London Study Blames Decline in Professionalism for Nursing Shortages

According to a 1998 study published by a London think tank, poor pay may not be the primary cause of the current nursing shortages in the U.S. and Britain. Instead, the study contends that a decline in professionalism is to blame.

To understand the problem, one must first understand the origins of nursing, which are indelibly associated with Florence Nightingale. Originally, nursing was modeled on a "sort of monasticism"-with nurses obeying rules of silence, obedience, and duty. Uniforms were required, and long hair and jewelry were forbidden. Formality, discipline, and service were paramount, and the climate was one of seriousness, calm, modesty, and purpose. The primary goal was service, with nurses learning their role at hospital bedsides-not in universities.

Yet these views of nursing "offend every modern sensibility." Feminism is offended by the junior status of the female nurse to the male doctor-as well as the "demeaning" orientation toward "self-effacing service." The modern era also rebels against uniforms and nursing's strict codes of rank and order. In addition, the desire to efficiently use scarce resources led to practices such as "hot bedding" and transforming experienced nurses into managers, who issue protocols from offices located far from the bedside. As a result, patients often feel "well serviced but not nursed."

To boost nursing's status, modern nursing shifted the focus from service to expertise. As a result, training moved from the bedside to the university, with theory replacing practice along the way. With "loyalty to knowledge" replacing "duty to vocation," nursing lost sight of its original intent and purpose-thereby committing "professional suicide."

The study's authors argue that professions such as nursing, teaching, and law are primarily defined by three things-expertise, service, and a set of formal virtues. Thus, entering a profession means "becoming a certain sort of person with certain virtues" and "entering a community...of others with the same character." Yet in the modern world, expertise has become the defining element of a profession-with service and professional virtue and character left by the wayside.

The study argues that nursing (or teaching and law) is about more than acquiring expertise. Nursing is also about the virtues of service, quiet, and formality. By forgetting these elements, nursing has become work without virtue-a profession without professionalism, a career without a purpose. According to the study, it is this lack of professionalism that has driven nurses from the field and led to dwindling enrollment in nursing programs. When nursing stands for nothing, no one stands for nursing. However, by balancing expertise, service, and professional virtues, the nursing profession can begin to heal and once again regain its original luster and purpose.

From the October 29, 1998 Wall Street Journal article, "Work Without Virtue, or the Decline of Professionalism," by Digby Anderson.