Terry Pratchett had a certain way that he wanted us to imagine auditors: dead-eyed, celestial soul eaters created by god-like bureaucrats. Pratchett and Hollywood have captured the zeitgeist surrounding what many in industry would consider the innovation-destroying, big-brothering of the accreditation process. Perhaps you agree.
But I think they go alright. And unlike superman, these real heroines/heros stand a lot closer between you and death and ruin than you may like to think. In the healthcare or education industries, where we can all so easily work in isolation, or cut corners, accreditation points us towards a common set of standards and outcomes. Essentially, for the accreditation period at least, personal agendas are trumped by nationally recognised-best practice and legislation.
A strategic problem I see with accreditation (in healthcare anyway) is that it does not occur often enough, and comes with too much warning. This might make me sound like a misdemeanour ninja – (lurking in the shadows, waiting to pounce on the first person to step a toe out of line) I swear I am not that person – but I get an overwhelming sense of disappointment when practice improves during accreditation and then quickly goes back to the status quo afterwards. This article, published in the Harvard Business Review found that during hospital accreditation periods patient mortality rates dropped by 6% and then climbed back to pre-accreditation rates within 3 days of accreditation! If staff do perform better when they know that they are being watched, then why aren’t we watching them more regularly than every 3-5 years?
Let’s not downplay the steep, stressful learning curve accreditation sends all managers on. I feel like I have been pushed beyond the edges of my intelligence each time I have been involved in the process. Also at times I have questioned the relevance of a particular accreditation standard or guideline to my subspecialty. But overwhelmingly, accreditation seemed like a help rather than a hindrance. And, in terms of building knowledge of and competence in your profession, there is no better teacher.
Getting back to the auditor trope used in literature and Hollywood. Though funny, I don’t think it’s fair. Never once have I felt that an auditor has been set on destroying me. Mostly I have just felt that they have empathy and will work with me to ensure we are protecting the public and offering a great service.
So as I head into another accreditation process, I reflect on how much more I have learned about teaching at the post-graduate level. Sure I’ll be nervous, but I understand that this is for the good of nursing education and patient safety and it will give me the tools I need to create an awesome course.
Being female is wonderful, but it is also complex and confusing. Working in the female-dominated profession of nursing emphasises the bewilderment. The outsider would assume that those occupied in the caring profession would share this caring attitude towards their colleagues. However, ask any nurse, and they will tell you this is not necessarily true. The amount and extent of overt and covert bullying which occurs between nurses are jaw-dropping. Hospital wards can resemble a favela or prison block, with gangs, rivalries and disputes where nurses psychologically and physically torture each other. Considering that nurses are the largest group in the health workforce (which is the biggest workforce in Australia), you can begin to extrapolate the economic cost to society in unproductive hours, stress leave, patient care and chronic health problems and suicide.
Why does this happen and are nurses responsible?
Freire, an educator and philosopher, theorised that the oppressed develop feelings of inferiority and contempt for their group causing them turn on each other. This feeling of powerlessness also creates anxiety and passive aggressive behaviour towards the dominant groups. Oppression is multilayered cake in the nursing profession. Traditionally viewed as being perpetrated by doctors, repression is also carried out by healthcare administration boards and reinforced by the nursing hierarchy itself. And, dare I say it, patients as well (check out this article)
At the very heart of the subjugation of nurses lies misogyny. The whole system is scaffolded and reinforced by the ‘doctors’ handmaiden’ fallacy. This campaign has for a century or more successfully relegated nursing to a vocation (or calling), both de-legitimising and dismissing the technical and artistic difficulty of the profession and ensuring meagre rates of pay. Misogyny also creates an atmosphere where the general public thinks that it is OK to verbally or physically assault nurses.
I believe nurse educators, managers and administrators do bare some of the responsibility for fixing this problem. I suggest we start by introducing Feminist Studies into the undergraduate nursing degree. The role of feminism is to legitimise female perspectives and create change which is beneficial to women. Feminist Studies provides people, embarking on a women-centred profession, the tools to understand and de-personalise the bullying and oppressive side of the job. It also gives them the instruments to push back against the societal stereotypes of nursing and negotiate for better working conditions.
While I believe the benefits of being a nurse outweigh the costs, I feel to attract and retain great nurses to the profession will take a cultural shift. Australia faces a nursing shortage with a projected shortfall of 123 000 by 2030 (report available on these links).
Nursing shortages will affect the health of the country. It is in our best interest to create a work and societal culture which is enticing to nurses. Feminist studies are one way in which we might achieve this.