The Poetic Nursing Heart

Trapped in Equilibrium: Game Theory, Violence, and the Collapse of Care

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Trapped in Equilibrium: Game Theory, Violence, and the Collapse of Care

The #hobopoet

What sort of game is this?

In game theory, a Nash equilibrium occurs when no player can improve their situation by changing strategies while others keep theirs unchanged. This concept, often associated with economic models, offers a lens through which to view the current state of the NHS. What if the NHS, in its current form, has reached a tragic equilibrium? One where violence against staff, particularly nurses, has become normalised, yet the system continues to operate despite its evident dysfunction?

Recent reports highlight a disturbing trend: violence against NHS staff is escalating. According to a survey, one in seven NHS staff members experienced physical violence from patients, relatives, or the public in 2024. This statistic underscores a systemic issue that cannot be ignored.

The Royal College of Nursing (RCN) has condemned this rise in violence, attributing it to factors such as prolonged waiting times, understaffing, and increasing pressure on emergency departments. Nurses face not only physical harm but also verbal abuse, threats, and emotional trauma.

The Government Response: Job Boosts and Recruitment?

In response to escalating violence, the government has announced measures to bolster the nursing workforce. A recent initiative aims to recruit more nurses and midwives to alleviate pressure on existing staff. While this approach addresses the symptom of staff shortages it fails to tackle the root causes of violence and systemic dysfunction within the NHS.

Focusing on recruitment without concurrent reforms in workplace culture, safety protocols, and support systems suggests a reactive rather than proactive stance. Is this response a genuine attempt to improve conditions, or a strategic move to maintain the status quo?

Generational Politics and the NHS

The current crisis is not merely a result of recent mismanagement but is deeply rooted in decades of political decisions. Successive governments have implemented policies prioritising cost-cutting over care, gradually eroding the NHS’s foundational principles.

Market-driven approaches, privatisation, and an emphasis on Foundation Trust efficiency have transformed the NHS from a public service into a business model. These changes have affected care quality and contributed to the dehumanisation of patients and staff alike (Francis 2013). Generational politics have allowed fear and marginalisation to fester, creating a tinderbox of public frustration, a tinder often ignited by narrow-minded political narratives into violence and scapegoating.

These dynamics were already foretold by Isabel Menzies Lyth in the 1960s, who showed how systemic defences in nursing organisations led to stress, depersonalisation, and the erosion of compassionate care reminding us that this crisis is not new news, but a pattern long recognised. The central citation from My MSc and a building block within my PhD.

Zero tolerance.

The increasing incidents of violence against nurses reflect a broader societal issue: the normalisation of aggression and hostility. When patients face long waiting times, inadequate care, and systemic failure, their frustration often manifests as violence. Nurses, as the most visible representatives of the NHS, bear the brunt.

This normalisation is further perpetuated by the absence of effective preventative measures. Without comprehensive strategies including staff training, improved security, and a culture of zero tolerance the cycle of violence continues, reinforcing a system where fear, trauma, and marginalisation are routine.

Breaking the Equilibrium

To disrupt this destructive equilibrium, a fundamental shift is required:

  • Acknowledging the Problem: Recognising that violence against NHS staff is systemic and urgent.
  • Implementing Comprehensive Strategies: Enforcing policies to protect staff, including security measures, support systems, and clear reporting channels.
  • Cultural Transformation: Fostering a workplace culture that values and respects staff, where abuse is intolerable, and support is accessible and tailored to the individuals needs.
  • Political Will: Governments must move beyond token gestures and commit to reforms addressing the root causes of dysfunction.

Eternal Recurrence and the NHS
Nietzsche’s thought experiment of eternal recurrence imagines a life lived over and over, every joy and every suffering endlessly repeated (Nietzsche, 1969). If we applied this lens to the NHS, we would see the same assaults, the same waiting-room frustrations, the same sterile promises relived without end. If such a cycle fills us with despair rather than affirmation, then it must be broken. To resist eternal recurrence here is to refuse the normalisation of violence and neglect, and to insist that history is not doomed to repeat itself. In this way, Nietzsche provokes us to confront whether we will let this destructive pattern endure or whether we will summon the will to transform it.

“This life as you now live it and have lived it, you will have to live once more and innumerable times more; and there will be nothing new in it.” Nietzsche (1969)

Who Am I to Have a Voice?

As a nurse who has experienced assault and witnessed escalating violence against colleagues, I cannot remain silent. The whispers from the waiting rooms are not just complaints; they are cries for help. If ignored, they may foreshadow a tragedy. I refuse to accept the comforting illusion that those in power “do not know.” They know. The evidence is clear. The headlines scream. And yet, silence lingers.

I am the #hobopoet, wandering the corridors of care, carrying the whispers from the waiting rooms. My words are not policy papers or press releases they are counterpoints. They rise in the silence between the beeps of monitors and the shouts of frustration, in the spaces where nurses are spat at, punched, or threatened, and where the government’s response is a sterile promise of “more jobs,” as if people could be replaced like pieces on a board.

So, I write to say: we are running towards a never event not the clinical kind that policy-makers measure, but a moral never event, when a nurse is killed in plain sight. It will not come as a shock; the warnings are stitched into every shift, every raised voice, every exhausted sigh. It will not be an accident; the pattern is clear. And when it happens, it will shatter not just a life but the ‘poetic nursing heart’ of the NHS itself.

It is time to open a free and fearless dialogue. To stop whispering and start shouting. To recognise that care cannot survive in equilibrium with violence, neglect, and betrayal. If the heart stops beating, all the numbers, job boosts, and statistics in the world will not bring it back.

The NHS today reflects a tragic equilibrium where violence, neglect, and systemic failure have normalised. This status quo is not inevitable but the result of decades of deliberate choices. To change it, we must challenge existing systems, demand accountability, and restore the foundational values of care and respect. These are not echoes of discontent; they are the voices of a system in crisis. They remind us that fear and pain in the margins are manipulated by narrow-minded politics as touch paper for violence and hatred. It is time to listen, to act, and to restore the NHS to its rightful place as a beacon of compassion and care.

I AM THE HOBOPOET

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