Learning to Win

One of the most important things I have learned about nurses since I switched careers in 1970 is that there is no such thing as an ex-nurse. Technically, of course, one quits, leaves, cases to become a practitioner, even drops one's hard-earned license. Nurses do these things in significant numbers. Yet at a deeper personal and social level, the integrity, the we-ness of nurses, the sense of community is something which never seems to fade. When I meet a woman who says "I'm a nurse," I almost always answer "So am I. " So I hope the reader will forgive me if I refer to "us," even if this is technically inaccurate. We-ness is more than organization, more than sentiment, more than shared interests, more than occupational solidariry: internally we are often healthily quarrelsome! But as a professional group operating under work conditions and a work structure imposed by others, we have had to battle for status and control of our work processes, and we have not always nor perhaps wen frequently been victors in these battles. We have often found ourselves in environments in which our services are seen as a bit like mothering: absolutely necessary but somehow rather trivial. Working through this contradiction of being both essential and low-status has meant that strategies for change have never been clearcut and non-controversial. Think, for example, of bitter disagreements around the issue of unionization, ofd' lverse views about apprenticeship training and post-secondary education, of attempts to redefine what we do in such perceptions of team nursing, nursing process, total care, whole patients and so forth. Add to these the tensions created by shift-work and the rapid development of divisions in the theory and practice of what used to be called the core task: all of these strains and others have made nursing a high-stress occupation and the phrase "burnout" has become one to which most nurses have an instant and visceral response. Yet despite all these and other divisive issues, nurses seem to me to have retained a sense of "we-ness" which is something deeper than the simple urge to close ranks against a hostile world; something even more profound than the shared humanitarian impulse which the ideologies of science and technique have failed to extinguish. What I think binds us, both current and ex-practitioners, is a shared but not always articulated conviction that good health is the necessary pre-condition ofa good society, not only on ethical but on very practical grounds. This view, instead of being recognized as a legitimate and thoughtful piece of social analysis, is often dismissed as mere sentiment. Yet nursing solidarity, I think, does exist precisely because nurses manage, often in the teeth of adversarial forces, to unify individual commitment with social good sense. That unity is forceful and yet problematic, because it has to be put in practice in a society where good health is perceived in much the same way as motherhood is perceived. It is so obviously a "good thing" that it can be taken for granted that no more needs to be said; it is so obviously "necessary" that there is no good arguing about what it actually means or how it is to be attained. Health, like motherhood, is perceived as a gift of nature rather than as historical, creations wrought by human action: society's job is simply to step in as Nature's surrogate when things don't seem to be following the old lady's prescriptions. It is profoundly significant that the vocatiom of being Nature's natural helpers in such fields as childbearing and rearing and caring for the sick are assigned to women. The jobs of assigning meanings to these things, of explaining how such essential services are so little rewardedandoff~ in~ themwhen they go wrong: all ofthese are male responsibilities of high prestige and concrete rewards. I have used this controversial word "vocation" quite deliberately, understanding it as signifying less a labour of love than working for nothing. For many years now nurses have prop. erly distrusted the term, recognizing that to have a vocation has Nurses have retained meant historically an exclusion a Sense of "we-ness" from the ranks of those who work deeper than the urge to creatively and purposefully as well as for suitable economic reward. close ranks against a Vocational work is stuck in the hostile world; more realm of merely responding to necessity, and is much less prestigprofound than the ious than the innovative tasks 06 shared humanitarian say, makinghistory.Yet thenotion impulse which the of nursing as a vocational commitment dies hard. A couple of years ideologies of science ago I was invited to speak to the and technique have Social Planning Council in a small Ontario town on the subject of failed to extinguish. health care. After delivering what I