The Nature of Nursing Work

Introduction

In this chapter, I would like to enter into a reflective debate with the reader about the construct of nursing work. I intend to provide both personal reflection and commentary from the literature, both contemporary and, in my view, seminal, in order to stimulate the reader’s own reflections on the construct. Therefore, the chapter consists of two main parts, my reflections, and then a follow on discussion which draws upon the views of others, plus some empirical work from an investigation into the nature of nursing role and work carried out in a hospital in southern England in 2004.

I would like to state that the debate into the nature of nursing work is not new, some may suggest that it is as old as humanity itself. However, society is at the dawn of a new century and if one accepts the views of Giddens (1999), the world is set for major change as globalisation takes a firmer hold of society, and forces changes and reform at a greater rate, not seen since the industrial revolution. Health is an area of major debate throughout the world, as governments struggle to find ways of providing health care to their citizens and seek to balance the demands of cost, quality and need. A difficult equation to balance, but as consumer expectations grow, governments are beginning to find the resolve to challenge the status quo and ask for fundamental reform of what a health system should provide, and who should be the providers of it.

Nursing and the work nurses do, or are expected to do, is central to this reform agenda. The work done by the International Council of Nurses (2004) is well worth consulting on this issue, for their monograph outlines both the threats and the opportunities globalisation and health reform may bring to the work of nurses. Social change always brings threats and opportunities. It was in response to social change, after the Second World War, that Virginia Henderson, ninety-five years after Nightingale, gave nursing, and society, a definition of nursing that is still to be found on the walls of many schools of nursing today:

This provides a good starting point in order to reflect upon nursing, and certainly this definition comes into the debate whenever nursing and its role in health care is to be had. It has stimulated others to put pen to paper and attempt to clarify the work of nurses.

The ideas of Lyon (1990) provide a specific description. This author tabled the view that health is defined as dynamic, subjective and manifests itself across the illness-wellness continuum. Nurses, Lyon argues, do work which consists of seeing to the following health issues in their patients:

• 1.

  Lowered self esteem.

• 2.

  Feeling different.

• 3.

  Suffering fatigue.

• 4.

  Pain-discomfort.

• 5.

  Negative/troublesome emotions.

• 6.

  Impaired social relationships, role strain.

• 7.

  Inadequate activities of daily living.

As one can appreciate, defining nursing work is hard and tends to get stuck into the competency debate, or a more esoteric argument ensues. Certainly this was the case when the great and the good met at a hotel near Heathrow airport, in 1994, to define the nursing constant in health care. This invited group of nurses and others were given the task of agreeing the nature of nursing work for the English Department of Health. This became known as the Heathrow Debate and provided nurses, and the wider society, with the following ideas about nursing and the work nurses do.

The nursing constant:

• 1.

  A co-ordinating function.

• 2.

  A teaching function, for carers, patients and professionals.

• 3.

  Developing and maintaining programmes of care.

• 4.

  Technical expertise, exercised personally or through others.

• 5.

  Concern for the ill, but also for the well.

• 6.

  A special responsibilility for the frail and vulnerable. (Department of Health, 1994)