Academic nursing – what is happening to it and where is it going?

Despite a positive but hesitant start in the 1960s and 1970s, academic nursing in the United Kingdom (UK) seems to be in danger of losing its way. Ironically, this may be due to the recent assimilation of all nurse education into the university sector and the competing demands placed on nurses and academics by the National Health Service (NHS). Many nurses, and others involved in nurse education, appear neither to understand the purpose of universities, nor to recognize the importance of scholarship. It could be argued that the wholesale move of nursing into the higher education sector in the UK was premature; that many nurses now in universities are on unfamiliar territory without a map. As Noel Annan (1999, p.3) cogently points out, universities exist for the ‘cultivation, training and exercise of the intellect’; they should be the cornerstones of intellectual life. As universities have developed over the centuries they have fulfilled two primary purposes: research and teaching. The former is concerned with the development of new knowledge and the latter is concerned primarily with the transmission of knowledge – usually in that order. The mission of a university could be described as the acquisition, assessment and dissemination of knowledge. In other words, knowledge needs to be acquired before it can be disseminated. Unfortunately, over the past 15 years there has been a ‘dumbing down’ of the higher education sector generally, an increasing failure to recognize the importance of scholarly activities, and a growing lack of distinction between education and training. This has been an unfortunate and perhaps unintended consequence of the drive to increase access to higher education. Training was traditionally the preserve of the further education sector (frequently in conjunction with employer in-service training such as apprenticeships), and the polytechnics – and they did it very well. However, during the 1980s employer-led apprenticeships virtually disappeared. Since 1992 there has been a four-fold increase in the number of universities, further education colleges have struggled to develop a new identity, and the polytechnics have been re-invented to become new universities. The goals of successive governments appear to have been to lengthen the period of most young people’s economic dependency by extending their formal education, and increasing the numbers going to university. Hence, the boundaries between education and training have become ever more blurred. Young people who once would have been in a variety of training environments have found themselves positively encouraged to go to universities, some of which were formerly training institutions. Nursing has suffered along with other applied disciplines and the question is raised of where is the scholarship and where are the scholars in nursing? A by-product of this anomalous situation is that there is currently an anti-intellectual ethos pervading nursing and anything perceived to be intellectual is criticised as elitist (see for example, the first article in this issue, ‘The accessibility of research-based knowledge in UK acute care settings’, pp. 10–21, and the associated commentary in ‘This issue of JAN’, pp. 3–4). Curiosity, creativity and a passion for ideas seem to be out-moded. The desire to explore ideas, to illuminate topics, and to subject them to criticism is being lost and only rarely do we see scholars in nursing who study a particular topic with single-minded devotion. The latter, of course, is also influenced by the vagaries of funding for nursing research and the idea of programmatic research extending forward for several years with a group of dedicated researchers is largely unknown in the discipline. There are many, including those responsible for nursing in universities, who would like to see nursing stripped of any aspirations towards, or pretence of, scholarship. They bring an apprenticeship model to the enterprise and would prefer a process of training with a ‘measurable’ input, throughput and output – preferably skills- or competency- based – resulting in meaningless but loquaciously titled certificates with little more than local credibility. Eraut’s (1994, p. 166) point that ‘competence may be preferred to excellence if the result is quicker and cheaper’ is being borne out. The last thing the people in positions of authority or power over nurse education would appear to want is questioning, confident and assertive nurses. Even in the era of evidence-based healthcare, nurses should know their place. Teaching and learning are central to academic life. Teaching should be recognized as a scholarly activity in which students are recruited with enthusiasm to participate in developing new ideas, and in questioning old ones. These are the skills supposedly valued when graduates move on into the world of paid work. Yet today, the competing pressures on student nurses mean that they are expected to read, write and think less. We have commented elsewhere on the potential danger of recent reforms in nurse education (Watson & Thompson 2000). A pervasive and not altogether positive influence on the quality of teaching and learning has been exerted by NHS education purchasing consortia, which are concerned primarily with ‘responsiveness’ and short-term outputs: training rather than education, and meeting the immediate needs of overcoming the current crisis in nursing recruitment and retention. Unfortunately, one area where training is required – research – is invariably given scant regard. The reduction of the common foundation course from 18 months to one year has weakened the educational foundation of nursing and the imposition of a three-year degree structure has compounded this situation. A commitment to research is recognized by scholars in all subjects. However, developing as a researcher takes time and effort. One research project does not make a researcher! Unfortunately, though the importance of research as an activity is increasingly being recognized, many nurses receive inadequate training often compounded by poor supervision and mentorship, lack of a clear focus, and superficial outputs. More worryingly, many nurses are given an exaggerated view of their status once such training has been completed. It is not unknown for those nurses who complete a PhD (which is, after all, only a research training apprenticeship) nowadays to find that their next promotion is to a university chair. The expansion in the number of university departments of nursing has created a vacuum of academic leadership that, as nature dictates, has to be filled. The glut of professorial titles being awarded, in many instances with little scholarly basis, has been damaging to the already fragile status of academic nursing. It is commonplace for directors of nursing, chief executives of NHS trusts, former directors of nurse education and others to assume the title, whether it be honorary or not, but thereafter to contribute little to the academy. Many universities award such titles on an honorary basis with the expressed view that they be used only in connection with academic work pertaining to that particular institution. Unfortunately, there is rarely any monitoring of the use of such a prestigious title, which should be awarded strictly on merit for contributions to the academy. The title is becoming devalued and is in danger of becoming virtually meaningless. If other disciplines nowadays pay little respect to the title-holders then there can be little surprise. The world is changing, and higher education has seen and continues to see its fair share of change. However, scholarly work in nursing is essential to the development of the discipline, both in terms of theory and practice. Of course, some research and teaching may seem esoteric and irrelevant to the practise of nursing, although this particular charge may have more to do with the reader’s inability or unwillingness to consider its application to the ‘real’ world, than to its actual utility. However, much other research is definitely relevant and this is not to say that every nurse should be a scholar. Nursing needs a body of scholars, which should be preserved and nurtured. Nursing has struggled over the past 40 years to gain acceptance in the UK university sector. It would be a tragedy to see such good work evaporate in the drive for rapid results, short-term goals and unscholarly ambitions.