On the education of nurses (in the USA) --and parallels

I know that some readers are in nurse education, so you might be interested in this new report from the Carnegie Foundation for the Advancement of Teaching, in the USA [link from post title]. It parallels in some respects the plan for nursing to become an all-graduate profession in England by 2013. That proposal has been met with some scepticism in the UK.

It does seem that what Etzioni (1969) called the "semi-professions" have been making strenuous efforts in the latter half of the last century to enhance their status. As the citation below shows, he identified teachers, nurses and social workers as the main semi-professions, although since he was writing there are many more candidate occupations. I used to teach social workers, and more recently I have been teaching teachers, among whom have been nurses taking what the Nursing and Midwifery Council terms a "Recordable Teaching Qualification"--so I have a certain amount of knowledge in the area.

When I first taught in a primary school in the early sixties, some of my colleagues had only one year's training, or indeed higher education; they were known as "Emergency Trained" in a scheme developed in the aftermath of WW2 particularly to replace the large numbers of male teachers lost to the occupation. The norm was two years (although there was one teacher on the staff, apart from myself, who was quite untrained). Graduates did not have to be trained.

The first social work course I taught on was just a year long, with no specific entry requirements other than at least six months experience in residential child care. When I moved on from social work education, the Diploma in Social Work was just two years long, but in practice only taken by mature people (in age, at least) with some prior experience. The standard qualification has only been an undergraduate degree for a few years. Strangely at my former institution it is a Bachelor of Science award. Recently, (December 2009) the Social Work Task Force has reported, recommending the equivalent of a probationary year for newly-qualified staff, with extra support and supervision and the estbalishment of a National College for Social Work (presumably to replace the National Institute for Social Work which was closed in 2003...)

And nursing is now either a Diploma or Degree qualified profession, in both cases following a three year course. It moved from being work-based training with study blocks to coming under the auspices of universities in a programme called "Project 2000" from 1992 onwards. This was itself influenced by practice in the USA.

So what?

The first point is that as the fully-qualified staff have moved up the professional scale in each occupation, much of what they used to do has been taken over by lowlier and less-trained people. So much of the routine activity in nursing (and crucially the long-term and continuing patient contact) is now undertaken by Health Care Assistants, whose basic qualification is at National Qualifications Framework (NQF) level 3. Classroom Assistants have become increasingly important in schools, they may have minimal training or be relatively well-qualified with a Foundation Degree; from being primarily concerned to help children with special educational needs, their roles have become broader to the extent that the may be asked to "deliver" lessons using material prepared by a "proper" teacher. And social work has always relied heavily on an army of poorly-paid residential or domiciliary care assistants, nursery nurses and others often with very basic National Vocational Qualifications. So a caste division is established.

Of course, the fully-qualified staff cease to be direct practitioners--they become supervisors and managers. And because of the  institutional anxiety engendered by the fact that direct "user" contact is increasingly undertaken by under-qualified staff, the quality assurance procedures have to be tightened which means that the qualified staff spend even more time in their offices dealing with paperwork... There is also a view which may or may not be legitimate that the new generations of highly-qualified staff are coming to see direct contact, particularly of a routine and even menial kind, as "beneath them".

And... Many commentators have made the point that raising the bar for the final qualification is likely to entail raising entry requirements and thereby excluding  many potential candidates from under-represented groups. I'm not entirely convinced by this argument. Further and higher education institutions are in practice going out of their way to create ladders through sub- and para-professional qualifications to full professional recognition. And--purely on the basis of prejudicial respect for dozens of people I have had the privilege of guiding to that recognition--I need actively to be persuaded that people following this route are not the very best all-round practitioners in their fields. Their commitment, stamina, and practical experience (tempered perhaps by their toleration of being taught by prats like me--putting up with that is not  a commendation)! ...does not merely add--it multiplies their practice wisdom.

But. From a different angle--

What is happening to those left behind?

Policies of social mobility which encourage able people to transcend their origins are great. Up to a point...

• in a norm-referenced world, for everything which goes up, something must go down.
  
  
• Gramsci (1971) (Italian marxist theorist imprisoned by Mussolini) was concerned about the development of "organic intellectuals" among the working class. Roughly, "traditional intellectuals" are people who think of themselves as such; organic intellectuals are people who undertake intellectual work without recognising themselves or being recognised by others. Gramsci argued that organic intllectuals were a by-product creation of the ruling classes, but that they also had counterparts "embedded" as we should now say within the working classes, in voluntary and community groups, in unions, in churches (not sure where he stood on religion) and families. In his view it was vital that they be enlisted to lead the revolutionary struggle.
  
  
• The problem from this perspective is of course that educationally-promoted social mobility may be seen as "creaming off" the working-class organic intellectuals, thereby leaving working-class communities leaderless and even more disenfranchised than before; hence, it may be argued, "sink estates" and so-called "broken Britain" (and perhaps vulnerability to right-wing demagoguery), as opposed to Hoggart's account of pre-WW2 working-class life in "The Uses of Literacy" (1957).
  
