The importance of humanities to nurse education should not be underestimated, says June Girvin
The Francis report findings and the more recent revelations from Morecambe Bay have led to much discussion about how best to respond to the growing realisation that all is not well in some healthcare organisations.
Responses include “pre” pre-registration experience for student nurses, improved leadership training and increased monitoring. Organisations have critical incident and “near-miss” reviews, and whistleblowing policies are widespread.
My faculty has a long-standing whistleblowing policy for students and provides support to those who choose to use it. But policy can only do so much when the root of the problem lies in organisational culture.
“How well do we prepare students to understand the nature and importance of exercising their professional conscience and the ethical, legal and human rights structures that protect and encourage speaking out?”
The history of openness around clinical care is neither a long, nor glorious one. The most cursory look at the literature on speaking out against poor practice reveals victimisation, career limits, ostracism, defensiveness, obfuscation and blame shifting. The weakness of the individual against the organisation and the power of professions and senior management combine to make whistleblowing a risky choice to make. A choice that is particularly hard for more junior staff, even though they may retain more of the idealism of the ethical behaviour of their organisations.
Socialisation into organisational norms blunts those expectations over time. Perhaps there is more that education can do to strengthen the resilience of health professionals when faced with a potential whistleblowing situation. How well do we prepare students to understand the nature and importance of exercising their professional conscience and the ethical, legal and human rights structures that protect and encourage speaking out?
When pre-registration nursing moved into higher education in the early 1990s it was with expectations that there would be benefits from exposure to the broader humanities subjects, such as law, ethics and the social sciences.
Many universities worked hard to draw these elements into the curriculum to develop nurses who had sufficient knowledge to practise competently with compassion and courage, and to be committed to high standards. Over the years however, the pressures on the curriculum have been relentless. Changing expectations of newly qualified nurses and a curriculum driven by commissioned utilitarianism have led to a concentration on mechanistic skill development and a devaluing of knowledge not associated with clinical practice and biomedical systems.
The original concept of the graduate nurse as “knowledgeable do-er” with the capacity for reflection and handling uncertainty is channelled more and more towards becoming a competency-proficient, system- compliant, process-driven operative.
The same is true of learning beyond registration. The demand is for clinical skill-based programmes, which is not unreasonable, but it is at the expense of opportunities to explore the dilemmas of 21st century practice and how to influence and contribute to it. Is it this change that has led not just to a reluctance, but an inability of staff to exercise their moral conscience and denounce inadequate care?
Education has an obligation to prepare professionals not only to be competent practitioners, but also to be confident judges of other people’s practice and to see the identification of poor practice as a vital part of their role.
Humanities needs to be embraced back into education. By setting professional preparation and ongoing education in a broader context, students will be better prepared for the dilemmas and tensions by which their practice is surrounded.
● The views expressed in this article should not be interpreted as my employer’s views
June Girvin is pro-vice chancellor and dean, Faculty of Health and Life Sciences at Oxford Brookes University