Born to be a Nurse /
Taught to be a Nurse
Or Forever a Student
In 1919, after a 30 year debate, Parliament passed the
Nurses Registration Act, this leading to the formation of the General Nursing
Council (GNC). For the first time, to
practice Nursing, you had to be “registered”, and you had to be trained / educated,
for that role. Today we can scarcely imagine a time before regulation, when
anyone anywhere could call themselves a nurse, and where educational preparation
to be a nurse varied from the ‘occasionally good’ to ‘absolutely nothing’.
Nearly a hundred years later the Profession of Nursing is again
beset by a similar debate. Should Nurses be educated in Universities? Nursing we
are told by the tabloids needs to ‘go back to basics’! Nurses are, after all, born,
not trained! Nurses today are apparently too posh to wash, too clever to care!
Every day the tabloids report on the latest scandal in the NHS, and nurses are frequently
a focus of press indignation over lack of compassion and care. Don’t get me
wrong, I am not in denial, what happened in Stafford was real, and it’s a sad fact
that ‘care’ can go terribly wrong, but that is often because a lack of
education, not because of education itself.
Thus, I (like others) am curious as to why catastrophic
failures in care are seen as a result of education. The governments own Willis
report (DoH 2012) clearly pointed to the benefits of graduate education for the
future of the Nursing profession. Consequently
I am constantly surprised by the media view that an educated nurse is
necessarily a bad thing.
Let me unpick these
thoughts a little.
You will all have heard of the nature / nurture ‘trait’ debate.
It is here that notions of being born with certain innate personal
characteristics are contrasted with the idea that we can teach diverse skills
and behaviours to people.
Firstly, consider “Nature”. It is widely believed that we are
born with different natural qualities; a skill for music, or mathematics, or
indeed a natural inclination for care and compassion. It is suggested that these traits emerge as
the child grows. With this in mind it may seem a paradox that humans are also all
born with a common and extraordinary innate ability – the ability to learn. Acknowledging
this leads to the concept of “Nurture”, the human ability to enhance or develop
new skills, new behaviours and new attitudes.
This profound ability to learn is never more evident than in
the early years of life. At birth a child is utterly dependent - as vulnerable
as a human can be in every way. At about
one year of age a child undergoes an extraordinary development - that is the
ability (determination) to stand and learn to walk. By two years of age the
child is learning language at an exponential rate, soaking up new words and
language in a way that defies imagination. By four years a child is running,
talking, communicating, listening to music, dancing and learning to read – and also
revealing their distinctive personality. The Nature proponents will point to
the particular and unique types of innate traits, interests and skills four
year olds present with – these illuminating the “Born With” trait perspective. Conversely
the Nurture proponents will also point to the enormous diversity of experiences
that the 4 year old child is being influenced by, even at such a young age.
That diversity may be exampled by gender, culture, ethnicity and a multitude of
other human influences. For me this
leads to one logical conclusion – both Schools of thought are right, and thus
we may comfortably accept that concepts of Nurture follows on rationally from concepts
of Nature. Every moment of our life,
from cradle to grave, we are constantly being exposed to our world, billions of
influences that shape us as people, building on those innate qualities that we
were born with. After all, it must be axiomatic
that life exposure is integral to learning – and learning is evident when behaviour
changes.
Where does this take us in this debate over educating
nurses? Well - educationalists will tell you that there are 3 quite distinct
domains of learning; Psychomotor, Cognitive, Affective.
The Psychomotor Domain describes areas of complex mechanical
technical skills (making your hands work) – this regarded as the easiest area
of teaching and learning. The Cognitive Domain captures those skills we learn
in using knowledge to understand the world, to comprehend and to reason – this
a more difficult area of learning than the Psychomotor Domain. Finally is the
Affective Domain, that area of learning relating to emotion, feelings and
attitudes – this is viewed as the most complex area of learning.
Our challenge is that many are troubled by the notion that
we can “teach” the intangible and complex human qualities; Love, Care, and
Compassion. But the evidence suggests that we can do just that. A most contemporary and current example of
this is the Terrorist Radicalisation of young adults. This subject is a
favourite of the tabloids where they witness the apparent ability to teach young
people to hate. I would agree with them, history provides us with countless
examples on how negative attitudes can be taught to individuals and
populations. But equally this implies that the opposite of this must also be
possible, that we can teach people to care and to be compassionate. Again, the evidence suggests that expert mentorship,
role modelling, and values education can instil and nurture the skills of care
and compassion that we want in a professional nurse.
This draws us (at this point) to fairly obvious
conclusions. Firstly we must carefully
select those who wish to become future nurses. Secondly we must assure that
‘what’ is taught, and ‘how’ we teach are clearly articulated foundations of
nurse education. Finally we must assure ourselves that the graduate nurses, at
the point that they pass through our “Gate of Entry” as a registrant, are fit
for purpose. It is my fervent belief
that we are already doing that.
However, logic
also dictates that following that initial registration, qualified nurses will
continue to develop further – we are after all constantly learning. It also
follows that the qualified nurse could go on to develop in either positive or
negative ways. Thus the notion of lifelong education in nursing must become a
structured reality – with a curriculum, and with checks and balances built in.
Education and learning can no longer be optional extras to the professional
nurse. If another Stafford is to be avoided it will no longer be acceptable to
accept clichés about being Born to be a Nurse, or time limited notions of being
Taught to be a Nurse. There is no end point, no termination of your education
in Nursing - there may be milestones, but you should be / will be a “Learning
Nurse” – FOREVER a student of our profession.
I opened
this short missive with an allusion to the history of nursing. I close it with
two Educational Statements, which to me illustrate that, whilst they were both
written nearly 100 years apart, they are in principle remarkably similar. That
values that we held dear in 1921 that nurses should be well educated are those
that we hold now.
"To stimulate and foster the nurses
power of development; increase her
capacity by a more extensive knowledge
of subjects, social and practical, pertaining to her profession;
to train her mind to a wider outlook
then that usually obtained within
the four walls of an institution, bringing into line with curative measures
the no less important branches
of preventative work."
GNC
Curriculum Statement 1921
“Nursing education across the UK is
responding to changing needs, developments, priorities and expectations in
health and healthcare. Nurses who acquire the knowledge, skills and behaviours
that meet our standards will be equipped to meet these present and future
challenges, improve health and well-being and drive up standards and quality,
working in a range of roles including practitioner, educator, leader and
researcher. As autonomous practitioners, nurses will provide essential care to
a very high standard and provide complex care using the best available evidence
and technology where appropriate.”
NMC
Pre Registration Education Standards 2010
FOREVER A STUDENT NURSE
No comments:
Post a Comment