Making a difference

Whilst the findings based on these participant narratives suggest difficult decisions around career choice, negative attitudes from others around that career choice and difficulties in maintaining values and beliefs whilst working in difficult situations within the narrative of the majority of the participants of my study is a specific reference to the notion of making a difference. Embedded in altruism, this is highlighted in the literature around identities of nursing and professional socialisation (Owen & Standen, 2007; Johnson et al, 2007; Price, 2008; Fisher & Byrne, 2011). Sixteen participants in my study specifically identified ‘making a difference’ or other altruistic comments as part of their motivation for being a learning disability nurse:

Making their lives better I think, changing things... Because it’s changing, it’s getting better. (Jenny)

My job satisfaction is from coming away that day and knowing that I’ve made that person happy for however or maybe their life worthwhile really and brightened their day up. (Julie)

It makes you feel like you have actually done something. (Angela)

I knew that I could make a difference to people’s lives you know. (Matthew) I thought I could make a difference and even if it’s just to a few people.

(David)

This focus on ‘caring for’ or ‘helping others’ is a feature of the constructed identity of nursing that has existed for decades and forms many of the definitions around nursing (Kramer, 1964: 1974; Eron, 1955; Davis, 1975; Fealy, 2004; Johnson et al, 2007). Perceiving oneself as someone who can ‘make a difference’ or ‘help others’ can enhance the self-esteem of those who already feel these characteristics are part of their identity. A strong association exists between nursing socialisation and the individual’s preconceived views around nursing (Johnson et al, 2007; Price, 2008). Altruistic vocabularies are common in the caring professions Fisher and Byrne (2011). However not all participants used an altruistic discourse within this aspect of their narrative; for Jane her memories of working with a child with learning disabilities led her to question the characteristics she possessed and whether she could be a nurse:

I did my Health and Social care course for two years at college and then whilst I was there I did a placement at what was called a special school and it was the first time I had come across children with learning disabilities and I was in a classroom with children of about seven or eight years of age and there was a lovely little girl there who I saw have the most horrendous seizures and I actually fainted, and I couldn’t believe when I came round I’d fainted because I was so upset about this child I couldn’t believe what had happened to her. So I thought oh God I don’t know if I can, can, look after these children if they’re going to be doing these sorts of things as at the time I’d had very little to do with anybody with learning disabilities. (Jane)

When describing sitting down with the careers officer to discuss what she would do after her Health and Social Care course, she remembers the little girl in the placement influencing her decision:

Things that stuck in my mind were that little girl as it always has done, and I suppose he picked up the cues from that and he must have known, I don’t know how, but he must have, I suppose because he’s a careers officer, but at the time, you know, he said why don’t you do this particular course. (Jane)

Jane had other motivating factors to influence her decision to train as a learning disability nurse, as at the time nurse education had moved towards a centralised admissions service and the opportunities for applicants to apply for training across the country were more widely available, offering not only the opportunity to train as a nurse but also to have a significant change in lifestyle and move away from your home town. For Jane this was key in her decision making after speaking to her careers advisor:

At that point in my life I was struggling with the fact that my grandmother was with us at home for so long, and really I wanted it as an opportunity to leave home. (Jane)

Whilst struggling to accept her elderly relative living at home and not perceiving that she would ‘cope’ with caring for people with a learning disability, Jane’s potential as a nurse was acknowledged by a careers advisor and the nature of nurse training at that time provided Jane with an opportunity to move away from home and her grandmother. Jane also reflects on this decision within her narrative and expresses this difficult situation:

So it was just an awkward situation really. It was a situation that very selfishly when I look back at a 17, 18, 19-year-old teenager, I didn’t want, so you know, and I just literally walked out and I got that opportunity to get that nurse

training and just left her to it which isn’t what you’d expect now for me because I think oh God that’s awful, but you know, you do what you do at the time don’t you? (Jane)

Jane’s story highlights her personal identity development; a key motivation for Jane was to leave home, away from the ‘caring’ her mother had to undertake for her grandmother. This is an interesting aspect of the narrative, as Jane questions her ability to ‘cope’, not only with her grandmother but also with the girl she remembers at school. However, she describes seeing nurse training as an opportunity for this move, and also describes this as not being part of who she thought she was at the time:

I didn’t really know what I was going in to, you know, my plan had worked so far, I’d got away from home, I was going to be earning money, I had somewhere to live, that was… (long pause) yeah, the plan. (Jane)

All of the participants’ narratives had an element of describing challenges they faced on the journey to becoming a learning disability nurse, an uphill struggle to achieve the vocation they had chosen, in whatever form that choice had taken. In the study by Fisher & Byrne (2011), learning disability professional identity was bound with the emotional commitment to practice. The findings of my study suggest that the participants also used the narrative to articulate their ‘emotional commitment’ to learning disability nursing.

5.4 Conclusion

The findings within the chapter suggest that the participants faced many challenges, but were still driven to complete their training. However, it is recognised that high levels of attrition exist in nursing nationally and studies suggest that there is a disconnect between expectations of nursing and the reality in practice settings. For learning disability nursing this disconnect is complex, as change in care practices in a macro and micro scale have impacted on the role of the learning disability nurse. A key theme for those interviewed in this study was around becoming a learning disability nurse, with all participants telling their story of how they came to choose learning disability nursing as a career and stories of their journeys through their nurse training to qualification.

Whilst existing studies have focused on nursing per se, and a minimal number of studies which asked specific questions of learning disability nursing students, there were no studies in the UK which sought the views of qualified learning disability nurses around their career choices using a narrative approach. Whilst for some participants they had experience of either working with people with learning disabilities or having friends or family who had a learning disability, some did not and chose learning disability nursing for a variety of reasons. All participants told of being drawn to staying within this field of work once they had some experience of working with people with learning disabilities. A number of the participants talked about the relationships that they developed with the people with a learning disability they worked with and how this had a positive impact on their choice of learning disability nursing. This suggests that for these participants their experience of working with people with learning disabilities reinforced their choice of learning disability nursing as a career option. The implications of this for the current recruitment issue for future learning disability nurses may include examining where ‘experience’ is now located following the closure of long-stay hospitals. Many HEIs have reported a decrease in the numbers of applicants to learning disability nursing, and this study offers a perspective on who chooses learning disability nursing and why. Data from the study with this focus has been shared through publication in the peer reviewed journal Learning Disability Practice (Genders & Brown, 2014), placing the findings into the wider learning disability community for scrutiny. A study by Price in 2009 had also focused on the recruitment of learning disability nurses and, whilst methodology differed, there are similar findings in relation to the reasons given for applying for learning disability nursing.

Literature also suggests that learning disability nursing as a specific field of nursing is not widely understood (Price, 2009), with the general public perception of nursing being around adult nurses in an acute setting (Price, 2009). The findings of my study suggest that learning disability nurses faced a number of questions about their choice of field of nursing and an acknowledgement that many family members, friends and other nurses were unaware of the existence of learning disability as a field of nursing.