‘We are all as vulnerable as the next person’
She tells me: ‘I felt it was a responsibility and a duty not only to be truthful about the horror of all of us but to make the point that we are all as vulnerable as the next person. We are all just bones and blood and shit.’
For Watson, our vulnerability is an inescapable part of our humanity, it blurs the line between nurse and patient, the well and the unwell, because none of these states are fixed, and we are all moving towards a point in our lives where we will need to be nursed.
‘None of us knows what’s coming, we just know something is coming,’ says Watson. ‘And that is a terrifying but also a comforting thought. Whatever you have been through or are going through you are not alone, because someone else has been through it.’
She adds: ‘The character of a nurse has to be really tough, full of grit. And also technically able and skilled, and also kind and caring – all those things.’
One of the ‘best gifts’ nurses can give, says Watson in the book, is ‘promoting dignity in the face of illness’. This means seeing the person, not just the illness, but it also means practising a skilful, compassionate deception – maintaining a ‘poker face’ when confronted with the body’s ‘horror’.
A lingering myth she is hoping to challenge with this book is that nursing comes naturally to women because they are women, that it is about the essentially feminine business of being kind. She argues that what unites nurses has nothing to do with gender. ‘There is an unwritten language of nursing around the world. You can tell a nurse by their way of being – it is somewhere between matter of fact and extremely kind.’
‘I’ve been given a platform to change things – it’s too valuable not to use it’
It isn’t just front-line nurses who Watson credits with ‘grit’. The buzz around The Language of Kindness has brought her into contact with senior nurses at the RCN (general secretary Janet Davies has praised the book as ‘searingly relevant’). ‘At the RCN there are a lot of extremely experienced nurses who have seen it all – you would not mess with those women! It’s wonderful, they’re tough.’
Her high profile as a successful author with an interesting backstory – she was a rebellious, academically underperforming teenager before she became a nurse, and still practising as a nurse when she won the Costa first novel prize for Tiny Sunbirds Far Away in 2011 – has given her an opportunity to speak up for nursing, and be heard. She is determined to make the most of it.
On the day we meet, at her publisher’s office in central London, she has just been confirmed as a keynote speaker at RCN congress in Belfast, and as a champion for the global Nursing Now campaign. ‘I’ve been given a platform to change things – it’s too valuable not to use it.’
‘I have spoken to people around the world and it is not just our problem – nursing is in absolute dire straits’
Near the top of her agenda is convincing the government that making nursing students pay for their training through loans is a mistake that is driving the workforce crisis. Perhaps it is because she is new to the political arena, but she makes reversing government policy sound almost easy. ‘I’m really hopeful we will get the bursary reinstated – we all know that needs to happen immediately.’
She is just as matter of fact, and essentially optimistic, in her view of the government’s pay offer which, while it scrapped the cap, has not been met with universal enthusiasm. Watson believes the offer should be accepted – voting against it because nurses deserve more would be self-defeating. ‘The RCN have said they do not expect to get a better deal from this government at this time, therefore this is as good as it gets. People fought and campaigned for it, and negotiated really, really hard for it.’
Nursing crisis goes far beyond the NHS
She is ambitious for nursing and in a hurry, willing to accept less-than-perfect wins (such as the pay deal) so she can move on to the bigger picture. Because the bigger picture is, for Watson, truly alarming. She emphasises that the crisis in nursing is ‘wider than the NHS’.
‘Internationally nursing is in crisis. Because of the book, I have spoken to people around the world and it is not just our problem – nursing is in absolute dire straits. In America they will be up to a million nurses short by 2020. That’s the biggest nursing shortage they have ever seen.’
The problem, she suggests, is unprecedented demand for nursing (fuelled by an ageing population) crashing into a depleted nursing and care workforce. 'Our patients have such great needs and we haven't caught up with the sheer volume of numbers and the complexity of people's situations. Outside hospitals there's an even more urgent situation. Social care and social services are suffering as never before.'
On top of it all, nurses are taking the blame for failures of care in an underfunded, overwhelmed system. 'Nursing is getting a bad name and this is largely led by the media. It is very newsworthy to have a story about a bad nurse. We don't celebrate nursing in the way we should, and must, in order to improve things for nurses.'
