The constraints that nurses face in delivering the care they believe their patients require are diverse.

Nurses work in an environment where their work is undervalued because it is mainly done in private.

The personal nature of nurses’ work with their patients while highly prized by the recipient is not something that nurses discuss openly.

It is invisible to nearly everyone else because nurses don’t talk about their work.

Except amongst ourselves.

The constraints that nurses place upon themselves means they end up caring “against the odds”.

A study looked at one part of the invisible work that nurses and care workers do such as when they provide continence care.

They identified dignity as being at the heart of the care that nurses and care workers provide.

Patient dignity is maintained with enormous amounts of time and energy on the part of nurses.

All of this effort is private and invisible.

The authors said that staff care “against the odds” because they work in a highly regulated work environment, encounter ethically challenging situations with highly dependent residents and their role is devalued.

Despite these challenges, nurses still strive to maintain their patient’s dignity every single time.

Nurses do this in private and behind closed doors.

The authors conclude that care is

“underpinned by a set of tacit rules about the need to present a sanitised (sic) and socially acceptable representation of residents, which involves concealing their disability, dependence and incontinence. However, this concealment also conceals and renders invisible the work that goes into helping restore residents’ dignity.”

Other health care workers, such as allied health workers, do a lot of their work in open situations.

Everyone can see the work that they are doing because they do not deal with discrete patient care.

Nurses need to talk more about the work they do and about how they protect patient dignity.

Telling people that you will protect their dignity is a good first step toward “caring against the odds”.

In a world where privacy is under perpetual threat, nurses are the first defenders of privacy and dignity for everybody.

To learn more about caring against the odds,

Ostaszkiewicz, J. , O’Connell, B. and Dunning, T. (2016), ‘We just do the dirty work’: dealing with incontinence, courtesy stigma and the low occupational status of carework in long‐term aged care facilities. J Clin Nurs, 25: 2528-2541.