Column

Absolute independence comes at a price

Charlotte staggers toward the lane, grimly clasping a medium-sized bowl to her midriff. Purple-cheeked she heaves it to her chest, then somehow manages to lift it to the top of the ramp. It teeters, then rolls slowly toward the pins. Not waiting for them to tumble, she runs back to the stack of bowls, desperate to prove her independence yet again.

When I’m not crawling behind her, frantically trying to prevent bowls dropping on her feet, I am amazed by the depth of my two year-old’s need for autonomy. But I shouldn’t be, for the quest for self-determination is everywhere.

It is particularly vigorously pursued by some nurses, the most radical of whom insist nursing is a special profession that should be free from doctors’ control. But though independence is a natural desire — and though many nurses do have a broader, more humane understanding of health care than some other professional groups — nurse separatists should be aware that distance comes at a price: thinking of yourself as separate is a prerequisite for alienation.

Believing you are part of something separate can help you feel you belong — you are a member of our family, you are a doctor, you are a nurse, you are English, you are white: you are one of us. But being part of something separate means you cannot be part of all those things you are detached from. You can’t belong to any other family, you can’t be a non-clinician, you can’t understand foreigners. Eventually you may realise that you are not infinitely many more things than you are.

Excessive separatism causes unnecessary division, needless repetition of ideas and research, and excludes ‘outsiders’ who might have much to offer. If doctors did not think of themselves as an elite they could not hide their mistakes from the rest of us, for there would be no ‘rest of us’ to hide them from. If nurses did not think of themselves as separate then they could argue that caring is something all health workers ought to do — rather than claim it as a capacity unique to nurses.

Separatism also corrupts the perceptions of the separatists. Only members of health care tribes think of themselves as separate from each other — it never occurs to the general public, who assume health professionals work together for the good of patients.

Charlotte knows only two differences at the moment — that there are different sexes, and that some people (old people) have ‘funny faces’ and everyone else does not. Too soon she will know a lot more: she will know the difference between an Albanian and a Serb, a Catholic and a Protestant, a black person and a white one, a friend and an enemy.

But until she does she cannot feel alienated because she cannot think of herself as different in kind from the people around her — she does see herself as an individual, but as an individual warmly connected to everyone else.

It is precisely this warmth that many nurses say lies at the heart of nursing. If this is true, then nursing should cease its quest for absolute independence. Separatism may have been politically useful as nurses fought for professional status, but the time has come for nursing to have confidence enough to join fully with others.

This is the effective way for nursing to influence other health professions: converting them from the inside rather than scaring them away from the good ideas which are presently defended as nursing’s own.