nursingforsocialjustice

I recent weeks I have been thinking more about the difference between the profession of nursing and it encompasses and the the discipline of nursing. One relates to the other but they are distinct. I have been thinking more about how disciplines like archeology, geology, perhaps even psychology have those who are educated within the discipline who become licensed professionals with a specific designation and work in the field within the standards set by their regulating body, while also having academics in their discipline doing research, also working on projects, developing the epistemology (ways of knowing) of the discipline, developing the science. And I wonder, is that the future of nursing? Nursing is based in practice, yes, but does that mean that to be a nurse one has to practice in direct care? And this takes me back to the question of what is the understanding of nursing amongst practicing nurses? We have a commonly accepted meta-paradigm (person, health, environment, nursing). And we accept that nursing wasn’t a thing that someone invented with modern nursing (ie Florence Nightingale) but is the understanding of that at the level of academia and within higher education translated in a way that embraces and accepts a diverse understanding of nurses?

One shift at work a few years ago I was working with a fairly new grad nurse. We were talking about nursing and they said something to the effect of “I didn’t need a degree to do this job”. And they were firm in that belief. Further evidence provided was that they worked with someone in a previous health area, prior to be a regulated health professional with an internationally trained regulated professional that falsified their credentials (I believe they might have used a relatives) and became licensed to practice and for years no one knew. My heart sunk a bit. Looking back, I think the limitation on that nurses perception on nursing was due to the limitations of the specific sites that they worked in, their understanding of nursing, the lack of post-graduate education and training that is nursing specific and the place of nurses within that team but also within that health service. Looking back, that health organization is still stuck on a very limited understanding of nursing as a discipline and nurses as autonomously professional practitioners. And so, in many ways it is stuck in a pre-degree entry to practice, pre-university based education era. The organization is stuck in a medical model, a restriction of nursing as a discipline. While managers and administrators might be nurses, that does not mean that are advocating for nursing or helping to shape the discipline of nursing as it is connected to day to day nursing practice. This is a huge disconnect for mental health nursing and a huge conceptual challenge for me as I am moving forward with research on the history of psychiatric nurse education in BC.

I get more and more stuck on the historical context of the separation of general nursing and psychiatric nursing. Conceptually, the designation of general nursing is all types of nursing (including mental health nursing) and psychiatric nursing limits the places of practice for those with the designation. There is not peer reviewed research taking a deep dive into what the distinctions in education, training, and practice are. Many assumptions are made that there are tangible differences. The belief is strong that practically there is a difference, despite entry-level to practice for general nurses and psychiatric nurses qualifying them for the same mental health service nurse positions.

The education streams are for the most part separated despite the philosophical underpinnings and theoretical models of psychiatric nursing coming from general nursing. The separation of the professional designations meets a need. Historically (and perhaps ongoing today), nursing students do not choose mental Heath as their first pick for post-grad work. I did. But many do not. So, a captive audience is maintained in keeping a separate designation that is limited to certain programs and worksites. A workforce need is met. But, as nursing as a discipline moves forward it becomes tougher to maintain this mind/body dichotomy. Nursing problems and nursing questions are relevant to all nurses, inclusive of the mental health ones. And, does it make sense that there are two designations, one for the mind and one for both? This term “general nurse” is an outdated term when there were not many speciality areas of nursing. Is an occupational health nurse a general nurse? Is a informatics nurse a general nurse? Is an mental health nurse a general nurse?

At the bottom, is the way that a nurse educated in a psychiatric nurse program moves through the world and understands the nurse meta-paradigm different than a nurse trained in a undergraduate nurse program? I don’t know and I don’t think formal research has been done to demonstrate either conclusion. I think about this a lot lately. Is my personal nurse philosophy different than a colleague who is an registered psychiatric nurse because of our professional designation? I don’t know. But I suspect the division perpetuates stereotypes and stigma.

Peace,

Michelle D.