CLINICAL EDUCATION
Nurse education: a political dimension The vast majority of nurses are employed by government in a service entirely funded by government. Health care priorities are also set by government and even the profession s controlling bodies have financial and legal ties with the state. On this basis alone it would be fair to suggest that the relationship between nursing and politics appears to be an inseparable one. One of the greatest political battles cur rently being fought by nurses, particularly in the UK, is to achieve reform in nurse education (1,2,3). There are two major issues Elizabeth Girot, RGN, SCM, involved: that of uniting the profession in Dip N Ed. RNT. agreeing their needs; and convincing the Government of the value of such change in spite of the extra cost involved and the inevitable manpower disruption (1). Over the past 50 years, there have been a succession of reports that have either been misinterpreted, partially implemented or ignored (1,4,5). The Athlone (6), Horder(7), and Wood (8) reports all made similar propo sals - that the course of training should meet the needs of the student and not the staffing References requirements of the hospitals (9). Fearful of 1. Clay T (1987) Nurses: Power and radical change, the profession itself rejected Politics. Heinemann Medical Books, London. many of the proposals (4). Then the Platt 2. Gott M (1985) 'Politics and Report (10) followed by Briggs (11) again professionalism in nursing' Nurse recommended the introduction of full student Education Today 5, 274-276. status for nurse education. While the Platt 3. Gooch S (1988) Why aren't we Report was rejected outright, again by nurse speaking our'' Nursing Times 84 (22) 23. managers (4), Briggs did pave the way to 4. White R (1986) Political Issues in educational reform through the 1979 Nurses, Nursing (2) P45-68 John Wiley and Midwives and Health Visitors Act to create Sons Ltd, UK. the statutory body the United Kingdom 5. Davis C (1978) ‘Four events in nursing history: a new look' Central Council (UKCC) and subsequently Nursing Times, occasional papers 74, their recommendations in Project 2000.
Elizabeth Girot argues that nurse educators need to become more aware of the politics of health care.
No. 18. 6. Interim Report of the Inter-departmental Committee on Nursing Services (Athlone Report) (1938) London, Ministry of Health. 7. Reports of Nursing Reconstruction Committee (Hordcr Reports) (1942, 1943): London, RCN. 8. Report of the Working Party on the Recruitment and Training (Wood Report) (1947) London, Ministry of Health. 9. Abel-Smith B (I960) A History of the Nursing Profession Heinemann Educational Books Ltd, UK.
Professional politics Nurses’ relationship with politics, at least in relation to education, over the past 50 years has at best been a conflicting one. Clearly the politics within the profession have been as important as those outside (4). This may be illustrated as clearly in the present situation. In spite of an agreement in principle for the Project 2000 recommendations, both by the profession and by the Government, there are still many, both within the profession and in
28 Nursing Standard May 23/Volume 4/Numtxr 35/1990
society in general, who see nurses in their 19th century role and the subsequent need to maintain the status quo with a ‘good practical training' best learned 'at the bedside’. There are those, on the other hand, who recognise the need for radical change to develop nurses both personally and professionally and im prove standards of practice, not only at the hospital bedside but also in the broader perspective of health care within the com munity (12). This conflict was experienced by Australian nurses in the late 1970s and early 1980s when they fought for their move into higher education (12). The Australian education move became the vehicle through which nurses learned how to use the political process to influence govern ment support. They also began to realise and develop their own enormous potential not known or recognised previously. To some extent this is beginning to happen in the United Kingdom. The profession's proposals for educational reform have been accepted and are now supported by govern ment. This is demonstrated in the recent 'Strategy for nursing’ by the Department of Health (13). The implications of changes in education are dealt with in the recent White Paper 'Working for patients' (14), the Gov ernment’s Working Paper Ten, Kducation and Training. Perhaps it would be prudent here to con sider what characteristics one would identify as being the model nurse in political terms. Kalisch and Kalisch (15) believe this model nurse to be not the quiet, submissive, hard working individual, but the cold, calculating professional who uses all available resources to advance the health care world around him or her. The model nurse seeks power. However, power in turn is often viewed pejoratively (16) in the sense of selfishness and detrimental to the woman's traditional role as caretaker and nurturer of the family (2,17). Power of itself is neither good nor evil. It is the use of power that has led to both negative (17) and positive views (18). Power, accordingly to modern organisational philosophy, is essential to goal achievement in the workplace. Nurses must seriously consider whether simple altruism in helping others and selfless devotion to duty
CLINICAL EDUCATION Nurses have learned how to use political power to influence the Government.
