Who cares wins

As a post-Salmon, pre-Griffiths thirty something nurse-midwife, I have accepted change in my professional experience as pretty much inevitable - sometimes welcome, sometimes not. What I haven't always engaged with is what shapes the politics that effect those changes.

This text takes the reader through a series of thought-provoking explorations encouraging debate. Is nursing an emerging profession or is it a managed service? Is the key to quality improvement in nursing to develop and promote professionalism or does its success as an occupation depend on its ability to colonise senior health service management posts?

I read this book in two sittings, fascinated by insights that illustrated my working experience. It took me into the past and invited me to reflect on the myths that surround Florence Nightingale and the early training schools, looking at concepts of caring and what it means to care.

More recent events are considered, such as clinical grading and the resource management initiative and its impact.

Finally, it brings us right up-to-date with the changing power bases brought about by the introduction of primary care groups and clinical governance.

Overall, it brought together many concepts and buzzwords that I vaguely knew about and made them real and relevant.

I found myself thinking through explorations of tribalism and identifying with expressed concerns. Caring? Of course we must preserve that par t of our role; caring is at the hear t of what we do.

I was reminded that, traditionally, caring was carried out by 'handywomen', but could see auxiliary colleagues wagging their fingers at me, saying, 'No, no, sister, you took that role from us!' It raised my consciousness on a few issues that I thought I understood.

It was interesting to see that the contributors have transparent nursing and education qualifications but not such obvious management backgrounds.

I found myself reflecting on whether this might be important when reading a section on evidence-based practice and clinical governance and how this has been spurred on by the managerial agenda.

Any nurse, midwife or health visitor who has spent the past few years experiencing rather than analysing the changing nature of their jobs will find lots to identify with here.

They might, as I did, find many issues clicking into place and becoming more meaningful.

Students should find it a very useful resource. And managers and health service planners who would like to - or perhaps need to - know how nursing and nurses tick would do well to give this their attention.

Helen Meehan Midwife practitioner/lecturer, Kings Lynn, Norfolk