Undoing Nurses as Functional Doers

Italian nurses June 2007. Nurses June 2007.
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The IOM/RWJ “Future of Nursing Report” talks about the fact that the vast majority of current nurses are ‘trained’ and have a mind-set of work as functional doers. “Functional doers” they define as “those who carry out the instructions of others–rather than ‘thoughtful strategists’–those who are informed decision makers and whose independent actions are based on education, evidence, and experience.” (p 5-3) I am reminded of one of my nursing school buddies (who dropped out and has done amazing things in health care without a nursing degree) who gave me a stuffed seal with a white nursing hat perched on (her) head–a ‘trained nurse.’ I still have that seal in my office to remind me of what I don’t want to be–and what I don’t want to model being for nursing students who pass through my life.

(An important aside: The term “functional doers” seems to mainly exist in this “Future of Nursing” report and also in a somewhat scary series of reports by some international group called the “Unicist Confederation” whose logo looks like the Trekkie Starfleet Command logo complete with the words “discovery of new frontiers.”They claim to be experts in “complexity sciences–the evolution of adaptive systems.” Perhaps a Unicist was part of the IOM expert panel?)

But apart from a science fiction “fix,” how can we ‘within’ the profession of nursing stop being a (passive aggressive, whining–my emphasis added) pack/herd/pod of functional doers? I think it is an important question for every nurse to ask him/herself. I’ve asked myself and two things action-oriented come to mind for me–things that are within my power to do/do better. One is that I need to step up my game when it comes to teaching my health policy courses for nursing students, and the second is continuing to speak up/advocate for admission of “non-traditional students “(students on the margin) into our nursing programs. I have taught/been involved with nursing admissions in four different academic institutions–here in the US and internationally–and I have seen the same sorts of things happen in all of them. There is a strong tendency (human nature) to choose people who are like us. In nursing education then it translates to choosing students  who are: 1) female, 2) white, 3) middle class Judeo-Christian background, and 4) docile do-gooder. (OK–in the international setting it was the local/cultural equivalent/different religion and race/ethnicity for that setting.) We want conformists, students who won’t question us in/out of the classroom—we want functional doers. So really, how do we undo nurses as functional doers?

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