U71
10. Report of the Working Party on the Reform of Nursing Education (Platt Report) (1964) London, RCN. 1 1 Report of the Committee on Nursing (Briggs Report) (1972) London, HMSO. 12. Parkes M (1986) In: White (Editor) Polmeal Issues in Nursing (21 John Wiley and Sons UK. 13. Department of Health, Nursing Division (1989) ‘A strategy for nursing', A Report of the Steering Committee, April, London. 14. Department of Health (1989) 'Working for patients', Education and Training, Working Paper 10, October, HMSO, UK 16. Bell E C (1984) 'Good commanders seek power'. National Guard 38. PI 3-14. In: Wynd C A (1985) 'Packing a punch! Female nurses and the effective use of power'. Nursing Success Today Sept 2(9), 14-20. 17. Wynd C A (1985) 'Packing a Punch! Female nurses and the effective use of power'. Nursing Success Today Sept 2(9), 14-20. 18. Claus & Bailey J T (1977) Power and Influence in Health Care CV Mosby Company, USA. 19. Bowman & Culpepper R (1974) Power: Rx for change'. American Journal of Nursing. 74 (6), 1053-56. 20. Castledine G (1988) 'Winter of discontent'. Geriatric Nursing and Home Care March, 8. 21. Kalisch B J & Kalisch P (1976) A discourse on the politics of nursing' Journal of Nursing Administration March-April, 29-34. 22. Judge H (1985) Interview with Harry Judge. Ioimpada Spring 23. McBride A B (1987) 'Shaping nursing's preferred future' Nursing Outlook 35(3), 124-125. 24. Bolger T (1987) ‘Is the RCN too political? the case against’ Nursing Times 83 (42), 41. 25. La belle H (1986) 'Nurses as a social force'. Journal of Advanced Nursing 11, 247-253-
-7Akjb I
/V Vy/' ss.
a* are sufficient to achieve effective performance within large health care organisations. How ever, to become more politically aware, nurses need to know how the system works; how' it connects with other systems and how' deci sions are made. They must learn the content of their politics. Bowman and Culpepper (19) recognised that nurse education in the past has not stimulated self assertion in students. In part this has been made worse by the students’ vulnerability as employees. However, in recent years, at least theoretically, this has begun to be addressed in many of the nurse education programmes. In developing their links with higher education, schools of nurs ing need to examine their strategies so that with a better grounding, such as that pro posed in Project 2000, nurses will be better equipped to make informed decisions.
Better grounding Castledine (20) recognises that after qual ifying as a nurse, often poor education or lack of it has led to situations where nurses have allowed others to make decisions about pa tient care for them. As Kalisch and Kalisch (21) recognised in the USA, the weakness and strength of politics in a democracy is that the fate of its members lies largely in their own hands. More recently in the UK, Judge (22), following his own committee’s recommendation for nurse education reform, identified, one year prior to
the presentation of the UKCC’s Project 2000, that when nursing itself agrees what it w'ants in education terms it w'ill get it; but until it does agree, it will get nothing! In the future through the implementation of Project 2000 nurse education will cease its subordination to the National Health Service and, like its Australian counterparts, acknowledge. ’.. .Professional responsibility to participate in the development of society, to influence political decisions and actions which will affect the w'ell being of individuals and social groups and to improve the quality of service nurses can offer.’ (12). Links with higher education have now been developed in many parts of the country and Project 2000 has begun in several schools of nursing. Perhaps through a system of education rather than training, the profession could work towards a future which enables its members to be individuals who live In the present and are mindful of shifting realities and new possibilities (23). Nurses can no longer remain isolated but need to develop a closer relationship with politics to understand the world around them and enable them to influence their own future. Nursing has altvays been political since it has considerable influence on the wellbeing of society (24). Unfortunately nurses have not always recognised their political role and have yet to realise their political potential. They have a responsibility to identify issues and present their solutions to government (25). May 23/Volume 4/Numbcr 35/1990 Nursing Standard 29