  
• The rise of the semi-professions fits into this argument because of their accessibility to aspirants.

Push the argument further (perhaps too far?) and it suggests that raising the bar for the semi-professions does not enhance but undermines not only the quality of the service they offer, but also the quality of life of a large proportion of the population...

Discuss!

Etzioni, A. (1969) The Semi-professions and their Organisation: Teachers, Nurses and Social Workers, New York: Free Press


Hoggart, R (1957) The Uses of Literacy; Aspects of Working Class Life London; Chatto and Windus

On community (whatever that is) adult education...

P. and I had a pleasant day at a graduation event at an associate college, although I don't think I shall go again, and I'm not sure the event itself will survive. It's billed as a "Celebration" (a.k.a. PR exercise) of the HE achievement of the college students; it can't be a graduation as such because that is the prerogative of the universities themselves.

In the days of B. College, which was a "community" college in the real sense, it made sense. We processed from the old Victorian primary school which had been converted into a college annexe, through the main shopping centre, parting the populace doing their Saturday shopping*, to the parish church, which was where the ceremony was held. The church was full, and at the buffet lunch afterwards, everyone seemed to be no more than one or two links away from knowing everyone else.

(*  At our "real" graduation a week or two ago, I heard a toddler ask his mother as we passed by in procession, "Why are all those people wearing those funny clothes?" She replied, "It's to show how clever they are." I don't know how the rest of the conversation went...)

Now two colleges have amalgamated, and the ceremony has moved into the city centre. And all indoors. Apart from a few odd graduates and indeed faculty standing outside the hall for a quick smoke, there was no public visibility at all. We robed up, chatted with other academic guests, formed into a procession and entered the hall to the usual organ voluntary, totally invisible to the city around us.

The hall was, as befits a meeting hall of a major city, too big. The attending graduates (perhaps 30% of those on the roster, but 60% for our course [!]) occupied little more than half of the central block of seats. Their families and friends were scattered in the surrounding arc of seats. It may be a distorted and subjective judgment based on the size of the space, but there seemed to be fewer graduates attending from the former two colleges than from the original one. One division had only two graduates to present out of the 20+ who were eligible.

And afterwards, we got not a substantial buffet lunch but tea/coffee and biscuits; I suspect the fallout of a trade-off of costs between the local parish church and a city-centre hall.

Afterwards, in the bar of the theatre next door, I had an interesting conversation with a college colleague who specialises in working with teachers of literacy skills. She reflected on recent government initiatives in basic skills (or--latest jargon--"functional" skills. Why am I suddenly struck with this urge to explore or even teach "dysfunctional skills"?)

She argued that while there was clear evidence that improving the teaching skills of literacy tutors has been effective over the past few years, it was not making much (or indeed any) difference to their target populations of disenfranchised and alienated people. Observing the practice of her students has taken her into seriously deprived areas of the city, and she implied (I don't want to put words into her mouth) that the issues were not about teaching skills, but about the encounter between bottom-up and top-down culture.

As I think about it, I would go further. The Moser report (1999) identified the basic skills problem affecting up to a quarter of the adult population of the UK [figures which have since been questioned, I must add]. From it arose one of the most obvious and downright stupid social engineering initiatives of recent times. Basic skills (literacy and numeracy--ESOL and later ICT are less significant) for adults were not being adequately addressed because many of the those teaching them were not sufficiently "qualified". [OK--I am short-cutting a lot of stuff here, I know...]

Many of those "insufficiently qualified" teachers were volunteers, recruited through earlier government initiatives. Indeed, they may not have been teaching perfect grammar, but;

•  Many volunteers simply gave up (at least officially); they were offering something for nothing and suddenly they were being told they had to do this training and that assessment, in order to continue to do something for nothing... Ugh? (There is a clear and present danger that the same will happen to voluntary and informal work with children because of the "Safeguarding Children" provisions coming into force...)
  

• there is evidence (sorry, this will take a long time to resolve and I'm not going there) that learners work better with teachers who are just a little ahead of themselves rather than stratospherically so. (See Dreyfus and Dreyfus, 1986 for the basic argument, and add a dash of Vygotsky for flavour.)
  
  
• They were not "professionalised"; they were not identified with "schooling", at which these adult learners had by definition failed and from which many had been actively excluded. They may even have been (and some still are where neighbour helps out neighbour outside any formal scheme) the "organic intellectuals" identified by Gramsci.
  

Once more the obsession with direct, professional, technical fixes has failed to engage with the messiness of the real world, I fear.

On an "outstanding" lesson

I've just been channel-hopping and came across Teachers' TV. It was citing an example of an "outstanding" lesson on elementary geometry for, I guess, 9-year-olds. "Outstanding" is Ofsted's term, by the way.

