the 46th patricia chomley memorial oration 2012 - Royal College of ...

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Nursing’s legacyMadam President, distinguished guests and colleagues. It is a particular honour to have beeninvited to present what will be, given the amalgamation of the two nursing colleges, the finalPatricia Chomley Memorial Oration for the Royal College of Nursing, Australia. What an eminentlysensible legacy to hand on to the following generations of nurses – a single national professionalorganisation!As in any year, this year (2012) has some major anniversaries to celebrate. Some of these are ofparticular interest and/or importance. The Queen for example has reigned over us for 60 years, whileMawson and his men traversed Antarctica 100 years ago. Quite different achievements but both haveleft or will leave a significant legacy. Terms such as ‘dedication’ and ‘tenacity’, among others, spring tomind.In a recent program on Mawson and his team’s achievements, the commentator remarked: “The menhave gone but Mawson’s hut remains and so their legacy lives on”. 1 Does Australian nursing have asymbolic ‘hut’? If so, are we tending that legacy so it survives? Is it even a legacy that should survive?Is it rhetoric or reality, or a mix of both? There are some in the profession who argue any efforts wehave made, if we made an effort at all, in this regard have been a dismal failure. Kieseker’s recentblunt assessment was that “after being central to the wellbeing of Australians for 200 years, nurseshave failed to make a mark”. 2, p.11 Others are more positive but whether we, as a national group, couldvery confidently say that we are perceived as having made a significant contribution to this country isa moot point. I wish to explore these and other related issues tonight.What might we place in nursing’s symbolic ‘legacy hut’? I obviously have some suggestions whichI will present in no particular order; you may well have some other ideas. I should also at this pointindicate the context in which my more recent observations of what was and is happening in nursinghave been made as this inevitably influences my thoughts on this topic. Over the last 12 years Ihave been, in some ways, on the sidelines of nursing. In the eight and half years I spent in universitymanagement, only one day a week was assigned to being a nursing academic (and that was usuallySundays). I then spent another two years full time in the School of Nursing and Midwifery beforefinally retiring, only to pop up again in an adjunct position. The decision to share this aspect of mypersonal history with you was generated by a point made by a fellow orator one year ago. She was ofthe view that nurses who take up positions that lie outside nursing, such as university managementroles or participation “in medical research of uncertain relevance to nursing … should not beautomatically endorsed by us as representative of our profession”. 3, p.18 A quote from another source,with one addition, that is ‘men’, and one substitution, that is ‘senior university managers’ for ‘doctors’,also resonated. This is from Helmstadter discussing nursing leadership at the end of the 19th century:4 RCNA The 46th Patricia Chomley Memorial Oration 2012
OrationRCNA“... the compromise on nursing education these women made with the doctors in order togain rank and a higher social station placed them in an impossible position in terms of their4, p.189professional aspirations, leading them into all kinds of inner contradictions.”These two statements led to some reflection on my part but my conclusion was that nursing hasalways been absolutely core to me and that my experience as a nurse, in a somewhat uniqueposition as executive director of university planning, may well have provided me with someuseful insights that I could contribute to the debate. I will leave it up to you to decide whether myobservations have any degree of credibility.What immediately comes to mind is the significant numbers of educated individuals nursing hasprovided Australia with. I am not confining this legacy just to the period from the advent of tertiaryeducation for nurses 38 years ago – as an aside you will note that we are edging ever closer to halfa century here. The foundations of this legacy were put in place by a small number of nurses whowent to the UK to study for qualifications in nursing education and administration, then built onby the College of Nursing era here in Australia – the oft quoted 600 graduates in Patricia Chomley’sera and many more after that. Add to that the recipients of the Kellogg Foundation scholarshipsfor study in North America in the 1980s. Then there are the nurses who gained higher degrees innursing overseas and/or university qualifications in other disciplines both before and after the adventof postgraduate nursing degrees. Finally there are those who educated themselves, in spite of theconstraints of their training. 5 Not bad for nice, kind girls (and boys) who didn’t need to be bright.The impact of tertiary nursing education in this respect is most evident in the number enrolling inuniversity at undergraduate level once the transfer was completed. The most recent figures available– 2009 – for domestic students enrolled in courses leading to initial registration as a nurse were 33489, an increase of 6.5% for females and 5.3% for males from the previous year. 6 Many of these wouldbe the first in their family to have gone to university. Nursing enrolments would also have made asignificant contribution to the situation whereby women now make up more than half of universityenrolments – 55.6% in 2010. 7But are these undergraduate students actually being educated? Judging by the content of a numberof articles in our national journals, 8, 9, 10, 11 this is a very pertinent question. I do not intend to enterinto a philosophical discussion here on what constitutes ‘education’. Suffice it to say that the goalof those whose vision it was to have all registered nurses graduate with a degree argued for thisrevolutionary change on the basis that, in order to provide effective and appropriate nursing care inthe future, nurses needed to have, among other abilities, a solid and current knowledge base across anumber of relevant discipline areas, critical analysis skills and the ability to apply knowledge and skillsmeaningfully to their practice. Are we achieving that? A number would say ‘no’.The 46th Patricia Chomley Memorial Oration 2012RCNA5
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