Reflection Paper 6
Listen to lectures, review articles and write a reaction paper in response to the content.
In Defense of the Traditional Nurse
Lisa H. Newton
Newton’s thesis: “The image and the ideal of the traditional nurse contain virtues that are found nowhere else in the health care professions;” these virtues and the value associated with them should not be lost in favor of a new notion of nursing that is developing—namely the nurse as a professional (562).
Definition of key terms (Role components)
Role: a norm governed pattern of action undertaken in accordance with social expectations.
Image: a component of a role—the image is the way a role is perceived in fact.
Ideal: also a component of the notion of a role—the ideal is the way that a role is perceived as how things should be.
Both image and ideal can be understood from the point of view of a person’s self-perception in the role (e.g. self-image/public image and self-ideal/public ideal).
Some roles are stable—in these roles there is not often a big degree of difference between image and ideals. When there is a large gap between what in fact is the image and what in fact is ideal then there is instability.
Transition in Roles: According to Newton—nursing is entering in an era of instability. (The public tends to perceive the nurses ideal and image in terms of the traditional nurse however the self-image of modern nurses tends to be as an autonomous professional.)
Newton’s Argument—the current debate lends itself to mis-formulation
Formulation 1. Many nurses currently see the issue as a struggle between self image/ideal and public image/ideal.
According to this formulation—the problem in nursing is a public relations problem. The public needs to start thinking of nurses as competent autonomous individuals.
According to this formulation, the public has many favorable views of horses but also tends to see them as under-educated, not as well informed etc.
Formulation 2. —There is a discrepancy between private ideal and private image.
The nurse sees her ideal as an autonomous professional.
However in fact her work turns out to be slavish and demeaning. The goal of those who take this view is a systemic reform so that nurses are not given work that is slavish but rather one that gives them work as equal consultants with valuable input in decision-making.
Formulation 3. The struggle is between a private ideal (held by the nurse) and an undesirable public ideal.
The public ideal is a power-based consortium of those who seek to maintain nurses in a subservient role economically because her present status serves physicians interests.
The solution to the problem, formulated in this manner, is to forge political alliances to counter the power base on those who promote a traditional view for their own benefit.
These formulations are separate and independent but they all converge to maintain two common goals:
The ideal nurse is the autonomous professional
They all reject that the claim that the traditional nurse is not a fit ideal. She is the “lady with the bed-pan.”
Why does Newton consider these to be mis-formulations of the problem? She claims that the problem with these formulations is that they fail to give any weight to the perceived public ideal.
The public ideal of a nurse as a caring face in the bleak hospital is a voice that needs to be heard.
Defending the traditional nurse
The defense of the traditional nurse is done in a broadly Aristotelian framework. Aristotle claimed that to know the virtues of a thing, we need to understand how that thing functions in its context.
Hence to know the virtues of a nurse we need to know the context.
Two major features of the context emerge:
The context of patient need
The context of the bureaucracy of the hospital
The bureaucratic context—
The bureaucratic goals of the hospital, like all bureaucracies are a matter of procedure. The high stakes of the decisions in hospital render adherence to procedure a legal necessity.
One crucial rule in this is subordination to the decision of the physician
Given this rule—the last thing that is needed is an autonomous professional.
The context of patient need
What do the patients need?
Specialized care beyond the time that the physician can be with the patient.
Help with simple tasks due to temporary disability.
He needs his “mother”
Nurse as a surrogate mother
A maternal image is useful to those in hospitals in a now dependent role.
It becomes ok to be in a dependent role (because previously it was ok as a child to be in a dependent role).
One disanalogy with the maternal role; with a child the mother assumes control over the child’s life—but, this cannot be the case in a nursing context—the person still remains an autonomous adult.
Therefore the role of the nurse must not include authority. She must be in a subservient role.
This lack of authority allows the patient to feel unthreatened.
The patients do not need another autonomous professional.
The Nurse also serves as the provider of humanistic care—she is the human face of the hospital
The bureaucratic and the professional aspects of the hospital are relatively cold and mechanical—they do not address the patients fear.
The nurse is also a mediator between the world of the hospital and the family in a way that neither the bureaucratic or professional dimension of the hospital can negotiate.
The family’s position in the hospital is to discover and express the proper emotion.
The traditional nurse steps up here to fill the gap.
“Without the nurse, the hospital becomes a moral monstrosity” (567).
An objection to Newton’s position from a feminist perspective.
Some feminist’s could claim that no non-autonomous role can ever be legitimately claimed.
(Kant might agree here too, to abdicate one’s role in choosing is to subject oneself to heteronomy and this, at best for Kant is non-moral, at worst immoral).
Second this subservient role is analogous to the role of slave and housewife and it exploits those who inhabit these roles.
Newton’s counters to this objection:
There is a distinction between those who choose to be subordinate in some roles but not in their whole life and those who choose to be subordinate in their whole life.
The role of slaves and housewives are not a good parallel, because neither the housewife nor the slave could step out of their role. Slave and housewife are life roles. However the nurse steps in and out of her role going to and from the hospital.
Conclusion: We need the concept of the traditional nurse, a person who is maternal, subordinate and humane. Many nurses entering the profession with a view to being autonomous would do well to pause and consider the virtues of the traditional nurse.
Questions for discussion:
What is Newton’s conception of the traditional nurse?
How would you contrast the traditional nurse with the notion of the professional nurse?
What tensions would do you see between the virtues expected of the professional nurse and the virtues expected of the traditional nurse? Could a person be both traditional and professional at the same time without being driven into schizophrenia?
What does Newton think would be lost if we lost traditional nurses?
Why might feminists object to the traditional nurse as a maternal figure? Do you think there is good reason for such objections? Why or why not?
Do you think there is a tension between the public image of nurses and the private image? Newton claims that the public image is in line with the traditional notion of the nurse, the private image of nurses as they see themselves is more in line with the professional image. Do you think she is right about this tension?
Terms to define:
Role
Image
Public image
Private image
