‘Things are aligning on safe staffing – and that’s where I’ll start as RCN president’

Anne Marie Rafferty has a tough road ahead in her new role – but she has a plan

Anne Marie Rafferty knows she has a tough road ahead in her new role – but she has a plan

Anne Marie Rafferty: ‘I don’t want to be a remote figure. I’m listening and learning.’
Picture: Barney Newman

Say the name Anne Marie Rafferty to most nurses and they’ll know of her, and may even give you a look of awe. Many will have read her seminal text, ‘An Introduction to the Social History of Nursing’ as part of their studies. 

But if her name is not yet familiar to you, it soon will be. Professor Rafferty has just been elected RCN president.

She takes up her role at an extremely difficult time for the college, which is reeling from a leadership crisis. In her pitch to be president, she promoted herself as ‘fearless in tackling difficult issues’, and she knows she has her work cut out.

So what made her choose to stand for RCN president at such a difficult time for the college?

‘Too few at the top of the profession’

It turns out her primary driver is safe staffing. ‘It is so of the moment. We’ve had legislation in Wales, and Scotland’s first reading of its bill – and England, the work being done here to gear up the case. Things are aligning.

‘We workforce plan not up to the senior levels, but only to the point of entry to registration. Then it’s sink or swim’

‘We have simply too few leaders at the top of the profession to support those below. It’s shaped like a Christmas tree. We’ve got lots of grade fives, but when you get to grade 7 the numbers are miniscule.

‘Unlike medicine, we workforce plan not up to the senior levels, but only to the point of entry to registration. Then it’s sink or swim.’

With safe staffing her key issue, she makes no apology for how she’ll bridge the RCN's dual role, as a union and a professional body, to bolster the evidence.

‘I see my role primarily as helping to boost the professional side. But I don’t see the two roles as being antagonistic to each other. It’s like the two sides of the brain, they do different things but draw strength from each other.’

Picture: Barney Newman

The other potential issue facing any London-based president is the risk of being too capital-centric. As a Scot, Professor Rafferty feels she’s less likely to be ‘dug in her wee corner’.

‘Having friends, family and having been up and down to help to look after my mum [who died last year, aged 99], I’ve been a flying Scot. I’m a keen traveller. I’ve got Irish roots as well.

‘I’m very conscious of the role of giving more autonomy to the devolved nations. I welcome that diversity and see it as a real strength.’

So what are her plans for the first three months? ‘I’m not going to jump in. I want to understand what the dynamics are – and I don’t want to be a remote figure. I’m listening and learning.’

Hospital nurse and elite academic

Professor Rafferty is someone who’s at the top of her tree academically. Her career path is intriguing, from conventional hospital nursing in Edinburgh to the elite world of Oxford academia and US health policy. So, who is this fierce intellect beyond the colourful clothes and softly spoken Scottish accent? And what made her want to become a nurse in the first place?

‘My mum was a nurse. As a wee girl I was intrigued by her stories of nursing prisoners of war in a military hospital in Scotland. They really fired my imagination.’

That, she says, alongside ‘a ghoulish, macabre’ fascination with the textbooks her mum had, and which she’d have as bedtime reading, even at the age of eight. Even now, she gets quite excited, as she describes the images she saw: ‘Carbuncles were my favourite, flowing with pus. It was terrifying... but also quite beautiful, because of the aesthetics of it.’

How to survive – and thrive – in nursing 

Anne Marie Rafferty nearly gave up on her nursing career when, as a student, she was bullied. These are her top tips for nurses:

  1. Find people who can give you a helping hand
  2. Challenge bullying. Don’t suffer alone, escalate it
  3. Be proud of what you do
  4. Never lose your zest for learning

You can hear her talk about her experience of bullying in our podcast

The transition from clinical nurse to academic specialising in social history becomes clearer when you hear an inspirational and moving story about her mother, a sister on the ward for German prisoners of war. It was Christmas 1944, and any festive celebrations for prisoners were banned, though the rest of the hospital still had them.