Nurse education: a political dimension The vast majority of nurses are employed by government in a service entirely funded by government. Health care priorities are also set by government and even the profession s controlling bodies have financial and legal ties with the state. On this basis alone it would be fair to suggest that the relationship between nursing and politics appears to be an inseparable one. One of the greatest political battles cur rently being fought by nurses, particularly in the UK, is to achieve reform in nurse education (1,2,3). There are two major issues Elizabeth Girot, RGN, SCM, involved: that of uniting the profession in Dip N Ed. RNT. agreeing their needs; and convincing the Government of the value of such change in spite of the extra cost involved and the inevitable manpower disruption (1). Over the past 50 years, there have been a succession of reports that have either been misinterpreted, partially implemented or ignored (1,4,5). The Athlone (6), Horder(7), and Wood (8) reports all made similar propo sals - that the course of training should meet the needs of the student and not the staffing References requirements of the hospitals (9). Fearful of 1. Clay T (1987) Nurses: Power and radical change, the profession itself rejected Politics. Heinemann Medical Books, London. many of the proposals (4). Then the Platt 2. Gott M (1985) 'Politics and Report (10) followed by Briggs (11) again professionalism in nursing' Nurse recommended the introduction of full student Education Today 5, 274-276. status for nurse education. While the Platt 3. Gooch S (1988) Why aren't we Report was rejected outright, again by nurse speaking our'' Nursing Times 84 (22) 23. managers (4), Briggs did pave the way to 4. White R (1986) Political Issues in educational reform through the 1979 Nurses, Nursing (2) P45-68 John Wiley and Midwives and Health Visitors Act to create Sons Ltd, UK. the statutory body the United Kingdom 5. Davis C (1978) ‘Four events in nursing history: a new look' Central Council (UKCC) and subsequently Nursing Times, occasional papers 74, their recommendations in Project 2000.
Elizabeth Girot argues that nurse educators need to become more aware of the politics of health care.
No. 18. 6. Interim Report of the Inter-departmental Committee on Nursing Services (Athlone Report) (1938) London, Ministry of Health. 7. Reports of Nursing Reconstruction Committee (Hordcr Reports) (1942, 1943): London, RCN. 8. Report of the Working Party on the Recruitment and Training (Wood Report) (1947) London, Ministry of Health. 9. Abel-Smith B (I960) A History of the Nursing Profession Heinemann Educational Books Ltd, UK.
Professional politics Nurses’ relationship with politics, at least in relation to education, over the past 50 years has at best been a conflicting one. Clearly the politics within the profession have been as important as those outside (4). This may be illustrated as clearly in the present situation. In spite of an agreement in principle for the Project 2000 recommendations, both by the profession and by the Government, there are still many, both within the profession and in
28 Nursing Standard May 23/Volume 4/Numtxr 35/1990
society in general, who see nurses in their 19th century role and the subsequent need to maintain the status quo with a ‘good practical training' best learned 'at the bedside’. There are those, on the other hand, who recognise the need for radical change to develop nurses both personally and professionally and im prove standards of practice, not only at the hospital bedside but also in the broader perspective of health care within the com munity (12). This conflict was experienced by Australian nurses in the late 1970s and early 1980s when they fought for their move into higher education (12). The Australian education move became the vehicle through which nurses learned how to use the political process to influence govern ment support. They also began to realise and develop their own enormous potential not known or recognised previously. To some extent this is beginning to happen in the United Kingdom. The profession's proposals for educational reform have been accepted and are now supported by govern ment. This is demonstrated in the recent 'Strategy for nursing’ by the Department of Health (13). The implications of changes in education are dealt with in the recent White Paper 'Working for patients' (14), the Gov ernment’s Working Paper Ten, Kducation and Training. Perhaps it would be prudent here to con sider what characteristics one would identify as being the model nurse in political terms. Kalisch and Kalisch (15) believe this model nurse to be not the quiet, submissive, hard working individual, but the cold, calculating professional who uses all available resources to advance the health care world around him or her. The model nurse seeks power. However, power in turn is often viewed pejoratively (16) in the sense of selfishness and detrimental to the woman's traditional role as caretaker and nurturer of the family (2,17). Power of itself is neither good nor evil. It is the use of power that has led to both negative (17) and positive views (18). Power, accordingly to modern organisational philosophy, is essential to goal achievement in the workplace. Nurses must seriously consider whether simple altruism in helping others and selfless devotion to duty
CLINICAL EDUCATION Nurses have learned how to use political power to influence the Government.
