Living Counter-Culturally for Christ in Nursing & Midwifery

As I write this I am uncomfortably awaiting the arrival of my second son in 2 days’ time and regard with fondness – and rose-tinted glasses – those days when at the end of an exhausting shift I could flop into bed, snuggle down and sleep soundly until the alarm woke me next morning / afternoon / evening!

When Christian Nurses & Midwives was launched I was working for the Universities and Colleges Christian Fellowship (UCCF) as their Staff Worker for student nurses and midwives (Christian Student Nurses & Midwives, or CSNM). Since then I have worked in a central London church as their women’s worker; got married; seen a little of missionary work in Latin America; been privileged to study theology for a couple of years at Oak Hill Theological College alongside my husband, and have spent the last three years getting to grips with being a mother to a lively little boy.

During this time I think the question that has been looming ever larger in my mind is what does it really mean to say 'Whatever you do, work at it with all your heart, as working for the Lord, not for men', (Colossians 3:23). What difference does the gospel really make to the way we live and think, to our priorities and values on a day to day basis?

When I took up the post of Staff worker for CSNM I inherited the organisation of a conference entitled Counter-Cultural Living. I don’t think I realised then the enormity of this phrase, or the astute diagnostics behind its selection as a conference theme; In particular in my three years as a women’s worker I saw on a daily basis the way in which the gospel had become something we added to our lives instead of the thing that transforms every bit of our lives.

It is all too easy to begin with the situation we find ourselves in and then ask how does the gospel apply? How do I act as a Christian faced with these set of circumstances?  But in truth Jesus says to us seek first his [God’s] kingdom and his righteousness (Matthew 6:33). Instead of saying “I am Christian in a place where I cannot talk to my patients about Jesus, so how then should I conduct myself?” we should be saying “Can I be a Christian in a place where I cannot talk to my patients about Jesus?” This will inevitably mean making the kind of sacrifices that we’re unused to making (for example are there jobs that Christians ought not to be doing?), and trusting God in a way we’re unused to trusting Him (how will people in those places come to faith without us there to witness to them?).

CNM has tried to support and encourage its members in this task of counter-cultural living within the workplace. I pray that it has been of help to its members over the past ten years, but sadly we have always struggled to increase our membership and so our impact on the profession has been minimal. Given the current anti-Christian enviroment, the need for CNM has never been greater because it has never been harder to be a distinctively Christian nurse or midwife.

One thing I think CNM can do is to encourage our churches to help us more specifically in this task of approaching our work Christianly and then to be ready to support us when we face serious trouble at work as a result. This will help CNM members lead the way in restoring the gospel to the heart of healthcare and should encourage other Christian nurses and midwives to join the vision of CNM and count the cost of discipleship.

CNM E-News Edition 2

The second edition of CNM's E-Newsletter is now available to download here

Elderly Care: Do we care?

A report by Age UK on Monday suggests that despite claims by Government that they are increasing funding for elderly care, the level of demand has outstripped funding as more and more people are living longer but with increasing levels of dependency. The report suggests that in the last half decade the actual funding has stagnated, while in the same time a quarter of a million more people need care.  Age UK estimate that the spending on elderly will be £7.3 billion this year, but needs to be nearer £7.8 billion.

Furthermore, local councils appear to be treating care of the elderly as a lower priority, diverting funding away to other services, while increasing charges for care, such that many face poverty just paying for essential help with washing, dressing and shopping.  An increasing number from a generation who grew up in the post-war austerity of this country, and helped rebuild it, as their parents had helped fight for its freedom, are being left destitute and unsupported. This is in the face of a seemingly never ending barrage of reports criticising the poor quality of nursing and social care for the elderly in this country, and by attempts to cap and reduce benefits for the disabled, dwindling pensions, collapsing social support from families, increased life expectancy (but not health expectancy), etc. etc.  It is not a great time to grow old in Britain it would seem.

No wonder some now look upon assisted suicide and euthanasia as the only viable alternative.  Some, I fear would see that as not only more compassionate but also cheaper and frankly less of an inconvenience.

It can be hard work looking after older people with health needs or disabilities.  I know, because I was a district nurse and a senior staff nurse in an acute medical unit for elderly men for several years.  But no more so than caring for any other group, such as children – and I should also know as I have been a parent for even longer!  But just as we find joys and delights in parenting alongside the testing and trying bits, so caring for our elders brings positives alongside difficulties.  I learnt so much from my grandmother and mother in their last few years of life about that quiet generation who grew up before and during the last world war, and their willingness to just get things done, however hard things got.  I learnt from elderly patients from this and other nations about what it was like to live through the great moments of our world’s history in the 20^th century, and about the joys and sorrows that await all of us as we age.  My life is richer for knowing them all.

