The landscape of professional learning is not exactly idyllic however. We have moved into a nightmare “post-truth” world where lies and fake news are just ‘alternative facts’, where expertise is pilloried as ‘elitism’ peddled by smart-Alecs, (The Death of Expertise: The Campaign against Established Knowledge and Why It Matters) ) and where fake news stupidity is a necessary foundation for a celebrity career. There has been a concerted attack on the very idea of expertise, usually led by the pack dogs of neoliberalism, internet bottom-feeders and various fringe-dwellers of the ‘alt-right’. There seems to be no limit to the semi-conspiracy theory industry that sees ‘the elites’ as being behind everything, whether it be sensible diets, vaccination, medication, gun control or whatever.
These ‘elites’ are never the millionaire or billionaire ruling class, for their ‘expertise’ is never questioned, only celebrated as ‘street smarts’ gained from that mythical ‘university of life’. No, the elites who must be disparaged and systematically ignored are those with qualifications, with deep knowledge and with clear areas of expertise. They are the scientists, the medical and health professionals, the economists, the artists. All of these ‘so-called experts’ - isn’t it fascinating how often they are ‘so-called’ - can be readily dismissed and trumped by ‘common sense’, ‘strong belief’, religious persuasion or any other mental process that is easily ready to hand.
In an era where everyone now has “a story” and where even businesses have been coached to ‘craft their own telling, selling narrative’ professional knowledge and experience is easily trumped by any random ‘personal experience’ story. Just try using science and medicine to explain why vaccines are a good thing to someone who is convinced that their child has been ‘damaged’ by said vaccines or whose entire personal-political belief system is built upon an infinite number of turtle conspiracy theories. It would be great to rely on quality investigative journalism or other erudite writing or speaking but this too has been debased to the point where it becomes a ‘churnalism’ of social media chimera and confected ‘outrages’ and where nursing and other health professions, crafts, disciplines, professions, arts or whatever, still struggle to say and ‘cut through’ with any unified voice, what they are, what they do and why it matters to people’s lives.
The world of healthcare that we are preparing today’s students for is light years away from the clinical world that the majority of their educators inhabited. Is there something wrong with this picture? There could well be if we fail to recognise that this new world comprises both new and possibly unimagined challenges for nurses, midwives and all health professionals. Yet for many educators, the battles to be fought are as relevant as the Trojan Wars. I still hear of university schools where faculty spend interminable hours in ‘beefing up their attendance policies’ or ‘strengthening their dress codes’, or ‘re-jigging their curriculum order’, or ‘rewriting the social media policy’ one more time. None of this has anything to do with 21st century health professional learning, practice or education but it has everything to do with what are hopefully the death-throes of a faculty class who still cling to their perceived power over students.
Every one of these educational micro-aggressions, every student ‘bawled out’ or ‘reduced to tears’, every ‘troublemaker taught a lesson’, contributes directly to the endemic and systematic problem of thuggery and bullying in health care that is as prevalent and widespread now as it was 40 years ago. That is the extent of the non-impact that we had on this issue and students learn very early on how professional power works and is wielded. Meanwhile, the fundamental, elemental dimensions of the human condition, especially when facing illness, injury, loss and more, that will be as germane now, and in the future, as they have always been.
Healthcare is now a multi-billion-pound business (NHS England alone cost £124.7 billion in 2018) and nursing and health professional education are most certainly part of this business. The challenge for educators is knowing the nature of their particular business and how they and their students can thrive in such a world with their humanity and integrity intact. Is this a big ask? Damned right it is, but no one ever promised you that healthcare education was going to be easy. If they did, they lied through their teeth.
So are our educators prepared to spend another 20 years in meetings tinkering with and re-ordering ‘curriculum content’ and having insular arguments in ever decreasing circles about academic progression, relative merits of qualifications, graduate qualities and career ladders while the world is not just changing but spinning on its axis? We have to hope not. The problem that healthcare education faces, is not that it needs to change. That is not even under dispute. The question is how do we change how we change, because how we have done this in the past has failed miserably. Surely, we are smarter and better than this?
