Subjective and objective histories of nursing in the academy: the importance of marking time In 2012, Cardiff University, Wales, UK celebrated 40 years of providing undergraduate and post-graduate nursing education. Marking the event, Professor Christine Chapman, the nurse academic who led the first programme and established Cardiff as a centre of repute, spoke about her first days of arriving at Cardiff University. Due to the University’s decision to move ahead quickly, once the decision had finally been taken, Professor Chapman found herself without a desk or an office on her first day as she assumed the task of guiding the first group of students through their first year as ‘degree nurses.’ In this paper, one the earliest degree students at Cardiff (KG, herself now a Professor of Nursing) shares memories and writes with one of the current Professors at Cardiff about the importance of marking the passage of time. History reveals the enduring nature of the debate about the place of nursing in the academy, but also reminds us to consider new challenges in the present day. In The Sense of an Ending, Julian Barnes (2012) writes: ‘I know this much: that there is objective time, but also subjective time, the kind you wear on the inside of your wrist, next to where the pulse lies. And this personal time, which is the true time, is measured in your relationship to memory.’ When looking back in the manner in which nursing took its place in the oldest university in Wales, both types of memory have a role to play. The first may be considered ‘objective memory’ from historical documents such as letters and records of meetings. These reveal the desire to emulate the strong academic departments of nursing that had already been established at Edinburgh University in 1956 and Manchester in the late 1960s. Letters from the early 1960s between Miss Eileen Rees, the Matron of Cardiff Royal Infirmary and Professor Mushin of the Department of Anaesthetics at Cardiff Royal Infirmary reveal that he had been to the USA, had encountered Graduate Nurses there and, with the assistance of Principal Tutor, Miss Miriam Gough, drove the idea forward. The earliest correspondence to be identified in the archive is from 1 December 1964 with notes about a working party © 2014 John Wiley & Sons Ltd
being scheduled to meet in the Boardroom of the Cardiff Royal Infirmary. At this meeting, Misses Curtis and Jones, headmistresses of Lady Margaret and Cardiff High School for Girls, had been invited to ‘deliberate on the entry requirements for girls attracted to a Degree Course in Nursing’. When ‘the girls’ had been asked about their interest in different careers, 25% were thought to favour teaching, a variable number suggested medicine and the arts, and only 6% opted for nursing. However: The Chairman, after thanking Misses Curtis and Jones stated that there was apparently a supply of suitable recruits and the views of the headmistresses would be of great help when considering entrance requirements.
A drop in the level of correspondence thereafter, however, suggests that it took another 8 years to make the nursing degree course a reality. During the intervening years, there are several letters between various parties that do help reveal some of the politics of the day. For example, a benefactor had to be identified as no funding from Cardiff University or the NHS was forthcoming. Eventually, the local financier Sir Julian Hodge agreed to supply funds. A willing department was found in the Welsh School of Medicine to host the fledgling school of nursing and the first students were recruited in 1972. Thereafter, the discipline of nursing, and later midwifery, were to be secured in Cardiff University. All students from the first cohort attended the 40th anniversary event last year. Writing about historical events, however, sometimes fails to capture the more subjective dimensions of events. Using Julian Barnes’ notion of subjective memory, I (KG) was amongst those who witnessed these events and the qualities of these early and pioneering champions of nursing as an academic discipline. The first cohorts of students who started the Bachelor of Nursing programme in the early 1970s were indeed pioneers. Many of those we encountered in clinical practice were both curious and sceptical about our future place in the profession. Luker (1984) describes the early experiences of undergraduate student nurses in the UK in terms of the ‘burden of being different’. We did indeed sense our difference from student nurses undertaking 241
what was essentially an apprenticeship model of nurse training. We wore a different uniform, clinical placements were educationally focused rather than service-driven, we were supernumerary to ward staff until the final year with the result that we constantly had to explain and justify our position to nurses, doctors, and patients. However, there were clear champions for the cause, although different supporters held different views of our future. The faculty of the small department of nursing shared a vision of graduates advancing the practice of nursing and becoming the nurse leaders of the future. Supportive medical staff saw the potential for nurses to advance to careers at the interface with medicine; for example, the Professor of Anaesthesia at the time enthused about our future potential as nurse anaesthetists. In contrast, some senior clinical nurses and managers envisaged graduates fast tracking into management roles. Our ‘difference’ was also exemplified in the pioneering undergraduate curriculum. Many of the reforms introduced into nurse education in the UK from the 1990s onwards were prominent features of our programme in the 1970s. We were introduced to the theory underpinning nursing practice (in the early 1970s, it was the Nursing Process) and the small but emerging nursing research base, we undertook a common foundation, which exposed us to adult, mental health, and children’s nursing, as well as midwifery, we studied a curriculum that focused on health along the life cycle and not merely disease; we learnt to practise nursing in community and hospital settings; we engaged in inter-professional learning alongside medical students, but above all, we were challenged to develop a critical and questioning approach to nursing practice. Whereas this formative education experience equipped the early graduate nurses from Cardiff with a robust knowledge base to underpin practice, it also engendered an enduring commitment to the fundamental caring components of nursing and to enhancing patient well-being and experience of care. This brings us to the present day. Nursing’s place may now seem secure in the academy, but it remains a somewhat precarious relationship. The Willis Commission recently reported favourably on the place of university education for the nursing workforce in the UK (The Royal College of Nursing 2012). It found no evidence that academic education was less likely to produce nurses with interest and skills in clinical nursing – similar criticism faced by the Cardiff University nursing students of 40 years ago. However, more
troubling problems are facing nursing as it struggles to cope with negative findings of cruelty, neglect, and apparent indifference of staff at Mid Staffordshire NHS Trust (Department of Health 2013). Whatever went wrong there should be a lesson for the objective memories of those of us looking at events from the outside, but such events will remain a subjective memory for families who endured poor care, on a scale that is hard to comprehend. Looking back to the challenge of establishing excellent opportunities for intelligent and caring young people to read nursing at Cardiff University in 1972 therein is a reminder of the values of nursing pioneers who had dared to think the unthinkable. Now more than ever, in the United Kingdom at least, nursing seems in need of new thinking. Courageous and innovative ways are needed to capture what is best about nursing practice, as well as research and education that will show its worth as a vehicle for promoting humane care based on values of social justice. History shows repeatedly what can be achieved against the odds and the present generation faces its own challenge: to create a new history that will be told of nursing in the early 21st century of which we will all be proud. Daniel Kelly1 and Kate Gerrish2 1
Daniel Kelly MSc PhD RN Professor Royal College of Nursing Chair of Nursing Research, Cardiff University, Cardiff, UK e-mail: [email protected]
Kate Gerrish MSc PhD RN Professor of Nursing University of Sheffield & Sheffield Teaching Hospitals, Sheffield, UK e-mail: [email protected]
References Barnes J. (2012) The Sense of an Ending. Vintage, London. Department of Health (2013) Francis Inquiry: Independent Inquiry into Care Provided by Mid Staffordshire NHS Foundation Trust January 2005–March 2009. Department of Health, London. Luker K. (1984) Reading nursing: the burden of being different. International Journal of Nursing Studies 21(1), 1–7. The Royal College of Nursing (2012) Quality with Compassion: The Future of Nursing Education. Report of the Willis Commission on Education 2012. RCN Publishing, London.
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