As things stand, she says the ‘Instagram generation’ have little reason to consider entering nursing: ‘Young people want to be Kim Kardashian, they don’t want to be a nurse.’
They also can’t afford to be a nurse. Watson says nursing made her ‘much less self-obsessed’ but she could never have trained to be a nurse without the bursary – and the same goes for almost all the nurses she knows.
The nurse’s journey with the family
She points out that an unreasonably high level of commitment is now being asked of nursing students and nurses in practice. She is particularly worried by the lack of support for nurses who are being left to ‘catch’ all of society’s woes, not just sickness but poverty, anxiety and loneliness.
This support needs to be put in place and nurses should have the time to access it. ‘Obviously, it takes time. At the moment there is no chance an A&E nurse can take a half hour for clinical supervision – they hardly have time to pee.
‘There is no 24-hour helpline for nurses. At the very least we need the same support that is available to other professions, if not more.’
Part of the uniqueness of nursing, she explains, is the closeness of the bond with the patient and their family, which sometimes does not end with the patient’s death. ‘Often when the patient dies, the nurse still goes on a journey with the family.’
The Language of Kindness leaves the reader in no doubt that Watson has been on many – too many – desperately sad journeys with patients and their families. Near the end of the book she escorts a mother to see her dead son, a boy Watson nursed for many months.
She stands back to allow them a private moment, but the woman ‘pulls me next to her, clutching my hand. She doesn’t cry. She simply looks at him and traces the shape of his face with her thumb’. When the woman notices Watson is crying, she asks her if she has children and says: ‘Then we are both blessed.’
‘Nurses have never worked harder than they do now. We need to acknowledge that nurses don’t have enough mental health support’
At this point in her story, Watson ‘feels like the worst mother alive’ and doubts whether she has the energy or compassion to be a nurse. That she can still cry for a bereaved mother is a surprise: ‘My ice-heart crashes.’
The book shows how exposed nurses often are, financially and emotionally, when personal crisis hits: ‘I feel as if I have no kindness in me at the moment. I am exhausted. I have split from my children’s dad, we had to sell our house and I can barely afford my rent. I’m working ridiculous hours, nursing and writing and teaching, and even that is not enough. I am not one of the many nurses who has taken a payday loan or gone to a food bank but I am dangerously close. I find my daughter putting Sellotape in her shoes.’
‘I’m still exhausted but I’m no longer as broke as I was’
The last time I interviewed Watson, in 2012, she was riding high with the success of her first novel, living with her long-term partner, a doctor, and insisting she could not imagine writing without nursing. Then everything changed. I tell her that reading The Language of Kindness made me worry for her. I have to ask: Are you all right now?
She laughs. ‘I’m still exhausted but I’m no longer as broke as I was, thanks to the book. I’m still split from my ex – but that was six years ago now.’ She seems to be in a good, and exciting, place. There was a bidding war for the publishing rights to The Language of Kindness and the publicity surrounding the book has made her one of the best-known nurses in Britain.
Her career in London’s hospitals, however (she worked in Great Ormond Street, Guy’s and St Thomas’ and St Mary’s) is over. She hasn’t held a clinical role since 2016 and is ‘grappling with the idea of staying on or coming off the register’.
An advocate for nurses
Whatever she decides, nursing will remain a big part of Christie Watson’s identity. She says nursing shaped her, saved her, and now she wants to advocate for her fellow nurses because they are being placed under unbearable strain. ‘We need to talk about this – nurses have never worked harder than they do now. We need to acknowledge that nurses don’t have enough mental health support.’ She wants to see a 'strategy around how we improve nurses' mental health'.
Did she give up clinical practice because she was burnt out? She says no - but admits she came close. ‘It’s not all sweetness and light. There are times when I’ve been a better nurse and times when I’ve been a worse nurse. Compassion fatigue happens all the time and it’s just not recognised.’
Watson argues that society is asking more than it ever has of nurses, so it is going to have to start looking after them or pay an enormous price in damage to public health. She is calling for a very big change in how nurses are valued. I won’t be at all surprised if she helps to deliver it.
Thelma Agnew is commissioning editor, Nursing Standard
The Language of Kindness: A Nurse’s Story, by Christie Watson, is published by Chatto & Windus, £14.99
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