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Fawcett J (2007). Nursing qua nursing - the connection between nursing knowledge and nursing shortages
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Fawcett J (2007). Nursing qua nursing - the connection between nursing knowledge and nursing shortages

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  • 1. JAN FORUM Your views and lettersNursing qua nursing: the connection between nursing knowledge and nursing shortagesAlthough it is not a direct response to a particular JAN paper, so hard for prescriptive privileges when pharmacists are the onlythis contribution to JAN Forum focuses on a continuing and healthcare team members with sufficient knowledge to prescribemajor worldwide issue – nursing shortages. Indeed, virtually drugs? Research findings indicate that nurse prescribing isevery nurse leader and every nursing organization worldwide acceptable to patients and is perhaps more patient-centred thanclaims that there is an unprecedented shortage of nurses (Watson physician prescribing, but some questions have been raised about2006). No one, to my knowledge, has claimed that there is not a the adequacy of nurses’ knowledge of pharmacology (Latter &nursing shortage. Noteworthy is that discussions of past, current Courtenay 2004).and projected future nursing shortages do not take into account What, I must ask, are the implications for nursing shortagesthe knowledge needed to be a professional nurse, nor do those of Graham’s (2006) comment that we are ‘slotted [into thediscussions consider a work environment in which nursing paternalistic healthcare system] as medical technician[s] orpractice is based on unique nursing knowledge. handmaiden[s]’ (p. 381) to physicians? What are the implications I am sceptical about shortages of nurses. Indeed, I am not for nursing shortages of Salvage’s (2006) declaration that ‘nursesconvinced that there even would be nursing shortages if what in every continent and from many different cultures complainWatson (1997) calls nursing qua nursing were the focus of that their work is trivialized and undervalued’ (p. 260)? What arenursing practice. However, I do agree that there are global the implications for nursing shortages of Gordon’s (2005) reportsshortages of nurses for the practice of what Watson (1996) calls of the dreadful and punitive conditions nurses endure as theynursing qua medicine. Nurses are, as most of us realize, ‘the practise against the odds? Although Gordon pointed out thatlargest single group of healthcare providers, and they oversee and nursing practice is undermined by healthcare cost cutting,deliver nursing care, which encompasses a significant portion of medical stereotypes and medical hubris, nurses rarely rebel.the care prescribed by physicians’ (Jones & Mark 2005, p. 271). Why do nurses continue to work in such oppressive situations?As Registered Nurses perform so many medical activities, Are nurses, as Anderson (2000) speculated, ‘a culture that valuesnursing qua medicine extends from those activities driven by or at least tolerates being oppressed’ (p. 53)?physician orders for vital signs, dressing changes and medications What are the implications for nursing shortages of Thorne’sto nurse practitioners substituting ‘for a physician in a range of (2005) statement that ‘the relationship between the practice ofpredefined, protocol-driven clinical tasks’ (Halcomb et al. 2006, nursing and the conceptual knowledge that is supposed to drive itp. 377). remains ambiguous and confusing’ (p. 107)? What, especially, We reward the medical activities performed by nurses even are the implications for nursing shortages of Mason andthough we must know that, as Sandelowski (1999) pointed out, Whitehead’s (2003) book, Thinking Nursing, in which not oneat least in the United States of America, such work relieves the chapter was devoted to unique nursing knowledge, because, asdeliberately controlled shortage of physicians, which preserves they claimed, ‘As nursing does not appear to have a uniquetheir market value. Noteworthy is Rayner’s (2003) report that, theoretical body of knowledge specific to itself, it has tradition-in the United Kingdom, ‘nurses are regarded as a key solution to ally drawn upon many other fields of study to provide the basismeet new legal requirements to cut junior doctors’ hours’ (p. 10) of nursing education’ (p. xiii)? Instead, the chapters of their bookrather than increasing the number of physicians. focus on thinking psychology, sociology, anthropology, public Furthermore, Registered Nurses perform activities that I health, philosophy, economics, politics and science – but notbelieve only pharmacists should perform, namely administering nursing science.medications. Nurse practitioners venture even farther into the What are the implications for nursing shortages of the lack ofknowledge territory of pharmacists when they prescribe drugs. unity within nursing about roles and the future? Salvage (2006)Why do nurses insist on administering medications when maintained that ‘Some factions wish to include under the nursingpharmacists could do so? Why do advanced practice nurses fight umbrella anyone who does anything that could remotely beÓ 2007 The Author. Journal compilation Ó 2007 Blackwell Publishing Ltd 97
