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Practice comment

Reawaken your sense of vocation by remembering nursing’s history


The element of vocation in nursing has been overshadowed by the quest for professional recognition. Aileen Walsh argues why the best traditions from our past should not be forgotten

I recently heard the eminent scientist James Lovelock commenting on the radio that science had become a career choice rather than a vocation, just like nursing.

Unpopular as I might be in stating this, I cannot help feeling he might have a point worth considering. I remember during my own Project 2000 education programme that the idea of nursing as a vocation was explicitly expelled from the classroom. This reflects the feminist slant that has influenced the academic development of nursing in the UK, as the word “vocation” has too much of a religious connotation, an association with a history where nurses were perceived as subservient to doctors.

But what exactly does a vocational attitude to work mean? A Google search leads to the conclusion that a vocation is something for which people feel a strong inclination to do. It involves a sense of commitment and purpose that extends psychologically deeper than merely satisfying our own needs.

Csikszentmihalyi and Nakamura (2007) identified that exceptionally creative people from a variety of professions had a strong sense of vocation similar to the idea of religious vocation. They identified that these people had a sense of duty to do “excellent work as defined by the traditions and current standards of the particular activity in which they are engaged”.

In reading this I was struck at how a sense of connection with people’s professional past, an appreciation of the excellence previously achieved, is so significant in attaining excellence in the present and projecting into the future. Has something been lost in nursing with the bid for professional recognition?

“Nursing will never be an autonomous profession. Our relationship to doctors will always be subservient”

Much of what I have read about nursing history has been negative; examples such as the tidy wards and regimented discipline are now laughed at and seen as irrelevant. The modern fallacy is that nursing can be an autonomous profession. But nursing was never and will never be an autonomous profession, except, of course, in the delivery of nursing care. Our relationship to doctors will always be subservient. Nurses have always and will always find ways to deal with this power difference; but let us not reward those nurses who take on “autonomous” roles more than those who provide excellent essential frontline care.

As I have considered these issues, I have begun to change my own practice in the classroom. I have begun to introduce some of the discipline that I have heard my mother and retired colleagues speak about in their own work. During skills sessions I have stopped students, to consider how their posture and language can communicate a sense of being a trustworthy person to their patients. I have asked them to walk around the room and observe what untidy procedure trolleys communicate and how their competence might be affected by such untidiness.

I hope that nurses in practice might consider doing the same, if they do not practise in this way already. The discipline and attention to detail that nursing history has so often been laughed at for, looked at through a different lens, could surprisingly help to cure some of the problems we now face in ensuring that patients receive excellent attention to their most essential and immediate needs.

By remembering our sense of purpose, by remembering and taking the best from our professional history, perhaps we can reawaken our sense of vocation and regain some of the esteem with which our profession was held in the past.

AILEEN WALSH is senior lecturer, Faculty of Health and Social Care, Anglia Ruskin University


Readers' comments (23)

  • Aileen Walsh; we need more lecturer like you. Vocation is a word that one hardly hear these days. Please add it to the nursing curricullum.

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  • At last! I trained in South Africa where professional recognition was miles ahead of the UK and yet the vocational aspects of nursing was so central to our training. Thank you for taking a stand.

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  • It's not as if I don't agree with the vocation (I do!) But isn't it the argument that we are a vocation that has been used against us so many times by our managers and government? Using emotional blackmail to beat our profession down in talks for better pay and conditions and used against us if any of us ever talk of striking?

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  • I entered into nursing and midwifery in my mid 20's and already had considerable life expereince having dealt with people of all ages and walks in life.

    I respected Dr's for their expertise from the start but never allowed myself to feel subservient. I felt rather an equal with different and very vital skills.

    At the end of the day we are not in a power struggle in our various roles but endeavouring to get people well or safely through a healthy pregnancy depending on your role.

    If you are confident in your practice and make a difference to the putcomes of those in your care you are very much on an equal footing with any Dr or other clinician.

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  • Vocation schmocation, what does it matter as long as we have a clean and tidy ward?

    But the bit about subservience - unpopular language but true, we are not all equal members of the healthcare team, the rest is gibberish. Seriously, get a grip. I never turned up for the cash. Try to do a better job today. Do I think for a second that discipline and tidyness are a necessary result of 'vocation' . No. Do I think vocation is a dark reminder of the authoritarian and religious past we endevour to escape. Yes.

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  • Is the word 'subserviant' the wrong one ? Yes Nurses act on Doctor's decisions but I find subservient to be a very negative word when discussing the relationship between different healthcare professionals. imagine the furore if Nurses said that HCA's were subservient to them ! I agree that more attention to details such as cleanliness, tidiness and attitudes is important in inspiring confidence in patients, as an agency Nurse I work in the NHS and private sector, and despite the shortages being prevalant in both sectors, patient in the private sector love the attention to detail and general 'housekeeping' standards of private wards.

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  • I am so pleased that this is being discussed as I have felt this way for so long. What's in a word? The word subservient may get people in a tizz, but it is as good a word as any. I really believe that the drive to make nursing a 'profession' has meant we have lost something special along the way. Creating a miriad of roles for nurses to ellevate themselves 'equal' to that of doctors has not taken the bulk of nursing forward. Indeed, I believe it has diluted the critical mass we once had. Fragmenting the service and giving a sense of inadequacy to some nurses who choose to remain at a more basic level. This has contributed to a weakness in leadership on many levels and so discipline and standards have gradually slipped.

    BTW: I say this as someone who began in 1977, has gone through many hoops of further education and now working as a Community Matron.

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  • There's nothing wrong with being tidy, but Ms. Walsh is doing British nurses a disservice by fixating on the image and hierarchy they hold in the healthcare profession. Come to America Ms Walsh, where nurses are emancipated. See how patients benefit by having highly competent, caring nurses working alongside housekeepers, nursing assistants, and - oh yes - alongside doctors! Nursing science is respected in many parts of the world, sometimes including Britain, though I wonder how it's taught in your classroom.

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  • Well! I have no argument, but I do know that I am in nursing as a vocation. This does not preclude professionalism, rather it is for me a precursor.

    As a third year nursing student, who also has 2 decades experience in a traditional profession, I can link this to the discussion on compassion. It it those who are vocationally led who seem to demonstrate compassion. The so called scientifically led students think their professionalism is in their knowledge, but more than that it is in their attitude.

    I heard a service user state that in his care he had no concerns that the nurses had the knowlege and skill to care effectivelly for him. He went on to say that their attitude, however, left a lot to be desired.

    There must be a point where we can feel 'called' to a profession, yet still be skilled and knowledgeable.

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  • I am a highly educated mature student, like many on my nursing course, and I absolutely love nursing. I would never have looked into nursing as a career if it was not degree worthy and recognised. I have no intention of being subservient to others - just purely working with them and valuing their expert contribution to patient care. I've found in every job you need to give a bit extra to get further, and nursing is no exception. If a nurse is not ambitious, that's their choice. Shame the grades don't really reflect that! Like many educated nurses - we do have a choice when it comes to career - our skills are transferable and the NHS is not the only employer in the world! If managers and government take the michael, then it is up to the nurses to stand up for themselves...

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