So why are we, as a society, underfunding and institutionalising our elders?  I could ask a similar question about the appalling struggles facing those with disabilities, especially children, whose parents have to fight doggedly for every single service and area of support (again, something I know only too well from the experiences of close friends and family).  Maybe we are afraid of growing old or facing disability in a youth obsessed culture? Maybe we are so self-absorbed that we would rather not deal with problems that seem millions of miles away, and maybe we are happier with the bread and circuses of reality TV and celebrity scandals, than face the realities of what is happening to the vulnerable?

Or maybe we do care, but our governments just think we don’t. (Do the elderly and disabled vote in large enough numbers to sway the parties I wonder?) Whichever way the truth lies, we need to seriously rethink where our priorities lie before we find ourselves abandoned in our dotage!

this post originally appeared in the blog of the Christian Medical Fellowship

Government Nursing Initiative: more tinkering at the edges?

In the face of a growing and alarming number of reports on poor standards of care for vulnerable patients in the NHS and the community, the Prime Minister earlier this month launched an initiative to try and tackle the problem in hospital nursing.

This is after yesterday also announcing a move back to integration of health and social services in the community.

The measures all make sense – reduce the amount of bureaucracy nurses are tied up with (devolving it down to ward clerks or other administrative posts), instituting hourly monitoring rounds, etc., etc.  These are all sensible measures in and of themselves, and along with reintegration of health and social services, are based on evidence that these measures really can improve patient care.

In addition, David Cameron has announced the launch of Nursing Quality Forum to explore further what measures can be taken to improve nursing care.  Interestingly, this is only a couple of years after the previous Prime Minister held a similar Commission on the Future of Nursing and Midwifery in England, which reported back in 2010.  Despite Cameron pledging not to tinker and  micro-manage the professions, it seems no government can resist the temptation of being seen to do something!

But this announcement does nothing to tackle two difficult issues that I feel lie at the heart of the problem. Firstly, staffing – in an NHS required to make £20 billion of savings by 2015, it is already apparent that most trusts are cutting nursing and administrative posts that would be needed to ensure the Prime Minister's new measures were properly implemented.  With recruitment freezes, and a shifting of skill mixes to reduce the proportion of RNs to care assistants on the ward, it is going to be harder and harder to achieve these goals.

Even more fundamental though is the deeper social attitude that devalues the elderly and disabled as nuisances to be kept out of sight and mind.  The recent reports of the CQC, Patients Association and EHRC all suggest that it is the attitude of staff and the culture in some hospitals, wards and care homes that is also the problem.  Where the care of the most vulnerable is seen as low status and low priority, and that those providing such care see themselves as doing the least valued roles, it inevitably affects the care that is given.  And such attitudes are transmitted from the top of the organisation, particularly in how resources are allocated.  And the values that determine such choices come from the wider society and culture – based on what we value, how we vote, how we spend, how we care for those around us in our communities.

Like it or not, as a wider society we are responsible, in part at least, for the standards of care in our hospitals.

Headline grabbing initiatives are one thing, putting in the resources and shaping the values that determine how they are deployed is something totally different. In the meantime, as nurses and as Christians we have the ability and the responsibility to shape that change one patient at a time.

Industrial Action: How should Christians Nurses respond?

Many Christian nurses and allied health professionals have been asking me how they should act in the face of a mounting industrial dispute. On 30 November, around100,000 health workers in the UK joined an estimated 2 million other public sector employees in a one day strike in protest about the government’s proposal for the future of public sector pensions. 


As the negotiations between government and unions reached a climax, we already know that Unite has rejected the latest (and possibly final) offer from the government, with the other health and professional unions likely to follow suite (including the Royal College of Nursing and Royal College of Midwives, to which most of our members will belong).

The arguments about the pensions issue are fairly well covered in an opinion piece in Prospect, needless to say that the issue of lower pensions, bigger contributions and later retirement are not unique to the public sector, – nor to this country.


Not all health sector unions joined in the day of action in November, including the BMA and RCN.  The RCN Council meets tomorrow (10 January 2012) to decide what their next steps would be, but industrial action has been mooted as a possibility.


In short, there is a real possibility that there will be ballots for nurses and midwives on industrial action over pensions in the next few months, and certainly more public protests.


So, how should Christians respond? The RCN has some guidance for members on the issue from a purely professional angle here, but I have found relatively little useful guidance on Christian websites and blogs, so here are some thoughts and pointers in relation to the current dispute.  This is not a full theological and practical shake down of the subject, but it is a humble attempt to look at the underlying principles.


