‘The dirty nurse, Experience…’

frontier nurse‘in her kind/ Hath fouled me–an I wallowed, then I washed–‘ thus says Sir Dagonet, King Arthur’s court jester,  in Alfred Lord Tennyson’s poem “The Last Tournament.”

‘The dirty nurse, Experience’ may be a familiar, overused, and ill-used phrase. Dirty, as in sullied and morally corrupt, or as in human and grounded to the reality of life, of what it means to be human? Nurse, as in nurturing, care giving, guiding through some sort of illness, tribulation, difficult transformation or period of growth? What did Tennyson mean by this line of poetry?

Tennyson was Queen Victoria’s Poet Laureate. In his poem “The Last Tournament,” he used the story of the demise of King Arthur’s high-ideals Round Table court due to the seeping in of un-virtuous, un-chivalrous morals (and surprise! this downfall was really caused by a woman—by the unfaithfulness of his wife Guinevere). Tennyson used this story to provide a lesson for what he viewed as the increase in un-Victorian morals heralding the downfall of the British Empire. In this poem, Tennyson also may have been referring to his own life, which by middle age when he wrote this, had been marked by a large Greek island-full of personal tragedies.

But never mind the poetic history lesson. ‘The dirty nurse, Experience’ has long fascinated me because the words ‘dirty’ and ‘nurse’ and ‘experience’ seem so unexpected when used together like this.

Since I’ve spent years mulling over this phrase, I decided to do the smart thing: I gazed into the digitized crystal ball—or Merlin’s truth mirror—of Professor Google. I typed in the phrase ‘the dirty nurse, experience’ to see what was associated with it. What was conjured up by this search? Besides the poem itself, the direct quotes, the mis-quotes, the mis-uses, there were the ‘dirty naughty sexy nurse’ renditions, but I’ll leave those to your (naughty and oh so un-Victorian) imaginations. Here is a Google search first-page result that did catch my eye. It’s a question posted by xobeeautiful on January 2, 2009 on the Allnurses.com social networking site for nurses and students, and, as I gather from this post, potential nurses—or at least from people posing as potential nurses:

“Is Nursing Really a Dirty Job?

i am interested in being a registered nurse but i’m scared that i won’t like it. Is it stressful? is it a dirty job? i dont like dirty things and that’s kind of keeping me away, i really do not want to be cleaning up after people. Do all nurses clean up? Would you do nursing all over again?”

This posting fascinates me. It represents a different take on ‘the dirty nurse,’ but it also raises questions that really go to the heart of the profession of nursing: Is it stressful? Is it a dirty job?

Yes to both questions. Nursing is a down and dirty and demanding job—or calling for the spiritually minded. It always has been, and—I hope—it always will be. Because it implies direct care of people—of humans—care which is always dirty. It implies direct care of some sort; whether of helping ill or injured people take care of basic bodily functions, use the bedpan or the urinal or take a bath or—wondrously—to give birth to a baby; or doing wound care and dressing changes; or doing home and community nursing, going out on the streets, in alleyways, under bridges, going into sometimes decrepit housing, dealing with the health effects of poverty and injustice; or dealing with infectious diseases like tuberculosis, HIV, or Ebola… The list goes on. Nursing is a practice-based profession and it would improve many things if all nurses—including administrative nurses, research nurses, leadership nurses, and even (or perhaps especially) nurses who teach—would be required to keep their hands dirty by continuing to do some sort of direct patient or community care.

“Do all nurses clean up?” Now, that’s an interesting question. Nurses deal with (and make) messes of all sorts—including in direct care, administrative, research, leadership, teaching—but this question could also be interpreted as “Once they are dirty, do all nurses clean themselves up?” Not just a basic infection control, personal hygiene issue, but also related to self-care and prevention of professional burn out—which, as we know, is something nurses are particularly prone to. As Graham Greene wrote in his novel A Burnt-Out Case, a bad nurse fails to take the necessary precautions to protect him or herself, becomes a burnt-out case ‘…and ends by joining the patients.’

Learn your own early warning symptoms of impending burnout. Learn and practice your own version of healthy self-care. Listen to those closest to you when they voice concerns about your health and sanity being adversely affected by your nursing work. Support your nursing and other healthcare colleagues in taking care of themselves, and that includes advocating for sane and safe working conditions. Do all nurses clean up? Yes. Or at least they should.

Finally, the question, “Would you do nursing all over again?” Hopefully, right now as you finish nursing school, your answer is still ‘yes.’ Although, to be honest, I wasn’t totally sure when I first finished nursing school. I’ve continued to ask myself this question—or to have it asked of me by different people (including by some of you)—over the many years I’ve been a nurse. Sometimes my answer has been a mewing runt kitten ‘yes’ and sometimes a roaring macho lion ‘YEEESSS!,’ but yes, if I could rewind the story of my life, I would do nursing all over again.

What do I love most about nursing? Of course, there are the usual favorable aspects of nursing, such as: it’s flexible and adaptable, there are so many different and exciting things you can do with it, so many places in the world it can take you, and there’s the oft-quoted statement that nursing is still ranked number one as our country’s most respected profession. But those, to me, are just background pleasant aspects of nursing. What I love most is this: Nursing gives us the privilege to peer beyond Virginia Woolf’s cotton wool of everyday life, to see “…that the whole world is a work of art.” Nursing takes us into the messy swampland of human suffering, of illness and death. It takes us into the messy swampland of living.

I also love the (dirty nurse, experience) of being able to teach amazingly bright and talented and impassioned nursing students like all of you, of knowing that you will go on to change the world for the better—to change nursing and health care for the better—or at least your little corner of it.

Welcome to the down and dirty, demanding—and delightful—profession of nursing.

** I wrote this as part of an invited (by the students) speech at the graduation celebration tomorrow for our University of Washington Accelerated BSN class of 2014. They are an impressive group of new nursing graduates who already have a ton of life experience, and as I told them, are about to get more experience than perhaps they bargained for. Congratulations!

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