the evolution of a profession - Semantic Scholar

THE EVOLUTION OF A PROFESSION Paper presented at the symposium Is a professional Association the answer? CHARLOTTE SEARLE

OPSOMMING Die begrip professie het ontstaan toe geneeshere, prokureurs, onderwysers en ander geleerdes in die kerkdiens georden moes wees. Hulle het bely (profess) voordat hulle die besondere diens kon lewer. Later het sekulêre groepe vir die verskillende beroepe ontstaan in die vorm van gildes, gevolg deur kwalifiserende verenigings in die 19de eeu. Uit hierdie organisasies het die kern konsepte ontwikkel wat as kriteria vir professionalisme dien. Die opvatting dat universiteitsopieiding en privaatpraktyk kriteria vir professionalisme is, het eers later ontstaan en is ongeldig in die lig van bogenoemde. In Suid-Afrika voldoen verpleging aan die kriteria vir professionalisme. Dit beteken egter nie dat elke verpleegkundige se optrede professioneel is nie. Baie aanvaar nie hulle professionele verantwoordelikhede, soos verantwoordbaarheid vir hulle eie optrede nie. Die funksionele taaktoewysing wat in baie hospitale steeds voortbestaan negeer ook die professionele model. Die verpleegkundige moet aangemoedig word om professioneel te wees in die wyse waarop sy haar rol vertolk en die beeld wat sy voorhou.

THE ORIGIN SIONS

OF

PROFES­

T h e w ord p ro fessio n d eriv es from the L atin p ro fiteri — to m ak e an o p e n o r p ublic sta te m e n t o f o n e ’s beliefs an d in te n tio n s, o n e ’s ac­ k n o w led g em en t o f a c e rta in fact. In th e m o d e rn sense th e w o rd has com e to d escrib e collectively the n a tu re o f an o c c u p a tio n , th e p ra c ­ tice o f w hich re q u ire s c e rta in a d ­ vanced p re p a ra tio n in som e liberal a rt o r ap p lied science. T h e practice is c h a ra c terise d by som e form o f ex­ clusiveness (such as only th o se w ho are q u alified in a c e rta in a re a of study m ay p ractise th e p ro fe ssio n ), by c o m m itm e n t, an d by o b s e r­ vances o f an eth ical n a tu re . T h e c o n cep t o f a p ro fessio n is copied from th e m edieval guilds in w hich th e m e m b e rs o f th e various highly skilled tra d e s b o n d e d to ­ g e th e r to fo rm u la te a n d u p h o ld high sta n d a rd s , to tra in n e o p h y tes in th e p a rtic u la r c ra ft, to socialise th ese le a rn e rs in to a b ro th e rh o o d , and to p ro te c t th e ir m em b ers. A s th e early learned occupations d e ­ v e lo p e d , th ey fo rm e d societies and associations w hich e v en tu ally fu l­ filled th e sam e ty p e o f ro le as a m edieval guild. T h e y p ro fe sse d c e r­ 4

tain levels o f know ledge, certain skills an d certain beliefs, an d in tim e b e ca m e know n as p ro fe s­ sionals. M illerson says: O f all sociological ideas, o ne o f the m o st d ifficu lt to analyse satisfactorily, is the concept o f a p rofession. (M illerso n , 1964 p . l ) H e believes this is d u e to se­ m an tic confusion, stru c tu ra l lim ita­ tions arising out o f a tte m p ts to d e ­ s c rib e u n iv e rs a l f u n d a m e n ta l ch aracteristics of a p ro fessio n , and th e slavish ad h eren ce to a static m odel, rather than the appreciation o f the d yn a m ic process in vo lv ed in p ro fessionalism (M illerso n , 1964 p . l ) . T his is the crux o f th e situ ­ atio n .

THE EVOLUTION OF A PRO­ FESSION L et us lo o k at how professions evolve, and let u> th en ex am ine the nursing profession in S outh A frica against this backdrop. P rio r to th e 13th C e n tu ry , anyone w ishing to be a physician, law yer, se c re ta ry , surveyor, a rc h ite c t, te a ­ ch e r o r diplom at, h ad to tak e H oly O rd e rs, th a t is, he h ad to jo in the C h u rch . H e professed. (M illerson, CURATIONIS

