Casos difíciles de Ronald Dworkin

These frustrations led to coping strategies that involved doing as the Romans do, that is: behaving as the British nurses do. One exchange in a Cardiff group described this process of acclimatisation as conscience killing:

You mustn’t do it, you have to walk away. Your conscience is telling you “let me do this” but you are not permitted to do it.

(male, 39 years old, Nigeria, black, D grade)

I think it takes the joy of nursing away……there’s no joy in it any more because you’re not allowed to work and get things done……When in Rome, do as the Romans do, so we’ve become complacent and instead of trying to bring them up with the standard, with the norm, with the Commonwealth, we are now in danger of going down to their standards. I don’t really know what to do about it because you’re reminded all the time that you’re an immigrant.

(female, 55years old, Zimbabwe, white, E grade)

Yes, it’s conscience killing. That is if you have a conscience. Not to exhibit what you know. You feel, what are you? You feel bad….

(female, 36 years old, Nigeria, black, D grade)

Those small things which a nurse can do waiting for a doctor like putting up a drip and a patient waits for …and you feel bad because we know how to do them…at the end of it, I say: ‘There’s nothing I can do, let me wait and get paid.”

(male, 27 years old, Philippines, South Asian, D grade)

But I came here, I discovered if you want to survive in the UK, you work alone and you protect yourself because you will lose your PIN….if you do anything here you don’t have anyone to fall back on. You want to do things, you want to help a client you want to give (care) but not lose your PIN. The patient doesn’t get the best care from you …..I don’t want to lose my PIN.

(female, 36 years old, Nigeria, black, D grade)

Another strategy to cope with these frustrations was to become deskilled or retrain to do tasks that the IRNs felt they were perfectly capable of on arrival. Some participants expressed this feeling of deskilling quite graphically:

So you come here, and whatever experience you have is just cut off. (female, 40 years old, Zambian, black, E grade)

I felt really demoralised when I first arrived [I’m not allowed to give] one tablet or anything and I’ve been nursing for so many years and I felt as though my hands were chopped off.

I think one of the things that I’ve noticed so much here is that they have all the policies, everything is a policy, and when I first arrived I took the medicine trolley to give the medicine, and one of the nurses said to me: “Have you been assessed in giving out medicine?” I said: “Well, I’ve been doing this.” Anyway, that was fine, I had to get assessed. It was the same for injections, the same for everything, so I spent the first six months doing every single precaution, for something that I had been doing for the last 15 years.

(male, 39 years old, Nigeria, black, D grade)

I immediately realised there was a limited scope here. When I came from home, I was an experienced nurse with lots of years of experience and I have to throw away certain things.

(female, 52 year old, South Africa, black, D grade)

Some participants tried to raise what they perceived as low standards especially in the privately owned care homes by modelling and, in some cases, teaching care assistants the proper standards of care. These quotes suggest the frustrated feelings this situation produced for IRNs:

When you come with a basin to say or there is a hand-wash basin there and you take the flannel, the flannels are there, all the equipment is there, but now it’s not in practice that people are cleaned like the eyes and other things and you’ll find the old lady with dirty eyes and sitting there going to have breakfast, then you’ll just wonder how can you really go and help give something for somebody to eat, something to eat without washing first….They can’t even wipe the glasses. Then they just sit there and you just think, and when you are there they think you are taking too long because you are trying to clean this person and like especially with the rest of the nurses the eye treatment they don’t want to do that because they don’t like to clean these eyes, so now I don’t know what is behind cleaning, whether during their training they are not taught how to clean.

(female, 54 year old, South Africa, black, D grade)

I think that a nurse in charge, as a staff nurse, you’ve got the responsibility to teach the carers what to do. That’s what our job description is. Yes. To supervise them, to tell them what to do and things like that, and to put everything in writing. If they don’t argue or follow, go to the manager and tell them “this has been our care”, but I guess, the standard of caring is getting poorer, so you have to do about it, isn’t it? (female, 53 years old, Nigeria, black, D grade)

With the care assistants at the homes, I don’t know about hospitals, I don’t know what they do there, but at the homes they are the most respected. People are taken to be knowing everything … even if you say the care assistants are not cleaning the patients, you leave the patient alone when you are there, but they don’t ask for that most of the time. They don’t care, because once you report something that has been done by the care assistant, the care assistant, before you know it says: “She’s

wasting time, she’s only done one patient and we have done five.” But when you are trying to do the correct thing, then you are told you are wasting time.

While coping with their frustrations, IRNs also tried to explain their experiences by arguing that British nurse training did not prepare student nurses for clinical practice. This was surprising for them because their training and education was based on a British model (often because of colonial ties) and emphasised traditional values of practical skills above academic skills:

Probably it’s the curriculum, you know because some of my (British) colleagues have not been given any training in medicine….they just observe. They don’t get any experience. They just observe.

(female, 49 years old, South Africa, black, grade not given)

I don’t think the education system in this country is up to snap. I think there are too many students in their third year who are falling through the cracks.

(female, 33 years old, Canada, white, E grade)

It’s true. We had to get a nurse out of the toilet because she’d locked herself in the toilet at the thought of taking the ward over.

(female, 56 years old, South Africa, white, D grade)

Yes, because, you know, in caring standards that we have set at home I think it’s just the same as in here because I see a lot that the standards, the ……standards that they have in here ……just the same as …..The other, just one thing, I don’t know whether I’m out of the point maybe, but what worries me a bit here is that like with the nursing care just the ordinary nursing care of the patient I don’t know whether people, maybe they just concentrate on both or the practical part is not quite, I’m not really impressed with the practical part that I come across, you know, especially with the members (registered nurses).

(female, 54 years old, South Africa, black, D grade)

They don’t know basic stuff and I’m thinking, why they spend three years studying and practising when they come and the next day after they qualified, they look as if they never been to hospital at all….

(female, 32 yeard old, Ukraine, white, E grade)

One of the key differences experienced by IRNs between nursing in their home countries and the UK are summed up in this exchange in a London group:

In our country, the patients respect nurses, you know they treat us with respect. (female, 39 years old, Nigeria, black, D grade)

Dignity with dignity.

(female, 32 years old, Nigeria, black, E grade)

IRNs clearly felt that these values underpinned the health care system in their home country. We will now discuss their more general thoughts of working in the British health care system.