27 September, 2006

Nursing and Foucault

Some NHS Trusts are saving money by cutting the number of specialist nurses, according to the Royal College of Nursing, a leading nursing trade union. In a RCN press statement, Professor Christine Norton, Chair of the RCN Gastroenterology and Stoma Care Forum says that,

The loss of specialist nursing posts is deeply worrying. There are already too few nurses with this level of skill working in the healthcare system. The loss of just one of these experts will have a disproportionate impact on patients.
It is also a terrible waste of their skills and training to have specialist nurses working shifts on other wards or departments. It is unacceptable that specialist nurses – or indeed any nurses – should be seen as ‘soft targets’. Ultimately it is the patient who ends up paying the price.
The RCN does not identify precisely the skills under discussion so it is impossible to make an informed judgement on the NHS Trusts' actions. Specialist nurses are unlikely to be primarily responsible for diagnosis of illness and decisions on treatment since such things are the roles of doctors. Is it operating specialist equipment? If so, then it is indeed a waste of expensive training to have specialists working other areas. However, if, as implied by the final paragraph of the press release, the skills are mainly the so-called "soft" skills such as counselling, then the Trusts might have a valid argument.

Either way, I am reminded of Foucault's argument that power and concomitant control are produced by specialised knowledge (discourse). The power in this case being professional status for nurses. What will the control consist of? Since the medical profession has a monopoly of diagnosis and treatment, I fear it will be control of how people lead their lives. We are already seeing significant movements in this direction in the nursing lobby's endless campaigning over smoking, drinking and diet. It represents a significant change in nursing, one which can be described as a move from a traditional nursing /caring role to a surveillance function.

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