U71
10. Report of the Working Party on the Reform of Nursing Education (Platt Report) (1964) London, RCN. 1 1 Report of the Committee on Nursing (Briggs Report) (1972) London, HMSO. 12. Parkes M (1986) In: White (Editor) Polmeal Issues in Nursing (21 John Wiley and Sons UK. 13. Department of Health, Nursing Division (1989) ‘A strategy for nursing', A Report of the Steering Committee, April, London. 14. Department of Health (1989) 'Working for patients', Education and Training, Working Paper 10, October, HMSO, UK 16. Bell E C (1984) 'Good commanders seek power'. National Guard 38. PI 3-14. In: Wynd C A (1985) 'Packing a punch! Female nurses and the effective use of power'. Nursing Success Today Sept 2(9), 14-20. 17. Wynd C A (1985) 'Packing a Punch! Female nurses and the effective use of power'. Nursing Success Today Sept 2(9), 14-20. 18. Claus & Bailey J T (1977) Power and Influence in Health Care CV Mosby Company, USA. 19. Bowman & Culpepper R (1974) Power: Rx for change'. American Journal of Nursing. 74 (6), 1053-56. 20. Castledine G (1988) 'Winter of discontent'. Geriatric Nursing and Home Care March, 8. 21. Kalisch B J & Kalisch P (1976) A discourse on the politics of nursing' Journal of Nursing Administration March-April, 29-34. 22. Judge H (1985) Interview with Harry Judge. Ioimpada Spring 23. McBride A B (1987) 'Shaping nursing's preferred future' Nursing Outlook 35(3), 124-125. 24. Bolger T (1987) ‘Is the RCN too political? the case against’ Nursing Times 83 (42), 41. 25. La belle H (1986) 'Nurses as a social force'. Journal of Advanced Nursing 11, 247-253-
-7Akjb I
/V Vy/' ss.
a* are sufficient to achieve effective performance within large health care organisations. How ever, to become more politically aware, nurses need to know how the system works; how' it connects with other systems and how' deci sions are made. They must learn the content of their politics. Bowman and Culpepper (19) recognised that nurse education in the past has not stimulated self assertion in students. In part this has been made worse by the students’ vulnerability as employees. However, in recent years, at least theoretically, this has begun to be addressed in many of the nurse education programmes. In developing their links with higher education, schools of nurs ing need to examine their strategies so that with a better grounding, such as that pro posed in Project 2000, nurses will be better equipped to make informed decisions.
Better grounding Castledine (20) recognises that after qual ifying as a nurse, often poor education or lack of it has led to situations where nurses have allowed others to make decisions about pa tient care for them. As Kalisch and Kalisch (21) recognised in the USA, the weakness and strength of politics in a democracy is that the fate of its members lies largely in their own hands. More recently in the UK, Judge (22), following his own committee’s recommendation for nurse education reform, identified, one year prior to
the presentation of the UKCC’s Project 2000, that when nursing itself agrees what it w'ants in education terms it w'ill get it; but until it does agree, it will get nothing! In the future through the implementation of Project 2000 nurse education will cease its subordination to the National Health Service and, like its Australian counterparts, acknowledge. ’.. .Professional responsibility to participate in the development of society, to influence political decisions and actions which will affect the w'ell being of individuals and social groups and to improve the quality of service nurses can offer.’ (12). Links with higher education have now been developed in many parts of the country and Project 2000 has begun in several schools of nursing. Perhaps through a system of education rather than training, the profession could work towards a future which enables its members to be individuals who live In the present and are mindful of shifting realities and new possibilities (23). Nurses can no longer remain isolated but need to develop a closer relationship with politics to understand the world around them and enable them to influence their own future. Nursing has altvays been political since it has considerable influence on the wellbeing of society (24). Unfortunately nurses have not always recognised their political role and have yet to realise their political potential. They have a responsibility to identify issues and present their solutions to government (25). May 23/Volume 4/Numbcr 35/1990 Nursing Standard 29
