When Professional Values and Organisational Pressure Collide
🩺 Care for Your Work
After 45 years in nursing, I have learned to pay attention when something doesn’t feel right.
Sometimes that feeling has nothing to do with being tired, overworked or having had a difficult shift. It comes from knowing what I believe good nursing care requires, while at the same time feeling pressure to act in a different way.
That can be an uncomfortable position to find yourself in, particularly when the pressure comes from people more senior than you or from an organisation you have always tried to serve well. Experience doesn’t necessarily make those situations easier, but it can help you recognise when you need to stop, think and trust your professional judgement.
Moral Discomfort Is a Signal
Over the years, I’ve learned that a nagging sense of unease after a shift is worth listening to. Sometimes you can’t immediately put your finger on what is bothering you. You may replay a conversation or a decision in your mind and wonder whether you should have said something differently — or spoken up at all.
In nursing, we become used to getting on with things. We work within teams, follow policies and respect the experience and responsibilities of colleagues. But we also have our own professional accountability, and occasionally those things don’t sit comfortably together.
I’ve come to see that discomfort as something worth examining rather than dismissing. It doesn’t necessarily mean that somebody has done something wrong, but it may be telling you that something needs thinking through.
Why These Moments Are Hard to Navigate
Nurses are used to adapting. A shift rarely goes exactly to plan, and much of the job involves responding to changing circumstances, helping colleagues and finding a way through whatever the day brings.
That ability to adapt is valuable, but it can also mean that we sometimes put up with situations for longer than we should. When everyone around you is busy and simply getting on with the job, it isn’t always easy to be the person who stops and asks whether something is right.
Speaking up doesn’t have to mean confrontation. Sometimes it simply means asking a question, checking your understanding, or taking time afterwards to reflect on what happened. With experience, I’ve learned that those moments are worth paying attention to.
Holding Professional Integrity
For me, professional integrity has never meant always having the answer or assuming that my judgement must be right. It means being prepared to stop and think when something concerns me, and being willing to check, question and seek another perspective.
There have been many times during my career when I’ve discussed a situation with a colleague simply because I wanted to be sure I hadn’t missed something. Good nursing isn’t practised in isolation, and being experienced doesn’t remove the need to listen to other people.
But ultimately, as registered nurses, we remain accountable for our own practice. If something genuinely concerns us, I believe we have a responsibility to explore that concern rather than put it aside simply because raising it might feel uncomfortable.
What I’ve Learnt
After many years in nursing, I’ve learned not to dismiss that feeling when something doesn’t sit comfortably. It may turn out that there is a perfectly reasonable explanation, or that I’ve misunderstood something. But taking the time to check is part of being professionally responsible.
Experience has also taught me that professional judgement isn’t something we acquire once and then simply possess. It develops through practice, reflection, discussion and, sometimes, through the difficult situations that make us stop and think about what really matters.
If this resonates, you may find my short book Caring About Your Work Without Losing Yourself helpful.