Editorial: Educating the good for nothing student
Post on 02-Apr-2017
Editorial: Educating the good for nothing student
The past several years have seen aseries of catastrophic failings inhealth care in the UK, with a greatdeal of attention from the press, fromprofessional bodies and from patientsand carers organizations being direc-ted particularly at nursing and nurseeducation. The Royal College ofNursing significantly understated thesituation in their observation thatNurse education and the quality ofits product has recently been thesubject of public and professionalcomment (RCN 2013), particularlyin relation to graduate nurses. News-paper headlines such as Nurserefused to clean up vomit becauseshe went to university and Nursestold, youre not too posh to wash apatient (both from the UK newspa-per The Daily Mail) continue to findtheir way into national consciousness,despite the conclusion of the WillisCommission on Nurse Educationthat:
The commission found no major shortcom-
ings in nursing education that could be held
directly responsible for poor practice or the
perceived decline in standards of care.
The so-called too posh to wash argu-ment referred to above runs as follows:
1 The mid-Staffordshire enquiry (Fran-
cis 2013) and other similar analyses
of the recent crisis in care suggest
that nurses are neglecting the basics
in caring for their patients and that
the profession needs to review its
commitment to what the chief nurse
for England has called the 5Cs of
caring compassion, competence,
communication, courage and com-
mitment (Cummings 2012).
2 Part of the reason for this gross dere-
liction of duty is that nurses are
overeducated; that they do not need
a degree to give a bed bath or feed a
patient. Indeed, that being in posses-
sion of an education and a degree
encourages nurses to believe that
their rightful place is in the office
behind a computer rather than beside
a bed tending to the needs of
3 Therefore, the profession of nursing
should end its flirtation with higher
education and return to a clinically
based apprenticeship method of
I would like to make a counter-intui-tive suggestion: rather than overeducat-ing our students, I would like tosuggest that they are woefully undered-ucated and that many of them are, infact, hardly educated at all. I am notdenying that they are well trained.Some are very well trained indeed, notonly in the skills required to be a safeand competent nurse, but also in howto write essays, how to pass examina-tions and even how to think critically.But most are not well educated, atleast not in the sense that anyone whostudied at university prior to the 1980swould understand the term.We know that having the skills to do
a particular job and being motivated todo it are two quite different things.The motivation to care for sick andvulnerable people, particularly whenthe care involved is hard, messy andexhausting work, derives in large partfrom caring about them. And caring
about people, particularly those towhom we are not particularly close,attracted or related, is largely a matterof empathy and imagination. I careabout my children because I love themand because they are my children,which motivates me to care for them. Icare about strangers whom I encounterin hospital because I am able toimagine myself or my children in theirsituation. Without this empathicimagination, we have only our trainingand our duty to fall back on. And asthe Francis report (Francis 2013)suggested, when times are tough, forexample when the ward is short-staffedor when we feel exhausted at the endof a long and tiring day, it is too easyto look the other way when we see astranger in distress. What is lacking isnot training and not the ability to per-form technical skills, but the empathyand imagination that a broad and well-rounded education provides.So how can we educate our students
to care about as well as for theirpatients? How can we help them toimagine and identify with the sufferingof others to the extent that they aremotivated to respond to that suffering?Richard Rorty referred to this abilityas solidarity, which he believed couldbe enhanced through the arts, particu-larly through reading novels and otherfictionalised accounts of the pain andsuffering of others. Solidarity cannotbe taught, it can only be learnt; it is tobe achieved not by inquiry but byimagination, the imaginative ability tosee strange people as fellow sufferers(Rorty 1989, p. xvi).Solidarity with those we care for can
also be increased through the study ofthe humanities (history, social geogra-phy, the classics), through anthropology
