When interviewing for student nurses over the years we have asked the same question to the candidates on many ocassions, always with predictable answers. A nurse has to be caring.
It's a bit of a no-brainer isn't it?
Nursing is a caring profession, therefore to be a nurse you have to be caring. What's the fuss? Why even ask the question if it is implicitly understood to be the case?
And you are probably wondering... why write a blog about it?
Well, let me explain...
My PhD journey began in 2008, some 7 years after becoming a lecturer in nursing at University of West London. During those years I had resisted the idea of ever doing PhD. Having seen colleagues going through the hours of reading, writing and generally stressing about their research; culminating in a lengthy Viva Voce examination.
The idea of the viva alone was enough to put me off. Having to explain, justify and defend your research's rigour for a prolonged period of time (in one case 5 hours!) did not appeal to me at all! Any exam that lasts longer than a Wagner opera is best avoiding in my world.
Although I have subsequently learnt that this is an exception rather than the norm, I wasn't passionate about anything enough to warrant that level of commitment.
And after all, God doesn't have one!
At this time I shared an office with Stefanos Mantzoukas (now Professor of Nursing, Ionaninia in Greece) who loved to discuss philosophy and nursing. Often at the end of the day we would kick back and bat ideas backwards and forwards about nursing and the nature of nursing knowledge.
Actually, I make that sound like a great 'meeting of minds' when actually it was more like me throwing a half-baked theory at him and he then breaking it down and handing it back to me in all it's illogical incongruity. But I learned a great deal from him during these exchanges.
When Stefanos left to move back to Greece we kept in touch via Skype and email and would have similar discussions. During one such emaiI discussion I told him that I had been reading about Marx's theory of False consciousness and that it occurred to me that caring in nursing was something of a false consciousness; that the promotion of caring as being central to nursing care was potentially used as a means of restricting the profession from reaching its full potential at the heart of healthcare delivery, and that over the years nurses have been repressed by more dominant professions and policy makers because the primary attribute of the nurse was to exhibit caring behaviours and to be selfless.
Why have nurses not gone on strike in the UK to demand better resources to provide better care? Because, to walk out on your patients and to leave them to fend for themselves would appear to heartless and uncaring. An un-nursing thing to do.
The response from Stefanos was immediate... "I think that you are onto something there!", he said, and then added a note of caution "but of course, if you try and challenge the notion of caring in nursing, then you will be burned at the stake as a heretic!".This was like a red rag to a bull. I was lucky enough to have been trained in a school of nursing that promoted the idea that we should challenge and question everything (quite progressive for the late 80's).
I just knew that there was something to this, but couldn't quite comprehend what this meant? What was I really trying to say? That nurses shouldn't be caring? Surely that's not right! Uncaring nurses are not what we want to strive for!
Over the following weeks I got myself caught up in a complex network of conflicting ideas:
-Caring is about being compassionate, empathetic and kind.
-Nurses have to be caring for the well being of their patients.
-Caring is central to (and synonymous with) nursing which means that the nurses role is restricted to caring behaviours, which can put them in a powerless position to change healthcare delivery.
-How can all of this be reconciled?
Nurses who extend their role to be more proactive and autonomous in designing and delivering new services are sometimes derided by fellow nurses. The introduction of nurse prescribers was met with enormous resistance by doctors and nurses alike and took an inordinate amount of time to come into being. When you throw in the introduction of a UK wide adoption of undergraduate nurse education, then you can see why the idea that some nurses were "trying to be mini doctors" became a compelling argument from some corners.
Because, as this argument goes, nurses are meant to be caring and shouldn't have their heads filled with such ideas of grandeur.
So, I set about the task of trying to understand how nurses can improve their effectiveness as agents of change on behalf of their patients, whilst they remained incarcerated in the identity of nursing that society has constructed for them.
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