Review

Are nurses different?

Nursing History and the Politics of Welfare
Anne Marie Rafferty, Jane Robinson and Ruth Elkan (eds)
Routledge 1997, £14.99

Nurses have been struggling with a number of seemingly insoluble questions for many years. What exactly is the (unique) role of the nurse? Is nursing ‘women’s work’? Does nursing have a professional identity that is separate from, and yet equal, to that of medicine? Although the contributions to this collection all stand very much alone, and this is perhaps one of its failings, the threads of these concerns can be picked up running through several chapters.

One of the ways that nurses have attempted in recent years to define the uniqueness of their role is to focus on the central aspects of caring, arguing that no other professional group has caring as its major feature, and in some instances even elevating ‘care’ into an ethical framework for practice. While care is undoubtedly important, to claim it as solely the province of nursing is somewhat unconvincing, relying, for example, on medicine sticking firmly with a ‘diagnosis and treatment of disease’ model. Tom Olsen’s chapter, looking at the language used about nursing in early training schools, undermines any claim to caring being the historical basis of nursing. The emphasis rather seems to be very much on order and control, with care being mentioned only in connection with inanimate things such as care of the ward. This of course raises interesting questions about nursing being traditionally seen as women’s work if it is seen as such because it encompasses the ‘feminine’ values of caring and relationship, values which have been drawn on heavily by some nurse-philosophers.

In a similar vein, Geertje Boschma examines the notion of holism in nursing and again links the attempt to identify a ‘holistic approach’ as being unique to nursing (in contrast to the mechanistic approach of medicine) as part of nurses’ struggle for identity. Boschma makes the same criticism of this approach as others have made of the focus on caring, namely that it fixes the focus of nurses on the individual patient and allows little room to address the organisational and cultural demands that affect the work of nurses.

A less clearly argued but nevertheless interesting contribution from Ellen Baer addresses directly the tension between nursing being seen as women’s work and the struggle to establish nursing as a valued profession. Baer’s complaint is that feminists have at best ignored and at worst demeaned nursing, but interestingly she falls exactly into the trap that Olsen warns of: identifying caring as the traditional value of nursing. While it may be true that feminism has found it hard to know how to regard nursing, the arguments used by Baer are too simplistic to be convincing, relying heavily on the caring/curing distinctions questioned by previous contributors.

This highlights what is for me one of the drawbacks of this book: that it stands as a collection of discrete, unlinked essays, some of which will be of interest to the individual reader, others not. Certainly the international perspective is comprehensive, but I wonder whether this is not at the cost of an overall analysis that might be useful to today’s nurses. I suspect that many readers will do as I have done – draw out the three or four of the fifteen chapters that are of particular interest and merely dip into the rest!