Freedom and Responsibility
D
URING THE PAST FEW YEARS, my family and I have hosted several young European visitors. It would border on trite to say that we have learned much from each other. A recurring theme in those visits has been our freedom, as well as freedom’s partner, responsibility. That theme, so evident in a changing world, may apply also to the nursing profession. Freedom is perhaps most appreciated in its absence. It has been conspicuously absent in many parts of the world in this century. People still die seeking it for themselves and their children. Entire populations choose starvation over domination. The cry for freedom is worldwide, even if ill defined. Freedom is understood only through experience. Seeing someone first feel freedom is poignant and heartrending. The overwhelming elation derives not just from the joy of the present, but also from hope for the future. Some of our young visitors have had their joy and hope turn to frustration. Freedom requires decisions. Decisions have consequences and personal accountability. Order and control are no longer the responsibility of distant and omnipotent authorities; each of us has personal and societal obligations. A long process of personal and societal maturation, including a considerable level of public education, is necessary for the exercise and survival of freedom. Developmental theories help us to understand the transition from dependence and domination to freedom and responsibility. Basic building blocks for autonomous action are self-identity, the capacity for intimacy, and a sense of independent being. Tyranny precludes the development of a sense of self; fear and ignorance prevent intimacy and independence. Freedom and responsibility are issues for many people in the world today. They are basic to many women’s issues. They are central to the struggle of nurses for recognition and autonomy. Some of the same principles and processes in the search for freedom throughout the world pertain to us in nursing. Nursing has been front-page news for several years because of the national shortage of nurses. Salaries and work-
SUE T. HEGYVARY, PHD, FAAN Profeessorand Dean Schooi of Nursing University of Washington T-3 I8 Health Snences Center. SC-72 Seattle, WA 98195
Copyright 0 1991 by W.B. Saunders Company 8755-7223/91/0701-0007$3.00/O
8
Journal
ing conditions have been a major focus. Nurses also have pointed out their inappropriate exclusion from decisions about care, both in sickrooms and in boardrooms. The cry for autonomy-freedom-has pervaded strikes, surveys, and editorials. I don’t disagree with those points, and have said those words myself. But we now are at a point of having had public attention longer than anybody usually gets frontpage coverage. We must assess what has happened to us as an occupational group, what we want, and what responsibility we are prepared to assume in health care. Like many other populations, we have subgroups with different identities and aspirations. As education has equipped a subgroup of nurses for greater responsibility, with a better understanding of the world in which they work and live, their self-identity has developed more toward that of the “professional’‘-a client orientation, longitudinal responsibility, individual accountability for decisions, and an advanced knowledge base unique to those responsibilities. Education is not the only relevant variable, but professional behavior requires a high level of education. Another subgroup within the nursing population has quite a different identity, that of hired worker for a shift, with a spoken dislike for longitudinal responsibility. These are valuable and greatly needed people in health care institutions. But with identity and aspirations focused on self as a dependent worker specific to task, time, and space, this subgroup by definition does not and will not have autonomy. These two subgroups, and likely some in between, represent different world views and desires for the future. Nursing has made attempts, but it still has a reluctance to subdivide itself for fear that some may feel regarded as lesser citizens. We have a problem with “equality,” confusing individual worth as persons with uniformity of roles and capabilities. Nursing’s lack of planned and legitimated differentiation is a variation on the theme of the classless, dependent society. The current cry for freedom, independent action, autonomy, and self-governance puts us on the line. Like our visitors tasting freedom, we have to decide how much responsibility and accountability we will shoulder, as individuals and as a professional group. Then we have to be willing to pay the price to exercise that freedom. The analogy of political and societal freedom, like all analogies, has limitations. But we can learn some valuable lessons from the world of the past few years. First, we have to make the choice ourselves. Second, we win freedom not simply by saying we deserve it. And third, we live with the consequences. May we, like others we observe, have the guts to do what we say must be done.
