That’s why you have to be ready to be the kind of nurse who doesn’t need to paint by the numbers. You need to be prepared to paint an original: one with no gaps.

Another part of being an artist is being proud of your work. When is the last time an artist said ‘Oh, that old thing? Well, yes, you could buy it for £10 million but here, take it for nothing, it’s not really very good …’ . They don’t say that; even school children want to be rewarded for their artwork: ‘Mummy, either this goes on the fridge or I will never eat broccoli again’. As a nurse, you have every right to be proud of what you do. Anyone can paint by numbers, anyone can take a blood pressure, but you – you are a nurse, an artist, and you know how to provide nursing care that makes people feel better about themselves. You know how to prevent illness and injury; you know how to take the pain away.

As a nurse, you have a power that is nearly unimaginable. You can make it better. You can take the pain away, perhaps not always the physical pain but at least the emotional kind that comes from being lonely and afraid. You can soothe the fears and stop the panic. And you can do it in a way that looks easy. Some people can’t be saved but you can still make it easier for them, through loving compassion and sincere sympathy. Use your skill and your knowledge to make a difference and some day, when a patient takes your hand and looks in your eyes, and says ‘I’m glad you were my nurse …’ you will know how important this wonderful profession really is.

You will never be the highest paid person in the world but how many people can take the pain away? And how many people can get the kind of satisfaction from their job that you can get from yours? If it ever stops giving you that satisfaction, stop and look, because you are going the wrong way. Don’t keep going day after day being a nurse who doesn’t want to be one – instead, be the kind of nurse who makes a difference, to your own life as well as to others.

From here, we will talk about certain types of skills and abilities. But I always want you to think about how you use them. Be an artist, not a nurse-by-the-numbers. Don’t perform the skills, do nursing with the skills. Always look for the way to heal, to comfort, to fill the gaps and do the things that make the difference between a colouring book and a masterpiece.

You might be sitting there thinking ‘I don’t know if I can do that …’ and you’re going to expect me to say ‘Of course you can!’. But I’m not going to do that: only you can decide what kind of nurse you want to be. Nurses are good at blaming everyone else – for saying it was short staffing, the doctors, the HCAs, the family – everyone else prevents us from doing things the right way except us. Look in the mirror and be honest with yourself. Acknowledge where you fail your patients but be just as willing to see where you excel. You will always do a little of both; even the worst nurse does excel sometimes. If you want to be the nurse artist – the nurse who makes a difference – then you need to plan and prepare. No artist became one without training. You have to learn the technical skills (the science) and become comfortable with the theories and beliefs, but only you can take the talent and turn your nursing into art.

It helps to think about what kind of nurse you want to be: in the space below, reflect a moment before we go on. Which things do you feel are important in nursing?

❒ Assertiveness❒ Communication❒Leadership

❒ Dealing with difficult people❒ Reflection❒ Understanding research

❒ Being accountable as a professional❒ Tracking your accomplishments in PREP

All those things you ticked are the colours in your pallet. Grab your paintbrush: the lessons are about to begin:

Towards the end of Chapter 3, I mentioned Simi, the HCA who was asked to set up a dressing trolley for a clinic. How could you assert yourself if she didn’t do as you asked?

Sometimes, you won’t need to go any further – the shared value might not need to be put into words. However, if it does, in the next step (step 3) you are clearly telling Simi that preparation of the trolley is important for the clinic by:

So if after this the trolley still isn’t set up, you will need to go to stage 4. Before you delegated this task to Simi, you should have thought ahead for what would happen if the task was not carried out. In this case, let’s say you have to set up the trolley yourself.

You then have to go to Simi – and although it’s not pleasant, you have to say something. You repeat steps 1 and 2:

Then you add step 3:

Then you add step 4:

It’s important that you do this in the right way:

No one likes to be scolded or humiliated. If you assert yourself in a calm, appropriate way it makes it much more difficult for the other person to react badly.

It’s easier to handle the response you might get if you think about it in advance. In this case, you would need to know in advance what kinds of alternatives you were willing to accept. Planning for a ‘win–win’ scenario (where each side gets some benefit) is important in making a good assertive confrontation. Think: what are the end results that you would be willing to accept?

One important thing to remember when being assertive: don’t be passive–aggressive.

Passive–aggressive behaviour is what happens when people are afraid of being angry, so they show their anger in a way that doesn’t look angry. In the example above, you could have made a big dramatic show, complete with sulking, that you had to prepare the dressing trolley yourself. It won’t do your relationship with Simi any good, you would feel worse and everyone would think you were a drama queen. After a few satisfying moments of self pity, you are worse off than you were before.

People will react to confrontations in different ways, and they might act one way when really meaning something else. Perhaps Simi thought you wouldn’t want to confront her, so she decided to ignore your directions. Or perhaps she was too afraid to speak up and tell you how busy she was. Clear, open and honest communication is essential to good working relationships.

If you know Simi struggles to get things done, perhaps giving her a task without helping her plan her work might have been a bit unfair. On the other hand, if Simi knows that no-one will say anything, no matter how little she gets done, then she might be manipulating you. Don’t let yourself be manipulated or bullied. If you are being fair and reasonable, don’t be afraid to raise your concerns at a higher level.

Third important point: this is about how you are feeling.

Start statements with ‘I feel’, ‘I want’ and ‘I need’, not ‘you do’ this or ‘you make me’ that. Don’t put words in people’s mouths. Don’t say ‘we all …’ or ‘everyone thinks …’ . If you are the one asserting yourself then speak only for yourself unless you are there as a member of a group and the other members of the group have agreed that you speak for them. ‘Simi, you never do what I ask you’ isn’t the same as ‘Simi, I expected that you would get this done’.

Asserting yourself can be difficult, especially if you have been raised in a culture where it is not right to complain or it is wrong to speak up to people in authority. It takes practice. Find someone who is good at being assertive and ask him or her to help you. As you become more confident and experienced, it will become easier and more natural for you to be assertive.

Assertiveness is a powerful leadership trait and, as a nurse, it is essential to use assertiveness every day. You need it to delegate your work, to work with others and to challenge practice. If you are not being assertive, then you can’t use the power and authority of your role to provide the best care for patients.

In this picture you see the usual, average patient area. What does it look like? Close your eyes and try to imagine every little detail, like where the call bell is, where the water jug goes, what the over-bed table looks like.



Imagine a patient in the bed. In a perfect world, how should it all go together? Where should it all be? How should the patient look? How is he or she dressed? How does he or she smell?

I want you to work hard on developing the ‘ideal’ patient environment in your head. Get every detail, and make it a picture you can’t forget. Now, whenever you are at work, try to keep the environment your patient is in as close to the ideal as possible. It doesn’t take an overwhelming amount of work. Just always think this way:

Little things. If you work in a hospital, try to commit to the following: