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Excerpts from Decalogue by Jan Svankmajer (1999)

Imagination is subversive, because it puts the possible against the real. That’s why you should always use your wildest imagination. Imagination is the biggest gift humanity has received. Imagination, not work, makes people human. Imagination, imagination, imagination…

Keep exchanging dreams for reality and vice versa.

The opposite of poetry is professional expertise.

 

Being good for nothing

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It would seem that the vexed issue of the ‘problem’ of nurse education is back on the agenda, if indeed it had ever left it. Only this week on the Radio 4 Today programme, the question of whether nurses are being over-educated once more raised its ugly head. The so-called ‘too posh to wash’ argument runs as follows:

1. The mid Staffordshire enquiry and other similar analyses of the recent ‘crisis in care’ suggests (quite rightly) that nurses are neglecting the basics in caring (or not) for their patients, and that the profession needs to review its commitment to what the Chief Nurse for England has called the 5Cs of caring – compassion, competence, communication, courage and commitment.

2. Part of the reason for this gross dereliction of duty (for that is what it is) is that nurses are over-educated; that they do not need a degree in order to give a bed-bath or feed a patient. Indeed, that being in possession of an education and a degree encourages nurses to believe that their rightful place is in the office behind a computer rather than beside a bed tending to the needs of patients.

That, anyway, is the ‘logic’ behind the argument.

I would like to make a counter-intuitive suggestion: rather than over-educating our students, I would like to suggest that they are woefully under-educated; that many of them are, in fact, hardly educated at all. I am not denying that they are well trained. Some are very well trained indeed, not only in the skills required to be a safe and competent nurse, but also in how to write essays, how to pass examinations and even how to think critically. But they are not well educated, at least not in the sense that anyone who studied at university prior to the 1990s would understand the term.

We know that being able to do a particular job and being motivated to do it are two quite different things. The motivation to care for sick and vulnerable people, particularly when the care involved is hard, messy and exhausting work, derives in large part from caring about them. And caring about people, particularly those to whom we are not particularly close, attracted or related, is largely a matter of empathy and imagination. I care about my children because I love them and because they are my children, which motivates me to care for them. I care about strangers whom I encounter in hospital because I am able to imagine myself or my children in their situation.

Without this empathic imagination, we have only our training and our duty to fall back on. And when times are tough, for example when the ward is short-staffed or when we feel exhausted at the end of a long and tiring day, it is too easy to look the other way when we see a stranger in distress.

What is lacking, then, is not training but the empathy and imagination that a broad and well-rounded education provides. The problem, not only for nursing but for society generally, is that for the past twenty years or so, the mission of our universities has been less about education and more about learning outcomes, attrition rates and student satisfaction, which is not at all the same thing.

So how can we educate our students to care about as well as for their patients? How can we help them to imagine the suffering of others to the extent that they are motivated to respond to that suffering? Richard Rorty referred to this as ‘solidarity’, which he believed could be enhanced through the arts, particularly through reading novels and other fictionalised accounts of the pain and suffering of others. Solidarity can also be increased through the study of the humanities (history, the classics), through ethnography and, particularly, through what R.D. Laing referred to as existential hermeneutics. This is not an esoteric philosophical game, but a real and genuine attempt to reach out to another person in order to place ourselves in her or his position. And whilst this might come relatively easy to some, others need to be educated in the humanity of others that extends far, far beyond an understanding of their biology, their physiology and their behaviour.

I am not talking here about an objective intellectual understanding of people, but a direct subjective empathic engagement with persons. And for those of us (including myself) for whom this does not come naturally, this requires a broad education that extends well beyond the skills of nursing, well beyond the theory and research underpinning those skills, and well beyond meeting learning outcomes and demonstrating safe and effective practice. I suspect that all of the nurses and most of the care assistants who contributed to the failure of care at Mid Staffordshire and elsewhere could, if pushed to do so, demonstrate safe and effective care. What was missing was the imagination and the humanity to see the need for it. And as numerous psychological experiments have demonstrated, we are all capable of a dereliction of our duty of care which at times borders on the murderous, so there is no room for smugness or denial.

