28 MAY 1988, Page 5


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For years, the College has been obsessed with professional status. It is by no means an unknown phenomenon that those who profess radical egalitarianism in theory should in practice be very concerned with their position in the social hierarchy. What we are witnessing is not an attempt to improve the Health Service, but a rather sordid power struggle.

Our hospitals teem with 'nurse adminis- trators' and 'nurse managers', who self- consciously adopt the dress of hospital consultants and who have abandoned the jobs for which they were trained. Like the junior clerks of newly-independent African countries, they have just discovered the intoxicating joys of bureaucratic power. To work with patients is now thought lower class: it is a desk that confers status, and paper that is the real world.

Nurses have become paralysed by fortn- filling even in the wards. A few years ago, a new method called the Nursing Process was introduced from the United States into Britain, and has spread like a plague. Originally intended to prove to private insurance companies that nurses do in fact work for their money, this minute written itemisation of the obvious is now used to demonstrate that nurses are not, as pre- viously thought, the willing hand-maidens Of doctors, faithfully carrying out instruc- tions, but professionals in their own right.

The Nursing Process has given an unpre- cedented opportunity to another group of pseudospecialists, the nurse educators. No longer a matter of apprenticeship, the education of nurses is now seen as some- thing requiring such deep theoretical foundations that during their first two years of training, nurses, like medical

students, should be kept in the classroom, only to set eyes on a patient in their final year. Their theoretical education will, of course, contain a considerable element of the sociological jargonising whose princip- al practical effect will undoubtedly be to persuade the nurses that they are ill used by the System.

The fundamental dishonesty that pre- vails in the nursing leadership is nowhere clearer than in its simultaneous advocacy of a more academic training and a lower academic standard for entry into that training. And one of the leaders inadver- tently let the cat out of the bag when he said that many people of lower educational qualifications made excellent nurses.

Precisely. Nursing is predominantly a practical craft, and only in its farthest and most specialised reaches does it require anything approaching a highly trained in- tellect. But it does require considerable devotion, tact and kindness, qualities not easily quantified on a flow chart: indeed, one suspects, they might be destroyed by flow charts. To make commonsense arcane so that it then has to be taught is profes- sionalisation in the worst possible sense.

How has this absurd situation come about? There is a deep-seated prejudice in this country that the only true form of education is academic. Practical training is despised and so, by becoming more 'pro- fessional', nurses become worse at their job. If nurses deserve more money, it is because they work hard and perform a vital function, not because the Nursing Process is incomprehensible to laymen.