Saboteurs come in many disguises
The recent editorial concerned with the sabotage of nursing by its own ‘killer elite’ had a tone and content, which were surprisingly judgemental and anecdotal for such established and highly cited Nursing academics as Thompson and Darbyshire (2013). In our view, the editorial was also disrespectful of the professors of nursing who have worked long and hard to improve Nursing and health care. When considering the UK, the editorial ignored the political and organizational influences on academic nursing, which have contributed to the appearance of the so-called ‘killer elite’ to whom they object.
The opening paragraph declares that the ‘stifling and inhibiting influence’ of this group is out of all proportion to their contribution to nursing, but provides no empirical evidence to support this statement. The authors attributed the appointment of professors of nursing in the 1990s to ‘luck, timing and professional self-interest’. A more detailed look at the history shows that, in the UK, the Project 2000 review of nursing education (UKCC 1986) led to the compulsory movement of nurse teaching from hospitals into universities. In a few cases, these schools joined established departments of nursing such as those at the Universities of Manchester, Hull and King's College London. For the majority, it was always going to be a 30–50-year project for nursing to develop an academic profile comparable to established academic disciplines. We are only about half way through this process, which has had to include rapid development of academic staff and only now, in 2013, achieving entry at degree level for all students starting their nursing careers in England. The recent Willis Commission (2012) report on nurse education unequivocally supports nursing as a graduate discipline.
Thompson and Darbyshire's argument would have been more convincing had they included a scholarly critique of a university culture, which was happy to accept a large influx of people, with few academic credentials, while enjoying the considerable government funding that came with them. It appears that relatively little of this money was used for internal investment in the research development of staff motivated to take their place in an academic environment. In what was a sink-or-swim environment for many, individuals coped in different ways with these imposed changes. A small number may have been promoted beyond their abilities, but the vast majority worked hard to meet the expectations of a university culture. Some poor academics have become successful self-publicists in the ubiquitous celebrity culture and, we agree, that this is undesirable and unhelpful to the profession – but it is a small minority.
Since integration into universities, nursing in the UK has been caught between two masters. NHS funding has been provided for teaching only purposes, while their employers, the universities expect research to be a central part of the academic endeavour. This tension has never been resolved and has impeded development of a research culture. Furthermore, the damage inflicted by the so-called ‘killer elite’ is negligible compared with that resulting from swingeing financial cuts from both Strategic Health Authorities and universities over the past five years. These have further damaged the development and sustainability of professorially led nursing research teams that include junior academics and PhD students and build the academics of the future. Other disciplines have also been affected by cuts, but responded by collaborating rather than undermining their own disciplines. For example, in response to primary care departments disappearing from universities, national funding was obtained and primary care groupings awarded membership of the National School of Primary Care on the basis of strict research criteria. The value of this approach is demonstrated in opportunities for cross university research collaborations and studentships (www.nihr.ac.uk/research/Pages/programmes_primary_care_research.aspx). Nursing should consider a similarly strategic approach to research rather than resorting to internal sniping. For example, the recently formed Academy of Nursing, Midwifery and Health Visiting Research UK (www.researchacademy.co.uk) has the potential to enhance academic collaboration.
To profess nursing is not simply to accumulate orthodox academic metrics such as authorship on numerous papers, highly cited research outputs, and impressive h-indices but also to take the profession of nursing forward. It is the impact of research that matters, as exemplified in the requirements for the upcoming UK Research Excellence Framework. Thompson and Darbyshire's assertion that clinical professors of nursing and those with joint NHS appointments have performed poorly was glib and ignored contextual issues. Their argument would have been more convincing had they critiqued the influence of the politics and power of the NHS. Much of the health service has a tick box culture, requiring a tick against research, but in reality, simply wants nurses trained who are ‘fit for purpose’. Even trusts that genuinely support research for nursing have virtually no resources to support it at a local let alone internationally excellent level. This makes joint appointments difficult, inevitably reducing research outputs in comparison with Professors based wholly within universities. At the same time, whilst Thompson and Darbyshire sneer at service development, there are examples of nursing professors who are leading the Collaborations for Leadership in Applied Health Service Research (CLAHRCs) and making serious contributions to improvements in health care.
A clear academic–clinical career pathway for nurses is generally agreed as the way to progress and develop a research profile over a whole career while maintaining clinical expertise. While new and small in scale, the NIHR clinical academic awards and the NIHR Mentor scheme offer hope for nursing to grow the next generation of competent researchers to help address the global health issues of the 21st century.
In conclusion, we agree that nursing is too important to be held hostage by anyone. It may be another 20 years before a critical mass of high-quality nursing researchers is achieved across the UK. Time and energy would be better spent now thinking strategically about how academic activities can continually be improved within nursing, for the benefit of the public. School-yard finger pointing at those naughty ‘killer elite’ is unlikely to change anything for the better.