  • 2. JAN Forumdescribed as nursing…, and want to be all things to all people, providing nursing and complementary healthcare services towhile others see the way forward in a high-powered portrayal of people’ (p. 33)?the advanced practitioner who can, and increasingly does, Will you join me in questioning whether there is a realreplace junior doctors’ (p. 260). shortage of nurses? Will you help me try to find out how much If we do not want to continue to practise nursing qua more time we would have and how fewer nurses would bemedicine, what can we do? What would happen if we declared needed if nursing practice were based only on unique nursingthat there was no shortage of nurses and maintained or decreased knowledge, so that only nursing qua nursing would be practisedenrollment in nursing education programmes? I have thought for by nurses? In conclusion, as long as we continue to practisea very long time that our continual quest for additional students nursing qua medicine, we will have nursing shortages. But, if wein our programmes, as a response to the periodic nursing qua practise nursing qua nursing, we may have enough nurses for allmedicine shortages, has resulted in undervaluing nursing in the people who seek and deserve our services. Clearly, our future liesmarket place. We rush to graduate as many nurses as we possibly in nursing qua nursing.can from the shortest and least professionally focused pro-grammes to flood the market and then wonder why working Acknowledgementconditions and pay do not improve. Do we really think our criesof a global shortage of nurses greater than ever before is the way This article is adapted from lectures sponsored by Epsilon Chito improve our future? What would happen if we insisted on and Rho Psi Chapters of Sigma Theta Tau International.practising nursing qua nursing? Jacqueline Fawcett PhD RN FAAN What, you may ask, is nursing qua nursing? The answer is Professor, College of Nursing and Health Sciences,that nursing qua nursing practice is based on unique nursing University of Massachusetts, Boston, MA, USAknowledge rather than knowledge developed by members of E-mail: jacqueline.fawcett@umb.eduother disciplines. Unique nursing knowledge is evident in themany conceptual models of nursing, the more than 50 middle-range theories derived from just seven of those conceptual Referencesmodels, and many other middle-range theories developed by Anderson C.A. (2000) Undereducated, aging, and… A cycle ofnurses (Fawcett & Garity, in press). Unique nursing knowledge decline? Nursing Outlook 48, 53–54.also encompasses all patterns of knowing – which can be Carper B.A. (1978) Fundamental patterns of knowing in nursing.regarded as types of middle-range theories – including empir- Advances in Nursing Science 1(1), 13–23. Fawcett J. & Garity J. (2008) Evaluating Research for Evidence-Basedical theories, aesthetic theories, ethical theories, theories of Nursing Practice. F. A. Davis Company, Philadelphia, in press.personal knowing and socio-political theories (Carper 1978, Gordon S. (2005) Nursing Against the Odds. How Health Care CostWhite 1995). Think about what would happen if nurses did Cutting, Medical Stereotypes, and Medical Hubris Underminenot perform activities that are driven by physician orders. If Nurses And Patient Care. ILR Press, Ithaca, NY. Graham I. (2006) To the Editor. Nursing Science Quarterly 19, 380–those activities actually are legitimate nursing activities – 381.assessments and interventions – why do physicians write the Halcomb E.J., Patterson E. & Davidson P.M. (2006) Evolution oforders? If the activities really are medical activities, why do practice nursing in Australia. Journal of Advanced Nursing 55,nurses perform them? What would happen if nurses practised 376–390. Jones C.B. & Mark B.A. (2005) The intersection of nursing andnursing conceptual model-based, nursing theory-guided nursing health services research: overview of an agenda setting conference.and collaborated with the people who seek our services to Nursing Outlook 53, 270–273.write orders for nursing care? Latter S. & Courtenay M. (2004) Effectiveness of nurse Graham (2006) called for nurses to ‘find their voice and prescribing: a review of the literature. Journal of Clinical Nursing 13, 26–32.participate in the debate on what professionalism… is all about Mason T. & Whitehead E. (2003) Thinking Nursing. Opento influence and stop the creation of medical somethingness’ University Press, Maidenhead, Berkshire, England.(p. 381). Will you find your voice and stop practising nursing qua Milton C.L. (2007) Information and human freedom: nursingmedicine? Will you begin to practise and support nursing qua implications and ethical decision-making in the 21st century. Nursing Science Quarterly 20, 33–36.nursing? Will you join Milton (2007) in declaring, ‘[T]he practice Rayner F. (2003) Are nurses ready to take over junior doctors’ roles?of nursing ought to be guided by discipline-specific schools of Nursing Times 99(36), 10–11.thought that include nursing theoretical frameworks, principles Salvage J. (2006) More than a makeover is needed to improveand concepts. Members of the discipline should be expected nursing’s image. [Invited editorial]. Journal of Advanced Nursingto demonstrate knowledge of the theory in practice when 54, 259–260.98 Ó 2007 The Author. Journal compilation Ó 2007 Blackwell Publishing Ltd
  • 3. JAN ForumSandelowski M. (1999) Venous envy: the post-World War II Watson J. (1997) The theory of human caring: retrospective and debate over IV nursing. Advances in Nursing Science 22(1), 52– prospective. Nursing Science Quarterly 10, 49–52. 62. Watson J. (2006) Can an ethic of caring be maintained? [InvitedThorne S. (2005) Conceptualizing in nursing: what’s the point? editorial]. Journal of Advanced Nursing 54, 257–259. Journal of Advanced Nursing 51, 107. White J. (1995) Patterns of knowing: review, critique, and update.Watson J. (1996) Watson’s theory of transpersonal caring. In Advances in Nursing Science 17(4), 73–86. Blueprint for Use of Nursing Models: Education, Research, Practice, and Administration (HintonWalker P. & Neuman B., eds.), NLN Press, New York, pp. 141–184.Ó 2007 The Author. Journal compilation Ó 2007 Blackwell Publishing Ltd 99