I believe that education is our last great hope, and that means the study of issues and subjects that appear to have little or no relevance to the theory and practice of nursing, such as literature and the arts, the humanities, the classics, philosophy, anthropology, the list is endless. And if there is no time and space in the current curriculum, we must find the time and space, even if it means extending our nurse education courses to four or five years. After all, it takes seven years to qualify fully as a doctor, so why not also as a nurse?

I will end by evoking an old fashioned concept: we must educate our students to be good, and as the moral philosopher and novelist Iris Murdoch tells us, good is concerned with means rather than ends, with how we act rather than simply with the technical aspects of what we do: “The Good has nothing to do with purpose, indeed it excludes the idea of purpose… The only genuine way to be good is to be good for nothing…”. So, more education rather than less, and education that addresses the means as well as the ends of nursing, the values as well as the science, the imagination as well as the facts. As educators, our challenge is to educate our students to be good for nothing.

 

Why be excellent when you could be good?

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Excellence is ubiquitous; it is one of the buzzwords of the 21st century. The mission statement of the Dublin hotel in which I am writing this blog is ‘Distinctive hotels distinguished by excellence’.  A quick scan of the websites of half-a-dozen Dublin colleges, universities and other educational institutions (let’s call them colleges A-F), reveal the following statements:

College A: ‘The college is committed to excellence in both research and teaching’

College B:‘Excellence through lifelong learning’

College C: ‘… prides itself on delivering excellence across all of its activities’

College D: ‘Excellence through learning’

College E: ‘promoting excellence in teaching and learning’

College F: Growth and excellence are the cornerstones of our strategy’

The Research Assessment Exercise (RAE), which was until recently the measure of the research achievements of university departments in the UK, has now been replaced with the Research Excellence Framework (REF).

The Higher Education Academy (HEA), which is funded and supported by the four UK higher education funding bodies and which operates a highly prestigious National Teaching Fellowship Scheme, claims to champion excellence in learning and teaching. Furthermore, the three criteria for the award of a National Teaching Fellowship are (i) individual excellence, (ii) raising the profile of excellence, and (iii) developing excellence.

The title of the National Institute for Health and Care Excellence (NICE), which is the Non Departmental Public Body (NDPB) with responsibility for developing guidance and quality standards in social care in the UK, speaks for itself.

The philosopher and cultural theorist Bill Readings first observed this new rhetoric of excellence in the early 1990s, particularly in higher education, and coined the term ‘University of Excellence’. Readings warned, however, that ‘excellence’, at least in its modern usage, is not an indicator of quality but an ‘empty signifier’ employed by administrators in order to direct and manage the function and mission of the university. It was, he claimed, a decisive move in the shift of power and control over the mission of the university from academics to administrators.

In order to illustrate how the rhetoric of excellence can be employed as a managerial device, Readings offered the example of the estates department at CornellUniversity in the USA, which was given an award for ‘excellence in car parking’. As someone who has little choice but to drive to work, my idea of an excellent car parking service would be one that somehow managed to accommodate the various and diverse requirements of the academic community for safe, efficient, reliable and (relatively) cheap on-site parking facilities. However, these were not the criteria by which CornellUniversity judged excellence in parking. As Readings pointed out, the award was given for ‘a remarkable level of efficiency in restricting motor vehicle access’. Thus, the term ‘excellence’ can be used to refer equally to the attempts both to facilitate and restrict parking depending on the needs and requirements of whoever is making the award.

Indeed, excellence can be used to signify whatever our managers and administrators want it to signify. As such, the award of excellence does not signify value; it indicates the desires and goals of those with the power to assign it. To refer to a car parking service as excellent tells us less about the quality of the service and more about the extent to which it has fulfilled the goals and mission assigned to it by the administrating body. And if the goals and mission statement changes (as goals and mission statements periodically do) the estates department might well find itself suddenly stripped of its status of excellence, despite continuing to provide what was previously judged to be an excellent service.

