Consequences for the profession and practice?

As argued by Fairclough and Fairclough (2011) critical social science seeks causal explanations of the normalisation (- it is becoming normal for nurses to be graduates), as well as pervasiveness and endurance within populations, of particular beliefs and concerns, for example historically that nursing is a vocational calling and not an academic discipline. It seeks to explain them in terms of the structures of material and social relations of particular forms of social life, with such questions as: Why do these particular beliefs and concerns endure over long periods of time? Why do they have powerful resonance for a great many people? Why are they so little challenged? What effects do they have on continuities and changes in social life?

It would be difficult to argue against the fact that Capitalism has transformed society including a restructuring between the economic, political and social and

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that governments on different scales, social democrat as well as conservative and liberal have embraced ‘neo-liberalism’ and the associated restructuring and rescaling of social relations in accord with the demands of capitalism with welfare states impacted by the effect of markets (Fairclough 2010). As a result and as Ball (2003) has argued there is a process of ethical re-tooling occurring in the public sector which is replacing client need and professional judgement with commercial decision-making. The space for the operation of the autonomous ethical codes based in shared moral language is colonised or closed down as the policy technologies of market, management and performativity leave no space for an autonomous or collective ethical self (Ball 2003). Neoliberal (‘globalized’) common sense assumptions about effective management and modernisation produce ‘hollowed out’ terms like ‘client’, ‘customer’, and ‘stakeholder’, that apparently require no further scrutiny or elaboration and concepts that once were central to the organisation of public life like equality, justice and professionalism, are removed as they indicate ideological positions (Ozga and Lingard 2007). The ‘achievement’ that grows out of the internal goods of motivation to improve, and which follows recognition and mutual deliberation of purpose, is replaced by the external imposition of quantifiable targets (Ranson 2007). The relative autonomy of the logics of practice of social fields (Bourdieu 1990) such as the profession of nursing is absorbed as a subset of economic policy. Professional discourses seem increasingly to be colonised from without – by managers, policy-makers and media and now for nurses through new professional standards that require academic qualification and a rigorous focus on quality assurance, evidence based practice and other elements of the positivist scientific paradigm.

As referred to previously, Bourdieu describes education as a means of cultural reproduction and therefore both one of the resources and one of the weapons in the struggle for and against economic and political hierarchy, and domination (Bourdieu 1988). Science and the use of scientific (evidence based) approaches is a powerful form of capital. Thus the move to an all graduate nursing profession can be seen as more than simply recognition that nurses need ‘better’ education and more of a culturally significant artefact- as a battle in cultural production, with important repercussions therefore in economic, political

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and importantly professional and personal terms (Hayes 2010). With pedagogic agency is the capacity to inculcate meaning through education, which can be argued as the mainstay of the process of imposition of cultural arbitrary, reproducing power relations which effectively rewrite their own operations. My conclusion to the primary research question has to be therefore yes, but with the caveat that nursing is not one homogenous being. There are pockets of resistance to this re-engineering and further research would be required to explore this resistance and to question whether nursing can (or should) maintain its bedside caring role in the social, economic and political context. This is the main implication of the research for the profession and was very eloquently voiced by one of the research subjects (P3 Day 16, 1635) who engaged with the RCN Discussion Zone debate:

‘The fundamental questions that the profession fails to address is what is the role of the nurse, and what education and training does she (or he) require to prepare them for that role; and what is the role of the nursing support worker, and what education and training does she (or he) require to prepare her for that role.’ nursing and the other healthcare professions have evolved and that the current role, whilst retaining some features of the old role, encompasses additional roles and responsibilities. This is probably true, but the profession continues to operate as if the word nurse still means what it always meant, whilst expecting practitioners to engage in the new role and for the patient and general public not to notice any difference. It is not possible to consider the role of the nurse without also considering the role of the nursing support worker. Nurses still struggle with the concept of nursing, and the relationship between being a nurse and being practitioner of nursing.………..The profession (if profession it is) needs to get to grips with the concept of nursing as an academic study, and as a professional practice, and what nurses are, or should be, and what support workers are or should be. Only then can the serious issues o recruitment, education and training, and retention be addressed in a meaningful way’.

165 8.4 Revisiting the Research Methodology

I believe that the methodology chosen for obtaining and analysing the data in this thesis has worked effectively to offer answers to the research questions. The examination of professional and policy text and the analysis of the online data using a CDA approach assisted my understanding of the area being researched. The choice of texts to examine took a great deal of careful consideration and my decision to look at a presentation of policy or position through the publication of a letter or preface to the actual documents resulted from careful consideration of the intent of the research, the practical necessity to narrow the potential number of texts down, a requirement on myself to look at texts with similar intent and a belief that the presentation of policy and professional intent through these documents in itself offered a specific type of medium through which the discourse I wanted to examine was revealed. It is the presentation of policy (political and professional) to an audience….the practical reasoning.

The adoption of a three layered approach to the CDA worked to give a level of complexity to the analysis which added robustness to the interpretation but that did not enable me to completely avoid times of concern regarding my approach and questions such as: Was this still CDA? was the critical linguistics systematic enough and presented well?, did the practical reasoning make sense?; and importantly was the method used actually becoming the focus of my enquiry rather that the research question? The understanding (understanding, as I am reluctant here to use the word conclusion as this denotes something fixed and unchanging), reached though through various iterations of the interpretation and presentation of the data has however has overcome those concerns. My positionality however insists that this was not the only way to address the research questions. The adoption of different methods of data generation and analysis may have led a different researcher to draw similar or different interpretations of the educational field of nursing, but the position reached through this thesis is a valid one.

This validity is based on acceptance of ‘knowledge’ as constructed on interests and values (Hammersley 2008) and therefore by using different methodological

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and theoretical approaches. As a researcher I presented a theoretical and methodological basis for my approaches and created and justified a method of data generation and interpretation to expose the cultural world by using an approach to critical discourse analysis. Research as knowledge creation is in itself a form of discourse based on the value of achieving degrees of mutual understanding. Because I fully acknowledge that any idea that it is possible to produce a stable genuine and complete representation of the social world is simply an illusion and/ or a rhetorical strategy designed to secure power by claiming expertise (Hammersley 2008), I must also acknowledge though that my research merely reflects one interpretation of the various layers of social ‘realities’ that exist. These realities exist within the constructed nature of the society in which we live and are the product of social political and cultural formations (Jaworski and Coupland 1999). In researching the social world which people are already interpreting and acting within (May 1997) I am merely adding to that interpretation and action. However through the use of a reflexive and self-searching approach, justification of theoretical and methodological approaches and acknowledgement (exposure) and even celebration of positionality my ‘findings’ become valid in adding to the rich diversity of social reality.