Those Who Can’t, Teach


A familiar phrase, and one that I think about often as I teach. It is appropriately humbling, an antidote to hubris. The phrase originates from George Bernard Shaw’s play “Man and Superman: A Comedy and a Philosophy,” from the main character’s “Maxims for Revolutionists.” The phrase is included in a section on education and reads, “He who can, does. He who cannot, teaches.” It is accompanied by: “A fool’s brain digests philosophy into folly, science into superstition, and art into pedantry. Hence, a university education.”  In his lengthy introduction to the play, Shaw writes, “(…) what we call education and culture is for the most part nothing but the substitution of reading for experience, of literature for life (…).” Shaw had a very unhappy childhood educational experience in Dublin, Ireland, was largely self-taught while living in London, and became a life-long ardent believer in socialist reforms.

In a practice discipline such as nursing, the tension between education and practice—between teaching and doing—is ever present. Further complicating this tension is the emphasis on nursing research in university-based nursing schools. Nursing is considered a minor (or wanna be) profession. As Patricia Benner and her co-authors state in their book Educating Nurses: A Call for Radical Transformation (Jossey-Bass, 2009), for the past thirty years nursing faculty and administrators have focused most of their attention on developing nursing research. Benner attributes this to the pressure to increase the prestige of nursing within academic settings. I am still unclear just what “nursing research” does to increase the prestige of nursing—or even what it means. Is nursing research any research having to do with nursing practice or workforce issues? Is it any research having to do with anything as long as it is led by a nurse?  I gave up teaching nursing research because I felt like a hypocrite since I didn’t understand or value it. In my experience, research methods classes taught in schools of nursing are not very rigorous, especially when compared with research methods courses in schools of public health or psychology.

Now nursing practice I do understand and value. I am an accidental nursing educator, and an occasional health services researcher. My first and real love is clinical work as a nurse practitioner. To apply Shaw’s maxim: I can and I do, but I also can’t and I teach. While my students value this clinical relevance, it isn’t valued within my school of nursing. This isn’t unique, as I hear a similar lament from my nurse educator colleagues at other top-rated schools of nursing. It also isn’t unique to nursing, as my academic physician friends tell me the same thing happens in schools of medicine.

Both the Educating Nurses and the IOM Future of Nursing Report emphasize the need for lessening the existing disconnect between classroom theory and clinical practice in nursing education. They point out that many nurse educators have not practiced nursing in many years and, therefore, have a hard time including appropriate classroom experiential learning. Much of nursing theory courses are taught with an overreliance on endless PPTs, busy work, and an emphasis on rote memorization. Nurse educators teach the way they were taught. It is not teaching; it is torture.

One of the most influential books on my own teaching of nursing is Donald Shon’s Educating the Reflective Practitioner (Jossey-Bass, 1987).  It doesn’t mention nursing at all, but is nonetheless applicable to nursing education. In the book he talks about professional practice as more of an art that a science, and emphasizes the teaching of reflection-in-action, a sort of higher-level critical thinking.

Here is his opening paragraph from the book:

“In the varied topography of professional practice, there is a high, hard ground overlooking a swamp. On the high ground, manageable problems lend themselves to solution through the application of research-based theory and technique. In the swampy lowland, messy, confusing problems defy technical solution. The irony of this situation is that the problems of the high ground tend to be relatively unimportant to individuals or society at large, however great their technical interest might be, while in the swamp lie the problems of greatest human concern. The practitioner must choose. Shall he remain on the high ground where he can solve relatively unimportant problems according to prevailing standards of rigor, or shall he descend to the swamp of important problems and nonrigorous inquiry?”

Contrast this with an unfortunate statement in Educating Nurses: “Critical thinking alone cannot develop students’ perceptual acuity of clinical imagination; and cynicism and excessive doubt are often the by-product of the over-use of critical thinking.” The authors have obviously misunderstood the definition of “critical” as applied to critical thinking, where “critical” is understood to be the “exercising of careful judgment or observation.” It is having an inquisitive spirit, questioning underlying assumptions—including one’s own assumptions—of being able to think about thinking. Critical thinking is the opposite of Shaw’s fool’s brain and is necessary for effective swamp work, the terrain of most nursing practice.

Hope is grammar. Hope Dies Last.

Don Quixote and Sancho Panza by Honoré Daumier
Image via Wikipedia

These are two of my favorite aphorisms on hope. The first is from the literary critic George Steiner. The second is from the title of Studs Turkel’s book Hope Dies Last: Keeping the Faith in Difficult Times (The New Press: 2003), and is a phrase he attributes to Jessie de la Cruz, a co-worker of Cesar Chaves. I have been re-reading Terkel’s book, concurrently with Cervante’s Don Quixote Of The Mancha—Shelton’s English translation version from 1611. They go together well.

In the Introduction to Hope Dies Last, Terkel writes: “Hope has never trickled down. It has always sprung up.” He points out that positive change, transforming despair into hope, has always been a bottom up, not a top down affair and is often initiated by groups of troublemakers: activists. The rest of his book is a series of oral histories of a variety of current activists in the US. In one chapter, Linda Stout, the Executive Director of the Amherst-based Peace Development Fund is quoted saying, “Our big challenge is the people’s spirit of helplessness. Power corrupts absolutely, but so does powerlessness.”

Not to make this a Hallmark moment, but I have to bring in a very concrete source of hope I have for the future of nursing. Graduation. Yesterday I had the great honor of seeing many of my most amazing students graduate from our nursing school. I got to hood three newly minted Doctor of Nursing Practice/FNP students who I know are going on to change their parts of the world. One did his research work on both maternal survival and HIV care at the Hope Center in Nairobi, Kenya. Another did her research on cervical cancer prevention in rural Costa Rica. A third did her research on CAM/Integrative Medicine modalities in academic research medical centers in the US. Another student I was blessed to work with did her master’s research on kidney disease and kidney transplants in African-Americans. She’s now on her way to start in a terrific FNP program in the South. And the crop of new BSN students—well, hopefully you will get to read some of their essays they wrote for my health policy class in Narrative Matters sometime soon. Including an excellent essay on men in nursing by a man in nursing. There are many hidden and not-so-hidden nurse activists in the graduation class of 2011. Godspeed! And remember what Don Quixote said (OK—it was really what Peter O’Toole said in Wasserman’s screenplay The Man from La Mancha): “When life itself seems lunatic, who knows where madness lies? To surrender dreams—this may be madness; to seek treasure where there is only trash. Too much sanity may be madness! But maddest of all: to see life as it is and not as it should be.” Go change the world. And health care. And nursing.