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 Gurkhas and Gramsci and...

Joanna Lumley's campaign (and she is the first to point out that she is just the media figurehead of a very serious and researched campaign behind the scenes) to grant the right to UK residence for former soldiers in the British army has rightly been celebrated.

But recently there has been newspaper correspondence and features in radio news (the sources are not particularly critical to the argument and I have finally given up after an hour of trying to cite them directly--sorry!) suggesting that while the opportunity to come to the UK was great for the former soldiers and their families themselves... what would be the impact on the communities they left behind?

It has been argued that former soldiers (and their pensions) have been critical to the (relative) prosperity of some communities in Nepal. It has not merely (merely?) been that the regular income from former soldiers' families have helped to sustain a wider family, and indeed by sustaining local trade, a whole community. It is that the presence of elders with a wide experience of the world has been an important asset to those often isolated communities.

For them to leave for the UK would be to deprive those villages of an incalculable resource, it has been claimed.

My view is that there are separate issues here. This is not a legitimate argument against the right of former soldiers to live in the country they were prepared to die for. The relationship of the Gurkhas to the British army goes far beyond that of "mercenaries", which would normally characterise nationals of one country enlisted in the armed forces of another.

So I am all for these ex-servicemen having the right to come and live in the UK.
I do hope that they will not exercise it.

Why? Because these men are what Gramsci called the "organic intellectuals" of their communities. They are the embedded "wise men" (factually they are all men). I have no idea how they feel about their obligations to their communities versus their opportunities abroad, which may well--as in the case of their military service--include remittances home. But their contribution will, I'm sure, not have been merely economic.

I'm not going on about this purely concerning the Gurkhas. Their case illustrates a more general principle about the naive promotion of "social mobility" as a political good. In particular it touches on government policies of promoting proportional targets for participation in higher education...

Mrs Gaskell, for example, (Mary Barton, 1848; North and South, 1854) makes much of the importance of autodidacts (self-taught scholars) in sustaining impoverished communities. In her day, those people could not escape their birth community. There was no social mobility. The minimal up-side of the situation was that the efforts of some very resourceful people were contained and employed in the interests of their home communities.

Once social mobility comes into the picture, there is a route out for these "community leaders" (as we might now term them--but only for some reason if they belong to an ethnic minority). And they go. And leave the less talented or committed or enterprising behind, to form an underclass. Michael Young had an inkling of this in "The Rise of the Meritocracy" (1958).

Does that mean we should not widen participation or promote social mobility? No, but...