And the same applies to the academy. For example, ‘impact’ has only recently been introduced into the Research Excellence Framework (REF) as a criterion against which research is assessed, and so most HEIs in the UK now include ‘impactfulness’ in their definitions of research excellence. And if the next REF exercise employs different criteria and measures, we can be sure that universities across the UK will revise and reconfigure their definitions of research excellence accordingly.

To repeat, the modern usage of the term ‘excellence’ is not an indicator of quality but an award for doing as you are told, for pursuing whichever goals and outcomes that managers, administrators, funding agencies and government bodies currently best meet their agendas. Excellence is an empty signifier whose meaning can change overnight. Today, excellent car parking practice might entail keeping as many cars off campus as possible. Tomorrow, following a change in management policy, it might be to accommodate as many cars as possible. Five years ago, excellent research had little concern with wider impact, today impact is a key component of ‘research excellence’. And neither of these changes have been driven by the so-called experts themselves. The expert parking attendants had no say in what their expertise comprised, and neither did the expert academics, particularly those theoretical researchers whose ‘blue skies’ speculative work took a sudden huge hit in its perceived value on the morning when the new criteria for REF 2014 were announced.

The warning that Readings alerted us to in the 1990s has now largely been realised. The views of academics, who have traditionally determined what constitutes best practice in research and education, have been trumped by an excellence agenda set by politicians, managers and administrators. Regardless of my own criteria for what constitutes excellent research, if I wish to make my research more ‘excellent’ in the eyes of my university, my attempts will be directed towards publishing in journals with higher impact factors, winning grants from prestigious funding bodies and ensuring that my research findings are applied outside of the academy. These criteria may or may not reflect anything that expert researchers and academics consider to constitute excellent research, but the most important points are firstly that I have little or no say as an experienced academic in what counts as excellent practice, and secondly that the criteria which I now have to satisfy are subject to change at very short notice.

So what is the alternative? What can I aspire to in place of excellence? My answer, which is prefigured in the title of this blog entry, is that whilst I have no interest in being an excellent teacher or researcher, I nevertheless want to be good at what I do.

At first sight, this shift in terminology might appear to be merely rhetorical, but it is not. Admittedly, each is an empty concept, a signifier without a fixed signified. On the face of it, to say that I am a good researcher tells you little more than to say that I am an excellent researcher, since the precise meaning of ‘good’ is equally undefined. However, whilst the empty concept of excellence is filled by outside agencies, is subject to the whim of politicians and is informed by politics, the concept of goodness is filled by the individual and is informed by values. Excellence is utilitarian and instrumental. It is defined and driven by ends. Goodness is values-based and concerned with means. As the philosopher and novelist Iris Murdoch tells us, “The Good has nothing to do with purpose, indeed it excludes the idea of purpose… The only genuine way to be good is to be good for nothing”.

I want to be good for nothing, but my aspiration contradicts the goals of the university of excellence, which measures my performance in terms of my research ‘inputs’ (grants) and ‘outputs’ (publications), with little concern or interest in what happens between the two. The ‘means’ of teaching and research which is the location of the values which define it as good (or otherwise), cannot be measured and are unproductive. As Readings points out, it “is non-productive labor, and hence does not show up on balance sheets except as waste”.

That is not to say that it is impossible to be good in the university of excellence, only that it is extremely difficult and goes largely unrecognised and unrewarded by the managers and administrators. If I am to be good in the sense of pursuing my own values and my own agenda, then I must also be good in the performative sense. That is to say, if I want to do good I must do it very well; if I aim to be good for nothing (that is, if my work does not show up on the balance sheet), then there must be some tangible effect or impact from the process that is of value to my university; if I am not concerned with meeting the ends that my university expects me to, then the means by which I achieve my own ends must be in some way notable.

In a nutshell, I must be good at doing good.