The first point to make is that the removal of labour is a coercive act, and therefore should be the last course of action in any dispute.  Consider the implications for your patients, their relatives and carers, your colleagues (not just medical and nursing staff, but ancillary, administrative and managerial), employer (the trust, the NHS as a whole), and your profession if you withdraw your labour. That being said, there are precedents for Christians taking direct action, from boycotting sugar during the anti-slavery campaigns during the eighteenth century, to the bus strikes during the US Civil Rights movement.  These were not purely Christian boycotts, but Christians did join in with them.  Where the cause has been just, Christians (and others) have found it well within their conscience to take direct action and practice civil disobedience.


But are NHS pensions in the same league?  If we have good grounds to believe that some of our colleagues are going to be left far worse off, even destitute as a result of these measures, then the answer is probably a qualified ‘Yes’.  On the other hand, if everyone in the country is going to have to pay more and work longer than we expected in order to have a reasonable (or even comfortable) retirement income, are the Government proposals really a major injustice, or just learning to live with the new economic realities of the decade?  I do not offer an answer to those questions, and I myself am not going to be retiring on an NHS pension, so cannot offer a personal perspective.


The Bible has a bit to say in general about industrial relations, although most of the scriptures you will see quoted relate to slaves and their masters.  I won’t go into the arguments about whether modern workers are wage slaves, or that we have rights, and our employers responsibilities (that would be undreamt of New Testament times), let alone the ethics of slavery. Nevertheless, they do highlight some general principles.

Colossians 3:22 ‘Slaves obey your earthly masters in everything’

1 Peter 2:18 ‘Slaves, submit yourselves to your masters with all respect, not only to those who are good and considerate, but also to those who are harsh.’

1 Timothy 6:1 ‘Let all who are under a yoke as slaves regard their own masters as worthy of all honour, so that the name of God and the teachings may not be reviled’.

It is clear that Paul and Peter, in writing these messages were urging slaves not just to do their jobs, but to be exemplary, going over and above the call of duty.  The motivation for this is also clear:

Colossians 3:23-24 ‘Whatever you do, work heartily as for the Lord and not for men. Knowing that from the Lord you will receive an inheritance as your reward. You are serving the Lord Christ’.

Matthew 25:40 ‘The King will reply “I tell you the truth, whatever you did for the least of these brothers of mine, you did for me”

We serve God when we serve our employers (and more importantly, our patients) well. But we are also enjoined throughout the Bible to have a concern for justice and to stand up for those who are disadvantaged or poorly treated: Isaiah 1:17 ‘Learn to do good, seek justice, correct oppression, bring justice to the fatherless, plead the widow’s cause’.

We are also called to make peace where there is conflict – Matthew 5:9 ‘Blessed are the peacemakers’– and to act with good conscience, putting others needs ahead of our own – Philippians 2:3-4 ‘Do nothing from rivalry or conceit, but in humility count others more significant than ourselves. Let each of you look not only to his own interests but also to the interest of others.’

(Scripture references taken from BibleGateway.com)

So, in Christian workplace ethics, obedience and service are vital, putting the interests of others first, standing up for what is right, but seeking to honour our employers, and in so doing honour God. We serve God ultimately through serving the needs of our patients in obedience to our employers (NHS Trusts and GP practices, etc.).

I would suggest that based around these theological principles, when we are facing questions about industrial action there are four key questions to ask when making a decision (listed here in reverse order of priority):

1: Is the cause just – regardless of whether I will be significantly worse off or not, will my colleagues on lower pay be badly affected by these changes? Would I be perpetuating an injustice by not joining in?

2: Have the Unions and Government exhausted all other avenues to settle this dispute?  Is there room for reasonable compromise on either side that has not been taken? And can I encourage my union and my government to make further efforts?

3: Will taking industrial action adversely affect the health, wellbeing and distress of my patients? What level of service will be left if I am striking, and will the cancellation of elective operations, clinics and other procedures cause significant distress?

4: Will I be honouring God in taking this action?

There are several challenges that arise, whatever our conclusions to these questions:

1: We should take trade union membership seriously.  Get onto union committees, become a shop steward in your workplace, be active in influencing the policies of the union and its relations with the NHS in your workplace.  Christians should be right at the coalface of industrial relations, standing for justice and righteousness in the workplace.

2: Following on from that, always make sure that you vote whenever there is a ballot, even if your feelings are not strong either way.  Choosing not to vote implies a passive agreement with the decision of the majority who do vote.  But only those who cast a vote actually decide the action to be taken.

3: Recognise that your colleagues and friends will have different perspectives, so try to act with integrity, grace in pursuit of justice, rather than offering judgements on their decision. Be gracious and forgiving.

4: But be prepared to be unpopular for taking a principled stand – whether to strike or not to strike.

5: Finally, however you choose to act – never lose sight of those higher principles behind your actions and the attitude you adopt. It is God that you serve ultimately, and your conscience should be clear with him throughout.

There is no right or wrong answer about whether to join in with industrial action that may be called during this coming year, but thinking and praying through these questions and challenges may help you come to a wise decision.