3.1 Introduction
Chapter one presented a history of nurse training/education and summarised the journey nursing has taken up to and including the move into higher education institutions (HEIs) in the late 1990s. Chapter two presented, through the device of a dramatized debate, some key arguments for and against the move to an all graduate entry to nursing. As discussed in chapter two, the move was seen as significant and did not meet with universal approval. Those in favour of the move highlighted amongst other positive impacts, the continued development of nursing, including its strive for a professional knowledge base. The undergraduate student nurse undertaking a degree in nursing in the United Kingdom (UK) is at the very heart of this development and, one may argue, will play a pivotal role in it. For this reason, the ‘undergraduate student nurse’ was central to the conceptual framework for this study (Figure 3.1). Theories linked with the framework include Situated Learning Theory (Lave & Wenger, 1991) and Social Learning Theory (Bahn, 2001; Bandura, 1971 and 1977), as well as an approach to understanding professional knowledge developed by Winch (2013 and 2014), considering the ‘Sociology of professional knowledge’ suggested by Young and Muller (2014). This chapter presents the conceptual framework. The concept of the move to an all graduate entry to nursing is multifaceted and this framework does not set out to present all possible facets. The scope of the study led to the development of the conceptual framework rather than identifying a theory or theoretical framework that would provide the necessary guidance for the study.
3.1.1 What is a profession/professional?
Defining what a ‘profession’ is, and therefore what a ‘professional’ is can be difficult. Within the sporting arena, being a professional seemingly entails being paid for what you do; an ‘amateur’ being one who does not earn a living from their chosen sport. It may be that to be professional is to be considered an ‘expert’ or one who does a particularly good job (Cribb & Gewirtz, 2015).1 Friedson (2001) focuses much of his attention on ‘professionalism’ which he suggests exists when an organised occupation gains the power to determine for themselves who is qualified to perform a set of tasks defined by the occupation, sets the criteria by which performance in undertaking these
35 tasks should be judged, and prevents ‘others’ from undertaking these tasks. The use of the term ‘task’ is interesting here and hints at ‘mastery’ of particular skills; an emphasis on the practical.
3.1.2 Is nursing a profession?
The struggles that nursing has had and continues to have regarding academic and professional recognition are well documented (McNamara & Fealy, 2014) and are multifactorial. In writing a definition for nursing, the Royal College of Nursing (RCN, 2014) indicate that nursing could be viewed as an activity, an occupation, a profession or a discipline. Writing from a historical perspective, Bradshaw (2001b) suggests that as nursing developed through the nineteenth and twentieth centuries it was considered as being both a vocation and a profession, the ‘profession’ element being rooted in the word ‘profess’ as an outward demonstration of an inward conviction. Bradshaw (2001b) includes a quote from Florence Nightingale where she uses the terms ‘profession’ and ‘my calling’ synonymously. The publication of the Briggs Report in 1972 introduced the idea of a new professional status for nursing, proposed mainly through changes in how nurses were prepared for registration; education not training (see Chapter 1). Although it took seven years for some recommendations from the Briggs Report (1972) to be implemented (as part of the 1979 Nurses, Midwives and Health Visitors Act), the report and subsequent Act signalled a move away from the ‘apprenticeship’ and ‘vocational’ approach to nurse training and perhaps led to a change in the definition of ‘profession’ as applied to nursing. The Nursing and Midwifery Council’s (NMC, 2015) ‘The Code’ is subtitled as ‘Professional standards of practice and behaviour for nurses and midwives’ and includes the statement, “This commitment to professional standards is fundamental to being part of a profession,” (NMC, 2015, p.2). Does following a set of ‘standards’ and acting ‘professionally’ define an occupation as a ‘profession’, or do these standards just promote ‘doing a job well’? Cribb and Gewirtz (2015) indicate that these are, at least historically, some of the ‘traits’ of a profession but there are also important social roles and expectations that should be considered. Fenwick and Nerland (2014, p.2) acknowledge that the term ‘professional’ is both problematic and highly debated, but do conclude that a professional is,
36 [A member] of any occupational group, usually committed to public
service, that defines itself as collectively sharing particular knowledge and practices, and that is publicly accountable for its service.
Although there is ongoing debate regarding the strength and uniqueness of the ‘particular knowledge’ of nursing, this definition would suggest that nursing is a profession and supports the stance taken in this study. The RCN (2014, p.10) suggest,
Professional practitioners (the doctor, the nurse, the lawyer) use their knowledge to identify and understand the problems presented by the client and to identify ways of solving them. The professional’s knowledge base includes some knowledge that is shared with other people, but also includes discipline-specific knowledge about the particular conditions or problems which constitute the discipline’s ‘phenomena of concern’ and the particular interventions that can be used to overcome them. This is the profession’s particular domain – their particular expertise, or what they know about.
This statement too supports the view that nursing is a profession and outlines, at least in part, some discussion on the relevant ‘knowledge base’.
Figure 3.1 outlines the conceptual framework for this study. It acknowledges key influences on the undergraduate student nurse and a number of ‘expected outcomes’. These influences and expected outcomes will be explored in more detail.
37 Figure 3.1: Conceptual framework – All graduate entry to nursing
Attitudes and Expectations Professional Knowledge and
learning
(Winch, 2014; Young & Muller, 2014)
Situated Learning
(Brown, Collins & Duguid, 1989; Lave & Wenger,
1991)
Social Learning Theory
(Bahn, 2001; Bandura,1971 and 1977)