A stitch in time

February 14, 1997

Pull yourselves together, Catherine Cadman tells her colleagues in nursing education, and swallow some home truths before the universities swallow you

Incorporating nurse education into higher education has not been easy. Many nurse teachers feel bruised and bullied by the very institutions which profess to welcome them. Strong leadership in nursing has never been more necessary and its absence more keenly felt.

I read with growing irritation that some academics feel that we nurse teachers should recognise our limitations. Apparently we do not have sufficient knowledge of the subject disciplines which underpin nursing theory to "go it alone" in our teaching. Indeed, such doubts have been expressed by my own institution in relation to our ability to teach nursing at degree level.

In effect, what we are being asked to do is doff our newly acquired and - by implication, undeserved - academic caps to those "first-class minds" in higher education. Until recently academics have on the whole remained silent about their prejudices about the integration of nursing education into higher education. Now we have proof of what we had previously only imagined; we are being told we are second-rate academics, in need of guidance.

The "nice but dim" and "too thick for university" view is currently being aired in academic journals and the national press. Nigella Lawson, for instance, writing in The Times before Christmas, feels that education is not simply undesirable but downright harmful to the profession as it discourages "the sort of person who would make a good nurse".

While not wishing to debate the issue of what makes a good nurse, I would just say that being one and teaching others gives me the edge here in suggesting that our involvement in, and access to, higher education is a key element in informing our practice, and that this is acknowledged by the enlightened majority of our profession.

Whether we are welcome or not, the current state of higher education does not look particularly inviting to a profession which has a female bias and its roots in vocational education. Promotion prospects, for instance, are limited for women in universities partly because research begets promotion and nurses have precious little time in which to undertake it.

Lecturers in nursing are also having to run in order to stand still in an alien world of high competition and intense intrigue. We have failed to understand the rules of the games played within higher education. Then there is the problem of the monumental and rapid changes in universities. There is turmoil over funding, increased demand for places and an obvious lack of resources to meet that demand.

Both nurse educators and university academics are deeply concerned about how, in the face of all this, standards of course delivery can be maintained and improved. To do this nurse educators must assert themselves more within academic institutions, and articulate the primacy and validity of nursing and its practice as a proper subject for academic study.

Nursing represents a financial prize for most institutions and as such has been subject to many bids by separate, often competing, disciplines. Unless we stop nursing being seen as a collection of loosely related but ultimately separate disciplines, open to hijacking by university subject specialists who have no nursing and often no teaching qualifications, the move into higher education may actually widen the "theory-practice gap".

Practice is central to nursing and if we allow it to be divorced from theory patient care will become fragmented. Students will be unable to perceive knowledge as being essential to good practice. Although nurse educators have challenged the assumption that nursing can be fragmented in this fashion, there have been too few to make a difference.

Our vulnerability has been exacerbated by the absence of a strong and well-informed leadership from among academics in nursing. I am not surprised by this:cohesion has never been easy to achieve in nursing, even within the confined world of professional education. Most nursing professors have remained silent about the key issue of teaching and administration staff cuts at a time when standards in nurse education are under critical scrutiny.

Hopes of strong educational leadership from either the Royal College of Nursing or Unison remain unfulfilled. Nurse managers, who purchase education and who therefore have the power to provide effective leadership regarding standards in education, have been shown to be if anything more trusting, more reserved and more dependent than the average British manager.

It is time to abandon the questioning of nurse teachers' rights and ability to teach nursing at degree level and develop a more meaningful dialogue based on mutual respect and a recognition of the potential for mutual advantage. But perhaps we should not invest too much in the hope that our purchasers will become strong advocates for the maintenance of standards in nurse education.

Nurse educators and those in higher education must act quickly to prevent further denigration of the clinical in favour of the academic role, making nursing itself a casualty of the integration process. We have to ensure that the clinical and the academic are never in conflict, and nurse educators need to be equally involved in both.

Strong leadership is the key. We must become more expert and confident in negotiating contracts that allow us to not only deliver good education but also to have time to take our rightful place in higher education in the pursuit of scholarly activity. This involves asking for support from our employing institutions.

If our leaders fail to do this, the combination of threats from higher education and the National Vocational Qualification might just be fatal to nursing as we know it.

Catherine Cadman is senior lecturer, faculty of human sciences, University of Plymouth.

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