1964, p. 16) G ra d u a lly , a fte r th e dis­ solution o f th e m o n a ste ries (1536 to 1539) this practice d isa p p e are d . Law w as th e first secu lar profession to be o rg a n ise d . T h e m edical p ro ­ fe ssio n rem a in e d u n o rg an ised up to a b o u t the 16th C e n tu ry w hen c e r­ tain guilds fo r physicians and for surg eo n s w ere esta b lish e d . It r e ­ m ained only superficially o rg an ised up to th e m iddle o f the 19th C e n ­ tu ry , only a few y ears b efo re F lo ­ rence N ightingale sta rte d h e r life’s w ork. T h e m ost n o ta b le an d sp ec tac u lar d e v elo p m e n ts cam e in th e 19th C en tu ry w ith th e rise o f th e q u alify ­ ing associations. P ro fessionaliza­ tion, as a process, d iffu sed through m any occupations by m eans o f the Q ualifying A ssociation. This type o f association d em o nstrated an ability to convert occupations into p ro fe s­ sions. (M illerso n , 1964. p .25) T hey o rg an ised the m e m b ers o f the p a rti­ cular o c cu p a tio n , p ro v id ed train in g courses and co n d u c te d e x a m in ­ ations so th a t a c ertain identifiable m ark o f quality w as a tta c h e d to the p rac titio n ers. T h e un d erly in g c o n ­ cep ts w ere — th e n e ed to e n su re p ro fessio n al conform ity VOL. 5 NO. 3

— th e m a in te n a n c e a n d d e ­ v elop m en t o f sta n d a rd s — th e elim in atio n o f co m p etitio n — th e n e e d to im p ro v e th e statu s o f th e m em b ers. T o this en d certain core p ro fess­ ional co n cep ts w ere d ev elo p ed nam ely th a t — the pro fessio n p ro v id es a service for th e public an d th a t this enjo ys p re c e d e n ce at all tim es — th e proficiency o f m em b ers has to be b ased on certain id en tifi­ able skills, a ttitu d e s an d a body o f th e o re tic a l know ledge. C o m ­ p eten ce has to be te ste d by m eans of ex am in atio n s — th e m em b ers have to subscribe to a code o f co n d u ct an d o f e th i­ cal no rm s an d values — the professio n is clearly id en tifi­ ab le, w hich m ean s th a t its p ra c ­ titio n e r s p ro fe s s a d is tin c t s p e c ia lis e d s e r v ic e a n d th e public m ust recognise it as such. T his was th e p o sitio n at th e turn of th e 20th C e n tu ry . T h e V ictorian era th a t en co m p assed m ost o f the 19th C en tu ry an d th e early p a rt of th e 20th C e n tu ry , saw th e hey-day o f capitalism — th e free e n te rp rise system , in B ritain an d h er colonies, E u ro p e an d th e U n ite d S tates o f A m erica. T his was th e e ra o f great individual capitalists w ho fo u n d ed en o rm o u s in d u strial em p ires, and this w as th e e ra o f th e p riv ate g e n ­ eral m edical p ra c titio n e r. So we find th a t a new dim en sio n is ad d ed to th e co n cep t o f pro fessio n alism , nam ely th a t th e p ro fessio n al p erso n is a u to n o m o u s an d is en g ag ed in his ow n p ractice. F le x n e r in th e U S A s tr e s s e d th is c o n c e p t, b e c a u s e A m erica at th a t tim e w as o n e of the m ajo r stro n g h o ld s o f th e free e n te r­ prise system , w hich it still is, and which n atu rally influences th e p o si­ tion o f the A m erican nurse on p ro ­ fessionalism . A t th e sam e tim e the drive for w id esp read university e d u ­ cation d ev elo p ed in A m e ric a , so th at in c o n tra st to th e qualifying association a p p ro a c h in G re a t B ri­ ta in , the university e d u c a tio n a p ­ p ro ach was p o stu la te d in th e U n ited S tates. M uch has b een said in A m erican lite ra tu re a b o u t th e fact th at all n urses do not have a u n iv er­ sity ed u c a tio n , an d d o n o t con tro l th eir ow n p ractice, th a t is, are not in p riv ate p ractice, an d hence SEPTEMBER 1982

can n o t be sionals.

