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Modern Matrons were introduced into the UK National Health Service (NHS) in 2001 (Department of Health 2001). Apart from being an oxymoron – matrons disappeared from the NHS in the 1960s – the creation of this additional post in the nursing hierarchy is another clear demonstration of where the UK government wants nursing to go. Immense damage was inflicted on UK nurse education in 1999 by the introduction of a new style of nurse education (Watson & Thompson 2000) and the general ‘dumbing-down’ of nursing curricula and the liberal use of inappropriate and spurious academic titles (Thompson & Watson 2001) is diluting scholarship in nursing and ensuring that nursing knows its place: not quite a profession and certainly not a subject worthy of academic study.

The demise of the matron in modern nursing, along with the move away from hospital-based training schemes for nurses – while these were not concomitant, being separated by nearly 30 years – have been blamed for the crisis in modern health care. Patients complain of filthy wards, poor food and poor standards of care and, of course, nurses must be to blame and the solution must lie in a return to the good old days. In fact, nothing represents the good old days of nursing better than the matron. She (and it invariably was a woman) had complete power over the work and training of nurses in her domain; she was easy to identify and, of course, while she was a formidable figure to the nurses, was amenable to control by the medical profession: they only had one person to persuade. In addition to nurses, the ancillary workers: cooks, cleaners and porters, all answered to the matron.

The solution for the NHS was too tempting to avoid: reintroduce matrons and give them back the jobs that used to be within their domain. Thus, the Modern Matrons will have responsibility for raising standards of hygiene and nutrition in hospitals and resolving clinical issues, such as discharge delays. They will be easily identifiable to patients (wearing distinctive uniforms) and accountable for a group of wards. All this, of course, flies in the face of the reality of the modern NHS. We already have clinical nurse managers, or equivalent, with clinical responsibility for a number of wards. Ward cleaning and anything to do with food – other than serving it – was long removed from the nursing domain. Those of us who were charge nurses in the NHS in recent years will recall the terrible consequences of daring to suggest anything directly to domestic staff or catering staff. While this situation was ludicrous, it was the reality and it is very hard to imagine how it will be overturned. Certainly, it would not be overturned simply by adding a new list of responsibilities to those of the clinical nurse manager. Frankly, the Modern Matron proposals look like a recipe for disaster. The UK government is nothing, if not consistent, and in line with the ‘dumbing down’ of the nursing curriculum the type of person that is being sought for the position of Modern Matron is congruent with the return to the good old days. There is absolutely no mention of the level of educational qualifications nor any record of achievement at any level in the NHS. Rather, the Modern Matron (presumably men can apply, if they wish to adopt this outdated and sexist title) must have ‘clinical credibility’, that most elusive of qualities and the one which is always thrown at, for example, nurse teachers and researchers – as if it mattered. How much clinical credibility does it take to ensure that wards are clean and that food is hot? None, of course! Anyone could do it, but the ‘good old days’ mentality requires the signs and symbols of the bygone era. It bows to focus groups and ill-informed journalists (Griffiths 2000) when the real solution lies in well-educated and properly trained nurses. UK nursing is facing a crisis in terms of a shortage of nurses (Finlayson et al. 2002a,b), an issue also evident in North America (Nelson 2002). A number of initiatives have been taken in the UK such as the introduction of a widened entry gate to nursing and a skills-based curriculum (Department of Health 1999a) on the one hand, and Nurse Consultants (Department of Health 1999b) on the other. The impact of Nurse Consultants remains to be seen but there is some difficulty in filling posts with the appropriate staff and creating the right conditions of work (Guest et al. 2001). However, the main thrust of these policies is to make nursing more attractive to people with low qualifications and this has already caused problems for lecturers (Watson 2002). Will Modern Matrons make nursing more attractive to educated and highly motivated young people, male and female, who may consider entering the profession? We contend that it will not. Reintroducing the term ‘Matron’ is likely to make nursing and nurses a laughing-stock for other professions, and even less attractive to the very people we should be trying to attract. The term Modern Matron is misleading and damaging to the image of nursing. It conjures scenes reminiscent of a Hattie Jacques-type figure1 in starched uniform and frilly cap bustling around the busy ward and interfering in everyday affairs. It panders to the whim of politicians, doctors and managers and typifies the poverty of ideas so redolent of UK government health policy.

References

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  2. References
  • Department of Health (1999a) Making a Difference. Department of Health, London.
  • Department of Health (1999b) Nurse, Midwife and Health Visitor Consultants. Health Service Circular 1999/217. Department of Health, London.
  • Department of Health (2001) Implementing the NHS Plan – Modern Matrons. Health Service Circular 2001/010. Department of Health, London.
  • Finlayson B., Dixon J., Meadows S. & Blair G. (2002a) Mind the gap: the extent of the NHS nursing shortage. British Medical Journal, 325, 538541.
  • Finlayson B., Dixon J., Meadows S. & Blair G. (2002b) Mind the gap: the policy response to the NHS nursing shortage. British Medical Journal, 325, 541544.
  • Griffiths M. (2000) Dumbing down medicine will be the death of us. Sunday Times, 9 April, p. 17.
  • Guest D., Redfern S., Wilson-Barnett J., Dewe P., Peccie R., Rosenthal P., Evans A., Young C., Montgomery J. & Oakley P. (2001) A Preliminary Evaluation of the Establishment of Nurse, Midwife and Health Visitor Consultants. King's College London, London.
  • Nelson R. (2002) US nursing shortage a “national security concern”. The Lancet, 360, 855.
  • Thompson D.R. & Watson R. (2001) Academic nursing – what is happening to it and where is it going? Journal of Advanced Nursing, 36, 12.
  • Watson R. (2002) Why Do We Have to Learn This, We're Only Going to Be Nurses? RCN Northern & Yorkshire & The Humber Research & Development Network – Grasping the Nettle: research activity in nursing. University of Bradford, Bradford.
  • Watson R. & Thompson D.R. (2000) Recent developments in UK nurse education: horses for courses or courses for horses? Journal of Advanced Nursing, 32, 10411042.