Posted by: ayrshirehealth | December 4, 2013

Born to be a Nurse / Taught to be a Nurse or Forever a Student by @bartontd

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.

GNC

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.

NatureNurtureFirstly, 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.

Domains of learning

Where does this take us in this debate over educating nurses? Well – educationalists will tell you that there are three quite distinct domains of learning; Psychomotor, Cognitive, Affective.

Learning domainsThe 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.

Forever a student

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. The-master-is-foreverThus 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 wellbeing 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

This week’s guest blogger was @bartontd (David Barton) is Head of the Department of Nursing, Swansea University.

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Responses

  1. […] Born to be a Nurse / Taught to be a Nurse or Forever a Student  by David Barton on the Ayrshire Health blog […]

  2. […] but they were 5 great blogs all the same. We had two from our health friends. The first was  Born to be a Nurse / Taught to be a Nurse or Forever a Student  by David Barton on the Ayrshire Health blog. This was a thought provoking blog which begins by […]


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