Not only was the lesson poorly constructed, but just under the surface it was teaching rubbish...

1. The teacher gave several instructions but then qualified them with, "but before that, you need to..."
   
   
2. She put up a small text slide outlining the lesson objectives. Why? This is teacher-speak, which means nothing to learners, who have no interest in framing stuff this way. Basically, in order to make sense of this kind of specification of steps towards a goal (if that is actually a good metaphor) you need to be able to stand outside the experience, to see the map of the journey; and of course very few learners can do that. Indeed, probably none of them... not even postgrads. So all this "explanation" does is to confuse further.
   
   
3. Most egregiously though, it reproduced precisely the offence I experienced at the same age. I can remember the class vividly. It was the first half of a Friday afternoon, just before Art or the Story which wound down the week, probably in the Spring of 1953 or thereabouts.
   
   We were given exactly the same exercise as the pupils in the programme. Construct a triangle (actually, these pupils had the triangles drawn and cut out for them), then use a protractor to measure the angles, and add them up to arrive at the magic total of 180 degrees.

Except that they didn't! As I recall, my total was about 183 degrees, and the girl next to me got 178 degrees. Neither our understanding nor the teacher's (OK--to confuse the issue but to explain much else, this was the bizarre year when my mother was also my class teacher) could cope with "margins of error". So there was a meta-learning in this lesson:

The theory and received wisdom is correct. If your experience differs, it is wrong. 

It was repeated many times afterwards, in practically every "science" lesson in particular throughout my schooling. To be fair, it wasn't surprising in those days. I was in secondary school in the late '50s when budgets were very tight, and the improvisation of equipment was taken for granted. 

But things have changed; we are no longer constrained by limited facilities (at this level). And while I and my peers understood at some level that our practicals were just playing at science, children today are accustomed to something more definitive.

I don't want to get hyperbolic, but forget "objectives" and aspirations, and get down to more realistic "takeaways" including the unintended ones.

About twenty years or more ago, there was a late night Open University programme on "Professional Judgement". [See; Dowie J and Elstein A (eds) (1988) Professional Judgement; a reader in clinical decision making Cambridge; Cambridge U P] It was fascinating, and I am amazed now to find out how old it is, but the relevant point is that at the end of each programme, there was space given to --as I remember-- an academic from the LSE, to critique the assumptions and the methodology of the preceding argument.

That's the way to promote sound development of practice, not facile and fiddled "demonstrations" of what "ought" to have happened.

On disputing "constructive alignment"

An interesting discussion of the limitations of Biggs' "constructive alignment" model for university teaching—which is referenced and outlined in the post. Briefly, Jones suggests that it leads to big top-down quality enhancement/staff development initiatives which just do not work. He proposes a more modest encouragement of "reflective alignment" which in effect says that if university teachers will just think more about what they are doing, they will not be able to resist improving it. This is in line with the Strivens article I have often drawn attention to.

On diminishing returns

Maria Colwell, Jasmine Beckford ... Victoria Climbie, baby P. Children who died at the hands of their carers over thirty-odd years. From what I hear on Newsnight, one still dies every week. But there are 50,000+ plus children on "at-risk" registers. In other words, one in a thousand dies each year, out of those already deemed to be at risk. In Maria Colwell's day, we didn't even know how many were at risk.

I used to teach social workers. In the discussion of the latest tragedy I was pleased to detect no sign of the strident blame which characterised previous cases. I was pleased to see that Herbert Laming is being commissioned not to review this particular case in the usual blaming exercise, but to look at overall nationwide strategies and procedures.

It's tragic. There is no acceptable level of child abuse, let alone murder. But there is a law of diminishing returns. The NSPCC has a Full Stop campaign against child abuse. And so they should. I've worked with NSPCC staff and I have enormous respect for their work (as well as some reservations about their care for their staff injured in the line of duty). But practitioners know that "Full Stop" is marketing bulls**t.

The danger is that defensive practice which is aimed more at forestalling criticism than working in the best interests of the child will inevitably create more problems than it solves. And I do mean "inevitably"; it is built into the nature of the system. I know that we can never be complacent, and that more can always be done, but there does come a point at which enormous amounts of time, resources and effort can be invested to no discernible advantage. After all, the measure of "improvement" is something which does not happen.

In the public services nowadays, in education and health care as well as social services, and as in the economy, the one taboo is the admission that we do not know what is going on and a fortiori that there is nothing we can do about it. Powerlessness is not an option, but as Taleb points out in that odd and infuriating book The Black Swan (2008) it may be a necessary admission.

Having said that, how did a paediatrician miss a broken spine, or two police investigations decide not to proceed, or sixty visits by professionals not notice what was going on? Perhaps this time all the inter-agency working led to a diffusion of responsibility, to no individual being prepared to take individual responsibility for launching that horrible juggernaut of care proceedings?

Indeed, is it just possible that it was the sheer level of resources and number of personnel involved which introduced those unintended consequences?