of Pvofesssional Nursing,
Vol 7, No
1 Uanuary-February),
199 1: p 8
D
URING THE PAST FEW YEARS, my family and I have hosted several young European visitors. It would border on trite to say that we have learned much from each other. A recurring theme in those visits has been our freedom, as well as freedom’s partner, responsibility. That theme, so evident in a changing world, may apply also to the nursing profession. Freedom is perhaps most appreciated in its absence. It has been conspicuously absent in many parts of the world in this century. People still die seeking it for themselves and their children. Entire populations choose starvation over domination. The cry for freedom is worldwide, even if ill defined. Freedom is understood only through experience. Seeing someone first feel freedom is poignant and heartrending. The overwhelming elation derives not just from the joy of the present, but also from hope for the future. Some of our young visitors have had their joy and hope turn to frustration. Freedom requires decisions. Decisions have consequences and personal accountability. Order and control are no longer the responsibility of distant and omnipotent authorities; each of us has personal and societal obligations. A long process of personal and societal maturation, including a considerable level of public education, is necessary for the exercise and survival of freedom. Developmental theories help us to understand the transition from dependence and domination to freedom and responsibility. Basic building blocks for autonomous action are self-identity, the capacity for intimacy, and a sense of independent being. Tyranny precludes the development of a sense of self; fear and ignorance prevent intimacy and independence. Freedom and responsibility are issues for many people in the world today. They are basic to many women’s issues. They are central to the struggle of nurses for recognition and autonomy. Some of the same principles and processes in the search for freedom throughout the world pertain to us in nursing. Nursing has been front-page news for several years because of the national shortage of nurses. Salaries and work-
SUE T. HEGYVARY, PHD, FAAN Profeessorand Dean Schooi of Nursing University of Washington T-3 I8 Health Snences Center. SC-72 Seattle, WA 98195
Copyright 0 1991 by W.B. Saunders Company 8755-7223/91/0701-0007$3.00/O
8
Journal
ing conditions have been a major focus. Nurses also have pointed out their inappropriate exclusion from decisions about care, both in sickrooms and in boardrooms. The cry for autonomy-freedom-has pervaded strikes, surveys, and editorials. I don’t disagree with those points, and have said those words myself. But we now are at a point of having had public attention longer than anybody usually gets frontpage coverage. We must assess what has happened to us as an occupational group, what we want, and what responsibility we are prepared to assume in health care. Like many other populations, we have subgroups with different identities and aspirations. As education has equipped a subgroup of nurses for greater responsibility, with a better understanding of the world in which they work and live, their self-identity has developed more toward that of the “professional’‘-a client orientation, longitudinal responsibility, individual accountability for decisions, and an advanced knowledge base unique to those responsibilities. Education is not the only relevant variable, but professional behavior requires a high level of education. Another subgroup within the nursing population has quite a different identity, that of hired worker for a shift, with a spoken dislike for longitudinal responsibility. These are valuable and greatly needed people in health care institutions. But with identity and aspirations focused on self as a dependent worker specific to task, time, and space, this subgroup by definition does not and will not have autonomy. These two subgroups, and likely some in between, represent different world views and desires for the future. Nursing has made attempts, but it still has a reluctance to subdivide itself for fear that some may feel regarded as lesser citizens. We have a problem with “equality,” confusing individual worth as persons with uniformity of roles and capabilities. Nursing’s lack of planned and legitimated differentiation is a variation on the theme of the classless, dependent society. The current cry for freedom, independent action, autonomy, and self-governance puts us on the line. Like our visitors tasting freedom, we have to decide how much responsibility and accountability we will shoulder, as individuals and as a professional group. Then we have to be willing to pay the price to exercise that freedom. The analogy of political and societal freedom, like all analogies, has limitations. But we can learn some valuable lessons from the world of the past few years. First, we have to make the choice ourselves. Second, we win freedom not simply by saying we deserve it. And third, we live with the consequences. May we, like others we observe, have the guts to do what we say must be done.
of Pvofesssional Nursing,
Vol 7, No
1 Uanuary-February),
199 1: p 8
