Review and Commentary Promoting dignity, respect and compassionate care Journal of Research in Nursing 15(1) 69–73 ! The Author(s) 2009 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1744987109353687 jrn.sagepub.com Julienne Meyer School of Community and Health Sciences, City University, London, UK Recently, the President of the Patients Association, Claire Raynor (a high-profile nurse), reported an increasing number of calls on their helpline from people wanting to talk about the ‘dreadful, neglectful, demeaning, painful and sometimes downright cruel treatment their elderly relatives had experienced at the hands of NHS nurses.’ (Patients Association, 2009, p. 1). She went on to suggest that she is: ‘sickened by what has happened to some parts of my profession of which I was so proud. These bad, cruel nurses ... should be identified and struck off the Register. If only the majority of good caring nurses ... would stand up for their patients and their own profession, and blow whistles it would make a difference and bring back to them the sense of pride in the provision of good, safe care that used to be enjoyed by the whole population of this country’ (Patients Association, 2009, p. 2) There is something very wrong when the Patients Association feels the need to speak in this way, and something very worrying when nurses are seen to be at fault for not standing up for better and more professional standards of care. The report makes depressing reading, but one is left wondering whether anyone really understands the complexity of what has led to this situation. Blaming nurses is not the way forward, it has not worked in the past and it will not work now. Nurses are part of complex systems and have only limited power to effect meaningful change. Menzies Lyth (1959/88) understood this, when in her seminal work she used her expertise as a psychoanalyst to describe how social systems in nursing supported nurses’ (understandable) psychological defences. Casting an empathic light on the role of the nurse she described how nurses have unusually high levels of contact with people who, for example, are in pain or dying. She suggested that the nurses protected themselves from such overwhelming emotions with psychological defences (distanced themselves from patients) and that systems of working (routine tasks) were developed to support these learnt defences. Add to this the numerous social changes that have gone on within the NHS over the last decade, which have added pressure to the day-to-day work of nurses Corresponding author: Julienne Meyer, School of Community and Health Sciences, City University, London E12EA, UK. E-mail: j.meyer@city.ac.uk