Candidates applying for places on a nursing programme often explain their career choice as being because they liked people. Other candidates argue it was because nursing is a ‘good job’ rather than a vocation. Often such candidates resent patients who see them in a vocational light, referring to them as ‘angels’ (Smith 1992). Over the last 20 years nursing programmes have changed considerably, but reasons for choosing nursing as a career have not, although, for many, studying at university has an added attraction or because they see themselves joining a profession (Smith et al 2005). Most applicants choose nursing because they believe they want to work with people or they feel the need ‘to do some good’. Doing nursing and being a nurse are different facets of the same role. Engaging with people in their most vulnerable moments and with those who are disturbed, mentally or physically, and being able to respond in a sensitive and therapeutic manner are things that all nursing students need to learn if they are to be effective practitioners. However, these are also probably the most challenging aspects of learning to nurse. By drawing on examples taken from research into nurses’ professional development, this chapter provides some guidelines about how to go about developing the skills of people-centredness whilst maintaining your personal integrity and humanity.

Earlier chapters in this book demonstrate that learning to become a nurse means balancing life between being a student in a university and being a member of a clinical team. Some of the images on recruitment posters are concerned with ‘the price of nursing’ (seen on a 2005 recruitment poster), the answer in the poster being ‘£20000 a year starting salary and a university qualification’. Would this be the message that attracted you to nursing? Other images are related to the idea of nursing being a vocation. An explicit example of this was a recruitment poster in the early 1990s, which asked the question ‘Do the financial rewards match the emotional ones?’ The answer (unlike the 2005 poster described above) gave a mixed message, on the one hand reassuring prospective nurses that, although they were unlikely to be attracted to the job for the money, they could expect emotional rewards as well as financial ones. The conclusion here was that the emotional rewards came as an added extra for working in one of the most ‘emotionally satisfying careers’ (Smith 1992, p 11). Even earlier images of nurses described the nurse as a ‘young lady’ or a ‘good woman’, and Nightingale’s descendants were identified as vocationally motivated, obedient and subservient to both medical and nursing superiors (Smith 1992, p 21). This image is exemplified in early extracts from the Nursing Times (see Box 3.1).

These early letters from the Nursing Times illustrate the emphasis on emotion in the ideal type of the ‘reformed’ nurse in the early 20th century. It would seem clear that the desirable nurse was also the ideal woman. Her virtues were womanly – kindness, even ‘love’ – as well as loyalty and obedience. It is interesting to note that ideally nurses should be socialized into the role through ‘love’, although in most cases ‘discipline’ was also necessary.

One hundred years later this image of a nurse is clearly outdated, but you might like to critically reflect on the extent to which this is still the case. Some may believe that subservience is no longer advocated, although ‘vocational motivation’ has perhaps been too easily discarded, often being viewed as an emotional tool used by management to make nurses work for low salaries; see Abel-Smith (1960) and Davies (1980) for further discussion on this topic.

Emotional labour is often described as a form of being present with patients at a psychological and emotional level that responds to their human condition. Smith & Gray (2001a) draw on Hochschild’s (1983) work to use the term ‘emotional labour’ to describe the intimate nature of care that draws on emotional work, and, along with Aldridge (1994), recognize that therapeutic relationships of this nature can be stressful and that practitioners as well as students need structures and processes designed to help and protect them from the consequences of engaging in emotional labour. Similarly, Graham (1983), in an account of women’s work, describes caring as both labour and love, caring for and caring about another person, doing and feeling. Although Graham’s work is focused on women’s work, it is not intended to exclude men, and the number of men in caring activities and in nursing is significant. The traditional view that nursing is essentially ‘female’, and to a great extent an extension of mothering, has now been revised, not least because it makes little sense to male students (Lorentzon 2004). This oversimplistic notion, that ‘maternal’ equals nurturing, without acknowledgement of similar behaviour by men, and that all women actually have such an ‘instinct’, has been seriously revised. There is clear awareness that, while most candidates for nurse education are likely to be persons of good will who want to work with people, specific techniques and behaviours may need to be learnt. Following earlier research on ‘feminine professionalism’ (Lorentzon 1990), one of the authors is now aware that this concept resonates with ‘emotional labour’ as described by Hochschild (1983) and Smith (1992). Both of these concepts can be seen as pointing to the connection between emotions and clinical care and as an essential part of professionalism. Perhaps the most important element of learning to provide emotional care is dependent on finding suitable role models. For many students, their first role models are familiar caring figures such as ‘mother’ or ‘parent’. As students progressed through their 3-year education, their perspectives were found to mature, and the roles of staff, lecturers and clinical leaders were mentioned more frequently as helping to develop the student nurse’s view of emotional labour and the job of nursing (Smith & Gray 2000). Case history 3.2 is an example of how one student, whom we have called Sally, developed her understanding of how to provide emotional support (try Activity 3.1).