2014 John Wiley & Sons LtdJournal of Clinical Nursing, 23, 14591460, doi: 10.1111/jocn.12556 1459
and through philosophy (hermeneutics,phenomenology, existential ethics). Thestudy of these subjects is not a distrac-tion from the business of learning tobe a nurse, but a real and genuineattempt to understand the suffering ofothers to place ourselves in their posi-tion. And whilst this might come rela-tively easy to some, many of us requirean education in the humanity of othersthat extends far beyond an understand-ing of their biology, their physiologyand their behaviour. I am not talkinghere about an objective intellectualunderstanding of people in general(although this too is important), but adirect subjective empathic engagementwith individual persons. And for thoseof us for whom this does not comenaturally, what is needed is a broadeducational experience that extendswell beyond the skills of nursing, wellbeyond the theory and research under-pinning those skills, and well beyondmeeting prescribed learning outcomesand demonstrating safe and effectivepractice. I suspect that all of the nursesand most of the care assistants whocontributed to the failure of care atmid-Staffordshire and elsewhere could,if pushed to do so, demonstrate safeand effective care. What was missingwas the imagination and the empathicunderstanding to see the need for it.And as numerous psychological experi-ments have demonstrated, we are allcapable of a dereliction of our duty ofcare which at times borders on themurderous, so there is no room forsmugness or denial.I believe that education is our last
great hope, and that means the studyof issues and subjects that appear tohave little or no relevance to the theoryand practice of nursing, such as litera-ture and the arts, the humanities, theclassics, philosophy, anthropology, the
list is endless. And if there is no timeand space in the current curriculum, wemust find the time and space, even if itmeans extending our nurse educationcourses to four or five years. After all, ittakes seven years to qualify fully as adoctor, so why not also as a nurse?I began this editorial by supporting
the 5Cs of caring: compassion, compe-tence, communication, courage andcommitment. Of these, competenceand communication can be taught; per-haps they can be taught more effec-tively in a clinical setting than in theuniversity. However, compassion, cour-age and commitment cannot be taught,they cannot be translated into learningoutcomes and they cannot be measuredby written assignments. They aremeans rather than ends; they are moralqualities or virtues related to that old-fashioned concept of the good. If weare serious about producing a genera-tion of nurses who are compassionate,courageous and committed, we musteducate them in what it means to begood. As the moral philosopher andnovelist Iris Murdoch tells us, good isconcerned with means rather thanends, with how we act rather than sim-ply with the technical aspects of whatwe do: The Good has nothing to dowith purpose, indeed it excludes theidea of purpose The only genuineway to be good is to be good for noth-ing. (Murdoch 1970, p. 69, myemphasis).That is to say, being a good nurse is
not simply a matter of being good atnursing. Being a good nurse includesbeing technically competent, but itentails far more. How and why we aregood are just as important as what weare good at, and part of the how andwhy is concerned with the capacity tounderstand, imagine and respond tothe suffering of others. So, more educa-
tion rather than less, and educationthat addresses the means as well as theends of nursing, the values as well asthe science, the imagination as well asthe facts. The challenge for our univer-sities is to educate our students to begood for nothing.
Gary Rolfe PhDProfessor of Nursing,College of Human and Health Sciences,Swansea University,Swansea, UKE-mail: G.Rolfe@swansea.ac.uk
Cummings J (2012) High Quality Care for
All, Now and for Future Generations.
Available at: http://www.england.nhs.
(accessed 8 December 2013).
Francis R (2013) Report of the Mid Staf-
fordshire NHS Foundation Trust Public
Inquiry. Available at: http://www.mid
8 December 2013).
Murdoch I (1970) The Sovereignty of
Good. Routledge, Abingdon.
RCN (2013) Willis Commission on Nursing
Education. Available at: http://www.rcn.
on_on_nurse_education (accessed 8
Rorty R (1989) Contingency, Irony, and
Solidarity. Cambridge University Press,
Willis P (2012) Report of the Willis Com-
mission 2012: Executive Summary.
Available at: http://www.williscommis
summary.pdf (accessed 8 December
2014 John Wiley & Sons Ltd1460 Journal of Clinical Nursing, 23, 14591460