‘The carol singers were coming through the hospital corridors,’ says Professor Rafferty. ‘My mum let the carol singers in to her ward. The room erupted into song as the German prisoners began singing Stille Nacht. That really stayed with me.’

Inspired by her mother's career, Professor Rafferty went to Edinburgh University in 1977 to study for a nursing degree. While a nursing student, she nearly quit because of bullying, but was brave enough to confront her bully (hear more about this on our accompanying podcast).

She took a ward sister post in vascular nursing at the Royal Infirmary, but Edinburgh had whetted her appetite for research. ‘I thought “this is where we can make a real intellectual contribution to the nursing discipline”,’ she says.

‘I thought at the time “that’s probably the end of my nursing career”’

In a leap of faith, she moved to Oxford, where she’d won a scholarship to study the history of nursing, a step that propelled her towards her current career path.

‘I thought at the time “that’s probably the end of my nursing career. Who the hell is going to employ someone with a doctorate in history of nursing?”. It was a pretty risky career decision, but I decided to go with it. It was my passion. It was what I really, really wanted to do.’

‘I did sometimes feel out of place at Oxford’

The daughter of a nurse and a coalminer, Professor Rafferty found herself catapulted into the elitist world of Oxford University in 1985. 

‘I come from a very working-class background and going to Oxford was a big jump in terms of your sense of self and your sense of identity,’ says Professor Rafferty. ‘For the first year I felt survivor’s guilt. All my friends were slogging their guts out on the ward and I was wafting around Oxford in the Bodlian library, having a rare old time.’

She found herself in a ‘left leaning and Labour-supporting group’, which she calls the Oxford movement. Among them was her supervisor, the historian Charles Webster, who wrote the National Health Service: A Political History. Her personal mentor was a leading light in evidence-based medicine, Muir Gray.  

‘I didn’t meet another working-class person in the whole time I was there’

‘They were absolutely determined to evidence the value of nursing, expand its scope and to link with the evidence-based movement. It was brilliant, but I did sometimes feel out of place,’ says Professor Rafferty. ‘I didn’t meet another working-class person in the whole time I was there.’

Some years later, Muir Gray was instrumental in Professor Rafferty’s next big break. He encouraged her to try for the highly prestigious Harkness Fellowship, which allowed for a period of study in America. There, the evidence-based approach had greater hold in healthcare than in the UK and nurses had achieved more political influence on government. ‘As a historian I was thinking “how is it so bloody difficult for nursing to get change?”. I wanted to know what were the ingredients of that success in the US.’

It was 1994 and she was the first nurse to get onto the programme. She spent a year working with the policy adviser to the Clinton administration, Linda Aiken, who advised Hillary Clinton on her controversial healthcare reforms.


You can’t help feeling that Professor Rafferty’s willingness to ‘just give it a go’ opened doors others would never have thought possible. Though she admits, with her self-effacing manner, that she wasn’t always sure herself where her career was heading. 

‘After having thought that studying history would lead me into a cul-de-sac, instead I ended up having a career boost’

‘The Harkness Fellowship was a real turning point, after having thought that studying history would lead me into a cul-de-sac,’ she says. ‘Instead I ended up having a career boost.’

She was appointed to the London School of Hygiene and Tropical Medicine, the first senior nurse appointment in the school, to set up a research think tank with the RCN. There, she became head of the health service research unit and was able to undertake research around safe staffing.

She’s advised ministers at the Department of Health in England, has a CBE, works as professor of nursing at King’s College London, and has advised on safe staffing legislation in Wales and Scotland.

Now, in her new role for the RCN, she aims to put safe staffing at the top of the agenda.

‘I’m looking forward to getting stuck in and forming my own views,’ she says. ‘Not being bish-bashed around by people who think their views should predominate.

‘As an academic that’s one of the virtues of being critical.’

Lynn Eaton is editor, Nursing Standard

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