I was asked to speak at a conference this week; sitting on a panel to discuss the ‘6Cs of nursing’. I thought that for a brief blog post I would share some of my thoughts that I had in preparation for this discussion. As it played out the discussion was interesting, although not quite the ‘debate’ that was proposed – instead simply being single panel members responding to audience questions. As such there wasn’t a great deal of depth to the discussion, but it was still an interesting experience.
My thoughts were that this listing of values to be adhered to had something of the Virtue ethics position to it – values that would be displayed by ‘good’ nurses. My concern however lies in the apparent individualistic nature of these discussions – rooting virtues within the individual member of the nursing team and not also within the institution as a whole.
Nursing is clearly an anxiety provoking experience and therefore individuals will take ‘defensive’ steps (both health and otherwise) in order to allay this anxiety. However it is important to note that institutional ‘group dynamic’ processes will also develop wherein the institution as a whole re-positions itself in order to minimise the collective anxiety of its constituent parts.
I think this can be seen in examples of institutional denial – where concerns raised by individuals within the institution are ignored, or minimised in a form of collective denial. There is also a risk, in keeping with the individualistic trend that is so rampant in society at the moment, to focus solely on individual responsibility in the face of distressing experience. This is not to deny the agency of individuals – but to my mind it is rare that ‘bad apples’ develop in the absence of ‘bad barrels’; few, if any, people will enter a profession such as nursing with the intent of being ‘abusive’ yet the existence of abuse within institutions speaks to someway in which peoples behaviour has become unmodulated. It is possible that this exists solely on an individual level, but my personal feeling is that group dynamics will be involved to a greater, rather than lesser, extent.
So there is a risk in focussing on the individual – leading to temptations to scapegoat individual nodes within networks, and thus allowing collective institutional denial to continue unchallenged. We need to be wary of this and develop structures that encourage clear communication and recognition of distress within both individuals and wider collective groups.