When Florence Nightingale treated the dying during the Crimean War, little did she realise she was creating a legacy that would become the backbone of the NHS. Almost 150 years later, the Lady with the Lamp would also be shocked to learn that nurses are leaving hospitals in droves as they become overworked and continue to fall behind in the pay stakes, writes Victoria Owen.

Did Ms Nightingale know that the nursing of the 1800s was to become the foundation stone of a profession regarded as important in its own right?

Now one nurse in Oxford is working to make sure her colleagues realise their true potential, making them more than merely the Florence Nightingales of the 21st century.

Nurse consultant Alison Binnie's philosophy is that nursing should be patient-centred, not task-centred. She says: "In the old days each patient was referred to by illness, and the tasks nurses did were seen as menial day-to-day things that had to be done.

"Now we need to get nurses to address their experiences of an illness through their relationship with a patient.

"By doing this we can help these people cope and motivate them to recover from whatever they are suffering."

Miss Binnie practises these techniques in her clinic at the John Radcliffe Hospital, as well as helping other nurses as she travels around the country as a consultant.

And now, according to Nursing Times, she has been named one of the top ten nurses in the country. She wants nurses to understand that their role in hospitals is not merely as minions to the medics, but that the qualities they have to offer plays an important role in helping patients recover from their illnesses.

She says: "The world of nursing complements the more focused world of medicine. They work in parallel with each other.

"Helping a patient have a bath, for example, is not a menial task. It is an intimate relationship that can be used to help that patient. A patient who is always buzzing for attention may actually have a reason for doing so - he or she may be unhappy or worried, and a nurse can help." Miss Binnie, 46, started her training in Cambridge before moving to the JR as a senior sister in 1984. There she was given the scope to encourage staff to use more than their technical skills on the wards.

And she has written a book, Freedom to Practise, which takes an in-depth look at how nurses can adopt her philosophy.

She says: "In the old days we weren't encouraged to get close to patients. We were always moving around and the doctors operated independently from us.

"But we are talking about human beings, and there is a lot of psychology behind our profession. If we can get that right, then we can bring in our technical skills.

"If you can gain a patient's trust and find out what's on their mind, then you can help them a lot more than simply by giving them a bed-bath." Many people would agree. But when do nurses get the time to have a one-to-one relationship with those in their care?

The NHS is under severe pressure, underpaid nurses are leaving hospitals while remaining staff cope with the high number of admissions that are shifted through the system quickly to make room for future referrals.

Do they really have time to bond emotionally with their charges?

Miss Binnie, of Ditchley Park, near Chipping Norton, believes they have. But she says that one pivotal building block has been removed, causing the whole NHS structure to come tumbling down, and needs to be brought back - the senior ward sister. She explains: "We have to recognise just how crucial is the leadership of an experienced and strong-minded sister on a ward.

"Nurses no longer have these highly skilled people to lead them, yet they are the key staff who cope under stress and who are focused on their work whatever the situation.

"At the moment, such experience is not valued. Nurses at this level are paid more to go in to management or teaching, so they are taken away from the wards."

Miss Binnie is also an advocate of university training for nurses, but claims that recruits are being taught to take more control in the wards while hospitals are still working to the old regime.

"Nurses come into hospitals with these newly acquired skills and find that they can't use them," Miss Binnie says.

"Ask a nurse what you need to do with a ward that simply isn't working properly. They know the answers and could tell you, but they often feel dis-empowered. I want to empower them."

Miss Binnie is certainly an inspiration. She is truly a crusader for the new Millennium - and the NHS would do well to take her advice.

Story date: Monday 07 February

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