An essay I wrote during my nursing degree

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Contemporary nursing in Australia has gone through many phases. Nursing was initially a vocation based on religious values, humanism, self-devotion and sacrifice. The fundamental Nightingale system was based on female virtues, emphasis on discipline and displacement of men (Godden and Forsyth, 2000).

Although the practice has evolved, the public image of the profession is still influenced by these historical factors. Many of these factors were caused by female inferiority which caused lack of involvement in science and education; thus nursing as vocation work rather than a profession.

This contributed to the silencing of the nurses of Bundaberg hospital in malpractices cases involving a surgeon named Dr. Patel. Their complaints were ignored and the nurses did not pursue the matter further as most feared redundancy. Tony Hoffman, who finally brought the matter to the parliament, was faced with ethical and professional issues when trying to fulfill one of her roles, as a client advocate.

The system, code of professional conducts, and ethics must be compensated at times to enable nurses fulfilling their obligations. It is argued that the ends justify the means and often an individual's personal life is affected in the process.

This paper will discuss the role of the nurse, historical factors, ethical and professional issues in contemporary nursing practice and factors relevant to the Bundaberg's case.

Historical Factors Contributing To the Bundaberg Nurses' Silence

Gender, science, education and professionalism issues have been reformed in contemporary nursing practice. However, historical factors still influence contemporary nursing practice and contributed to the silencing of the Bundaberg's nurses.

Gender

Women's role played a major factor in gender division in nursing (Godden and Forsyth, 2000). Men were defined as human subjects and women were defined in relation to nature and the feminine (Parker, 2006).

The development of nursing as an exclusively female occupation has therefore had major ramifications for its status and image. This long standing attitude of inequality caused poor self-esteem among nurses and a lack of belief in the value of the nursing role by the public (Bloomfield, 1999).

Science

Nursing was established in Australia during a period of male dominance, patriachialism and female subservience. Men dominated science and women's social position was replicated by nurses' subordinate position in relation to doctors (Bloomfield, 1999).

Operating room nurses were portrayed as "handmaidens" to the surgeons. It implies that nurses' bodies and their practical knowledge are sites of discursive control by surgeons, rather than nursing colleagues and managers (Riley & Manias, 2006).

Vocation

Nursing was practical work based on intrinsic Nightingale values. Holten said (as cited in Bloomfield,1999), Nightingale promoted obedience to doctors, moral development, religious values, discipline, and self-control. These principles were strongly enforced within a rigid hierarchical structure. The position of the nurse now, although respected, is still primarily associated with domestic duties.

Education

The Nightingale apprenticeship system, introduced by Lucy Osburn in 1868, was significantly fundamental and remained substantially unchanged in Australia for about 100 years (Department of Human Services and Health, 1994).

By the end of the 19^th century, hospitals were responsible for training. Different pressures led to policy change in 1983, when higher education for Registered Nurses was supported by the Commonwealth government (Department of Human Services and Health, 1994) and nursing was acknowledged as a profession.

Education equipped today's RNs the ability to think independently and solve clinical problems, once held to be the monopoly of doctors.

Ethical and Professional Issues

The organization of nursing practice in Australia is influenced by historic, social, economic, political and technical factors (Lange & Cheek, 1997). 

Nursing today involves education, body of knowledge, autonomy, and code of ethics. The profession is complex and multifaceted. Nurses' roles include direct care provider, clinical manager, client and family advocate, researcher, and educator (Potter & Perry, 2001).

The information that nurses gather is considered sensitive under the Federal Privacy Act 1988. This resulted in code of ethics, conduct, and boundaries being developed; to ensure community protection and guidance for ethical decision making.

Nurses, therefore, have ethical obligations to the patient, society, government, co-workers and employer. This, and the hierarchy system within the healthcare system, can contradict nurses' obligations to fulfill their roles because of the different power and bureaucracy inside the healthcare and legal system.

Regulatory power is held by the government and accrediting bodies such as the Nursing Board Victoria. Physicians historically had almost unlimited power within the health care system. They have opposed changes that would disperse their power, arguing that they are the most educated and knowledgeable. Nurses commonly have had limited power due to the traditional aspects of nursing. Nurses are most concerned about client well-being in the midst of a powerful system and often responded to negatively when they speak with a voice of reason and act in the best interest of their clients (Ellis & Hartley, 2004).

Pressures divide the nurses' loyalty among patient, employer, and self. It is not unusual for an ethical decision to involve conflict between the best interests of the employer and the patient (Ellis & Hartley, 2004).

Relevant to the Bundaberg case, both the Australian Nursing and Midwifery Council and International Council of Nurses code of ethics state that nurses have an ethical responsibility to report instances of unsafe and unethical practice by anyone. The Bundaberg nurses were fulfilling their professional obligations in reporting Patel's malpractice but were initially ignored by the hospital and Queensland health beaurecracy. The nurses' union argues that the culture of bullying in Health Queensland resulted in the early internal complaints by nursing staff being ignored (Burton, 2005). All, but Hoffman, decided to not get further involved as they fear redundancy. 

Hoffman might have failed to gather consent when she brought the matter to further government bodies. This contradicted the Privacy Act which had to be compensated for the community's benefit, hence, the ends justify the means (Firtko & Jackson 2005). Consequences of whistleblowing can be severe for the whistleblowers as nurses are placed in a situation that they are unfamiliar with, including the law, system, media and politicians. Hoffman, for example, had to earn everyone's trust again and experienced threats (Jones & Hoffman 2005).

Conclusion

I believe that Australian contemporary nursing has evolved. However, the public image of the profession is still influenced by historically influenced traditional views.

Female inferiority developed problems such as lack of education for nurses, as it was viewed as a female's work. These biases therefore contributed to the physician jurisdictive power. One can argue that this factor is not relevant today but in practice, they still and will continue until nurses stand up and exercise their power in influencing policy development.

The contradiction between the law over ethics, bullying and underestimation continue to silence nurses. Nurses are obliged to protect the community and fulfill their roles. However, they are constricted within a rigid hierarchical system.

I believe that nurses should be protected legally, mentally, physically and intellectually. Threats of unemployment and dismissal of reports will discourage nurses in fulfilling their professional obligations. To ensure that nurses can fulfill their diverse roles, there should be laws that protect individuals, their futures and reputations. Therefore, nurses are no longer bullied, as perhaps, their biggest enemy is the whole political and legal system.