'You have to have an assessment!'

HONG KONG—I am easily irritated by what I take to be stupid comments or questions, especially ones that convey a bureaucracy with which I don’t agree.

“You have to have an assessment” was the response in Hong Kong when I tried to use an indoor climbing wall.

“But I’ve been climbing for nearly 30 years,” I replied.

“You have to have an assessment!” was the firm response with that “the-issue-is-now-closed” look that the charming but invariably inflexible person behind a desk in Hong Kong conveys so well.

“Can I have an assessment?” I asked, conceding that safety is an important issue and that they had no proof I could climb safely.

“You have to make an appointment” was the reply, at which point I turned and walked out, deciding that my training regime would have to be suspended during this trip to the Far East.

The incident reminded me of a friend who graduated as a nurse in the United Kingdom and, after moving to Hong Kong, was required to pass a local exam prior to practicing. As she had graduated from my own alma mater (Edinburgh) and from the school where I first taught, this offended me ... until!

We do exactly the same in the United Kingdom to all incoming nurses; we even ask native English-speaking nurses (North Americans and Australians) to take an English language test (IELTS or TOEFL) to quite a high standard before they can register. They also have to have a period of induction prior to practice. The Australians have reciprocated by insisting that incoming nurses also take an English test, including native UK nurses.

I have mixed feelings about the need for all this assessment and for the resulting assessment industry that has grown up around it (a view I won’t be expounding on too much at the reception I’ve been invited to attend by the Commission on Graduates of Foreign Nursing Schools during the upcoming meeting and annual conference of the American Academy of Nursing in Washington, D.C.). I can see that safety is paramount, and guaranteeing the competence and educational level of everyone arriving from a foreign country with a nursing registration is crucial and, probably, impossible without a formal approach. However, when I arrive in Washington, DC, as I could do here in Hong Kong, I can produce my driving licence and hire a car with the likelihood of killing a great many more people than if I turned up to work as nurse. This is only an analogy. Nursing is infinitely more complex than driving, but the principle applies, and I see no efforts in any country to streamline and accelerate the processes.

I have no solution to the problems encountered by nurses who wish to migrate or just gain experience outside their own country. In fact, I can acknowledge that there is a need for some “barriers” to free movement of registered nurses. I know very well how a rash of scandals involving non-native nurses in the United Kingdom leads to calls for tighter regulations. In addition to protecting patients, these regulations protect the nurses from beyond our borders who are practicing safely and making a major contribution to our National Health Service. All this is notwithstanding the fact that registered nurses from anywhere within the European Community can work in the United Kingdom without let or hindrance, including an English language test.

So, I did not manage to do any climbing in Hong Kong. But if you have read this entry to my blog, I hope you will think I have made reasonably good use of the time that was freed up.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

I could almost be a nurse!

UNIVERSITY OF HULL, UK—“I’ve had so much contact with nursing over the past few years I could almost be a nurse.” This statement, or a slight variant thereof, has been uttered in my presence in each of the four universities where I have worked and in others where I have undertaken quality assurance or other external work. The protagonist is, invariably, male; a member of a university senior management team; and coincidentally, I presume, an engineer. Perhaps engineers are more adept than most at “engineering” their way into the higher echelons of university management, but I’ll have to consider that possibility another day.

Before entering nursing, I studied biochemistry at the bachelor and doctoral levels. However, I long ago gave up all pretensions about being a biochemist, not due to modesty, but lest I get “caught out” by a hard question. In the same vein, I have never heard fellow nurses, even though many have been in senior university positions and with significant exposure to other disciplines, claim that the exposure led them to consider themselves “almost a physicist,” “almost a philosopher” or “almost a mathematician.” So, what is it about nursing that leads people to say these things, and what should our response be?

My guess about why people in these positions say these things is that it is due to a subconscious—I am being generous—attitude of superiority about their chosen discipline whereby what they do is considered difficult, and nursing is considered easy. I can only guess further that their image of nurses is immobilised in stereotypes: feminine; middle class; not highly educated; and “caring.”

I would not wish to dress nursing up to be something it is not. Nursing is a practice-based discipline that lies at the crossroads of several disciplines that include life sciences, social sciences and medicine. Nursing, as a subject, may not grapple with the origins of the universe, solving the world economic crisis or designing iconic buildings. Nevertheless, we do deal with the origins of someone’s distress, finding a solution to that stress and helping rebuild people who may become iconic in their own right. And we don’t just do this once, but many times a day and hundreds of times a year.

We don’t do it alone; we work in partnership with many professions and have to know more about them than they ever seem to know about us. It may look easy but, reflecting on my own clinical practice many years ago and the kinds of problems I currently address in my research, it certainly doesn’t feel easy.

My response to statements such as the one at the top of this post used to be a polite laugh; followed by a stony face and then a grimace, with an inwardly expressed gratitude that the person found their métier elsewhere. I have, more recently, decided to return to smiling and inwardly expressing gratitude that, however easy it seems and however hard it actually is, I found my own métier.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.