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General nursing does not seem to have progressed.

It is 21 years since I wrote my first ever column for the Nursing Mirror (Castledine, 1978). On that occasion I discussed my role as a joint appointment between education and service. Half my time was spent as a charge nurse and the other half as a lecturer in the Department of Nursing at the University of Manchester. Now, several years later, I have decided again to devote half my time to clinical practice. The reason for doing this is that I have become disillusioned at the way the theory–practice gap has widened and general nursing care has deteriorated. Twenty one years ago I believed that nursing in the UK was at an exciting and critical stage in its development. We were moving away from a reductionist model of task–oriented nursing to a more research-based holistic approach which emphasized patient involvement and individualized care.