Nurses aren't caring for their patients

Deconstructing Caring part- 2

The great thing about my job is that I get to talk about nursing all the time. This might be in the classroom, or in the many tutorials and meetings that I hold with students.
At other times I inevitably will be discussing aspects of nursing and education with my colleagues. This is something that I find particularly interesting.
So what do I do in my spare time?
Well, my PhD occupies a lot of my mindspace most of the time; it is hard to escape this as I am constantly thinking about how I am going to translate all of these random thoughts into some kind of meaningful discourse in the form of a thesis.
I am also married to a nurse (well actually she is a manager in the health service but she is a nurse at heart still), so we do discuss various aspects of each other's work and other issues in the news.
Don't get me wrong, I am interested in other things too. And being parents of 2 teenagers, we do have to change the record some times.

So, making the transition into being a PhD student was a fairly natural process. Once I had decided that my ideas about caring might make an interesting research study (see Part 1) I suddenly found that I could make some use of these ideas buzzing around in my head.

Over the years I have learnt that there is much more to being a nurse than just to be kind and caring. You can get by with a little learning, but it has only been since I jumped on the ladder of education that I have really come to appreciate the complexity of nursing and the true nature of what it means to be a professional nurse in the 21st century.
You see, caring is something that we intuitively feel that we understand, even though we have great difficulties trying to articulate exactly what it is.
Caring has only been in the nursing lexicon since the mid 20th century. And the notion of compassion has received very little attention until very recently. That is not to say that nurses never used to care about their patients, but any historian of nursing will tell you that the context of care delivery was very different in the first half of the last century. Nursing then was more about duty and vocational devotion to the sick. The idea that nurses could be considered to be professionals created great conflict and vociferous debate before, during and since the passing of the Nurses Registration Act of 1919. Even Florence Nightingale held deep reservations about the professionalisation of nursing.

Enough history... what I am trying to say here is that the caring discourse has become a very naturalised form of language in nursing. So much so that to say that what nurses do is NOT caring is to commit an act of heresy. 

I once began a lecture to 300 students thus:
"Nurses aren't caring for their patients. They never have,and never will. Caring is not what nurses do".
Stunned silence and some rather shocked looks followed.
I let that sentence hang out there for a few seconds to let it sink in, then followed up with,
"of course, nurses care about their patients, and hence we could describe nurses as being caring. But what nurses do, is not caring. To say that would be to simplify a complex range of skills, knowledge and behaviours that are required to practice nursing, into a vague and ambiguous term.".

The reception to this was actually very positive, once people got what I was trying to say. Because, once you start digging around the concept of caring you find that you enter a very strange and ambiguous world. In our desire to make caring a science (and thereby raise the discipline of nursing to something more empirically based) some inconsistencies emerge.

If caring can be measured, predicted and modeled (as is required of scientific knowledge) then we have to decide what caring is; what is included in the concept? To do this, many authors set about performing concept analyses and what they ultimately concluded was that just about everything that nurses do are included within the concept. 

Hence: Caring = Nursing 

In other words, caring (the verb) and caring (the adjective) became enmeshed. But this is illogical both grammatically and theoretically. To be caring you don't have to be a nurse. Likewise, to do caring is not the exclusive domain of nurses either. 
However, to be a nurse you do have to be caring.

So, if we take caring in it's purely adjectival meaning to represent the desire to have genuine concern for the wellbeing of our fellow man, then that clearly underpins everything that nurses do. It is an ontological position out of which action arises.
This would include tasks like paperwork and other non-clinical roles, because the bottom-line is that these things will eventually lead to some positive benefit for our patients. 
But caring only underpins nursing, it is a foundation block but it is not an adequate descriptor of the totality of the nurse's role. 
To be a nurse you have to have a wide range of skills, knowledge, experience and self-awareness; all of which can easily sit outside of being caring. They are mutually exclusive.

Underneath the most beautiful building is a mass of concrete and steel that forms its foundation, without it the building could not stand upright. But to describe the building to someone you wouldn't say that it is a mass of concrete and steel, you would instead talk about  the beauty of the building itself. 
Caring is what we are, not what we do.

With this in mind I set about backing this up by getting my ideas out into the academic world and my first paper was eventually published in print last year.
I was very nervous about how it would be received because I was aware that it could be very easy to misinterpret what I was saying and make it sound like "nurses don't need to be caring". Playing into the "too posh to wash" brigades hands.

I needn't have worried. On the back of this publication, I have received positive and encouraging emails from all over the world. I was even invited to present some of my work in the USA, Australia, Canada and Germany.

In this paper I began to deconstruct caring as a central and defining concept in nursing. Not for any malicious or antagonistic agenda, but just as an opening gambit to emancipate the complexity of nursing practice from being confined to one simple defining word. A word that is ubiquitous and not unique to nursing.


(as always... my opinions are expressed here only)