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I read with interest the thought-provoking article in JRSM by two nursing academics, Shields and Watson, entitled The demise of nursing (JRSM 2007;100:70-74).1 As a junior doctor (Senior House Officer, Registrar and old-style Senior Registrar), consultant surgeon and clinician manager (Clinical Director and Medical Director), I can claim to be a witness to changes in nursing practices in the UK over the last 25 years. Gone are the days when the sister on the ward was the conductor of the orchestra of patient care, who along with his/her staff knew everything about every patient. Yet there was neither a clear promotional structure in the nursing hierarchy nor a financial inducement to retaining this highly committed workforce. With the changes in health care—particularly in the NHS—and expansion in the health care industry, a large number of better remunerated management positions became available; the vast majority of these were taken up by nurses, which left a vacuum on the front line of care.
It may not be politically correct to say that the introduction of ‘Modern Matrons’ was the last blow, when highly skilled and senior nursing personnel were relieved from front line duties, handed a red uniform, an office, a computer and mountains of paperwork loosely lumped as ‘modernization’. It is high time for the nursing strategy to move back to basics, which is the care of the sick by the bedside.
Competing interests None declared.