Philip Darbyshire is internationally recognised as a leader in nursing and health care research and practice development.
He enables the best in staff potential to solve problems, think creatively and ‘raise the bar’.
He has won over a million dollars in competitive research funding and established and led one of Australia’s most successful Research & Practice Development units for thirteen years.
Philip will deliver his keynote address, ‘Does healthcare have a future?’ at the NET2019 Conference, 3 - 5 September 2019 at Keele University, UK
References and other reading:
Lorenz C (2012) If You’re So Smart, Why Are You under Surveillance? Universities, Neoliberalism, and New Public Management. Critical inquiry 38(3). The University of Chicago Press: 599–629. DOI: 10.1086/664553.
Rolfe G (2012) Fast food for thought: how to survive and thrive in the corporate university. Nurse education today 32(7): 732–736. DOI: 10.1016/j.nedt.2012.03.020.
Schwartz JM (2014) Resisting the Exploitation of Contingent Faculty Labor in the Neoliberal University: The Challenge of Building Solidarity between Tenured and Non-Tenured Faculty. New Political Science 36(4). Routledge: 504–522. DOI: 10.1080/07393148.2014.954803.
Tudiver N and Canadian Association of University Teachers (1999) Universities for Sale: Resisting Corporate Control Over Canadian Higher Education. James Lorimer & Company. Available at: https://play.google.com/store/books/details?id=eeKCMCYqEjkC.
Wiarda HJ (2014) Universities in Decline: From the Great Society to Today. University Press of America. Available at: https://play.google.com/store/books/details?id=jgqgBAAAQBAJ.)
Darbyshire P, McKenna L, Lee SFSF, et al. (2016) Taking a stand against predatory publishers. Journal of advanced nursing 73(7): 1535–1537. DOI: 10.1111/jan.13004.)
Darbyshire P (2018) Fake news. Fake journals. Fake conferences. What we can do. Journal of clinical nursing 27(9-10). DOI: 10.1111/jocn.14214.)
Darbyshire P and Ion R (2018a) The Gosport War Memorial Hospital Panel Report and its implications for Nursing. Journal of advanced nursing. DOI: 10.1111/jan.13781.
Darbyshire P and Ion R (2018b) The lessons of Gosport for nursing education. Nurse education today 70: 130–135. DOI: 10.1016/j.nedt.2018.08.018.
Darbyshire P and McKenna L (2013) Nursing’s crisis of care: What part does nursing education own? Nurse education today 33(4): 305–307. DOI: 10.1016/j.nedt.2013.03.002.
Darbyshire P and Thompson D (2018) Gosport must be a tipping point for professional hierarchies in healthcare—an essay by Philip Darbyshire and David Thompson. BMJ 363. British Medical Journal Publishing Group: k4270. DOI: 10.1136/bmj.k4270.
Ion R, Olivier S and Darbyshire P (2019) Failure to report poor care as a breach of moral and professional expectation. Nursing inquiry: e12299. DOI: 10.1111/nin.12299.)
Hunter DJ, Erskine J, Small A, et al. (2015) Doing transformational change in the English NHS in the context of ‘big bang’ redisorganisation: Findings from the North East transformation system. Journal of health organization and management 29(1). Emerald Group Publishing Limited: 10–24. Available at: https://www.emeraldinsight.com/doi/abs/10.1108/JHOM-01-2014-0019.
Maynard A (2005) The costs of redisorganisation. British Journal of Healthcare Management. DOI: 10.12968/bjhc.2005.11.2.18651.
Normand C (2002) The‘ redisorganisation’ of the NHS-Radical changes can be made only if the basic environment is stable. BMJ 324(7338). BMJ Publishing Group: 672. Available at: https://researchonline.lshtm.ac.uk/16835/1/The%20%E2%80%9Credisorganisation%E2%80%9D%20of%20the%20NHS%20_%20The%20BMJ.pdf.
Smith J, Walshe K and Hunter DJ (2001) The ‘redisorganisation’ of the NHS. BMJ 323(7324): 1262–1263. DOI: 10.1136/bmj.323.7324.1262.