re g a rd e d

as p ro fes­

T his sta n d p o in t is rejected on the basis th a t a university degree is n o t th e only c riteriu m for idm ission to a p rofession in W e s te n E u ro p e and B ritain w h ere m em bership o f the p restigious qualifying associations have g re a te r status th a n university degrees. M oreover, h u n d red s of th o u san d s o f professionals includ­ ing learn ed judges are salaried em ­ ployees. F lexner p ro p o u n d e d his th e o rie s befo re th; m ass ad v en t of socialism . If th e premise is correct th a t p riv ate p ra ctce is an essential criteriu m fo r professionalism , then all law yers, doctors, en g in eers, arch itects and the like in socialist and com m unist countries and all salaried professionals in o th e r co u n ­ tries are d ep riv ed o f th e ir p ro fes­ sional statu s at a stroke o f th e pen. In o th e r p ro fe sso n s, w ho are not so co n c e rn e d about th e validity of th e ir professional statu s as nurses a p p e a r to b e, th e r; is a ten d en cy to accept th a t the term profession oug h t to be applied freely to anyone able to demonstrate a high standard o f exa m in ed competence, experi­ ence, achieved responsibility and g o o d education. iM illerson, 1964, p .212) M any accept W ard D a rle y ’s p o in t of view th a t the truly p ro fe s­ sional person is one who, by virtue o f intellectual capacity, education and m o ra l o u tlo o k, is capable o f the exercise o f intellectual an d m oral ju d g e m e n t at a high level o f respon­ sibility. (D a rle y , 1971, p .83) H e m akes th e p o in t ihat ju d g e m e n t is based on b ro a d know ledge, p e n e ­ tra tin g w isdom about th e p a rtic u ­ lar circu m stances in d a g rea t m oral certitu d e a b o u t one’s actions.

THE SOUTH AFRICAN CON­ TEXT A sketch o f th e developm ent o f the profession o f n irsin g in South A frica, w ould be too lengthy so this discussion is confined to the criteria form ing the conceptual fram ew o rk o f p ro fessionalisii for nursing in South A frica. It can be describ ed as follows • th e specialised know ledge and skills pertaining to th e profession o f nursing are based on a b ro ad fo u n d a tio n of th e o retic al know ­ ledge. T his th eo retical know ­ CURATIONIS

ledge is draw n from — the sciences basic to m edicine (th e biological, physical, m ed i­ cal and social sciences) — the age-old accum ulation o f e m ­ pirical know ledge a b o u t the in­ stru m en ta l and expressive func­ tions o f the nurse at any point along the co n tin u u m o f health care — the legal and ethical fo u n d atio n s on w hich practice o f the p ro fes­ sion rests — the specialised function it fulfils in society • th e exp ertise know n as nursing is based on a clearly defin ed and w ell-organised body o f know ­ ledge, with a c o n tro lled system of ed u catin g and train in g th e n e o ­ phyte • th e a sp iran t to professional status m ust p rove his co m p e ten c e by su bm itting p ro o f o f the ed u catio n he has u n d e rg o n e fo r th e p u rp o se and m ust successfully co m p lete a professional ex am in atio n . T h a t p a rt o f the ex am in atio n dealing w ith practising the profession and w ith th e synthesis o f all the know ledge th a t cu lm inates in professional acts m ust be co n ­ du cted by m em b ers o f th a t p ro ­ fession • the p ro fessional integrity o f the p ra c titio n e r is re g u late d by e n ­ forcing th e o b serv an ce o f an e th i­ cal code an d o f th e n orm s o f his p ee r-g ro u p as well as th o se of society. T h e p ro te c tio n o f society is a p a ra m o u n t fe a tu re in such n orm s and ethics • the d esignation o f reg istered (professio n al) nu rse is a te m p o ­ rary o n e , w hich can be rem o v ed from th e h o ld er u n d e r c ertain cir­ cum stances. A nu rse w hose n am e is rem o v ed from th e re ­ gister fo r any rea so n w h atso ev er, e ith e r for v o lu n tary o r discipli­ nary reaso n s o r fo r n o n -p ay m en t o f registratio n fees, m ay n o t use th e title o f re g iste re d n u rse, n e ith e r m ay she p ractise nursing fo r gain in any capacity w h a t­ soever. T his w ould c o n stitu te a crim inal offence • the service re n d e re d by th e p ro ­ fessional n u rse m ust rela te to the w elfare o f th e com m unity. T his m ust at all tim es ta k e p rec ed e n ce w hen decisions in reg ard to the practise o f th e profession have to 5

be m a d e . (T his d o e s n o t m ean th a t th e pub lic can ex p lo it th e p ro fessio n al p ra c titio n e r). It m ust reco g n ise th e dignity an d rights o f o th e rs • a p ro fessio n al n u rse is held ac­ co u n ta b le fo r h e r actio n s b o th to th e law an d to h e r p e e r-g ro u p (th e o th e r m em b ers o f th e p ro ­ fession as e m b o d ie d in th e South A frican N u rsin g C o u n cil). T his, o f c o u rse , also app lies to o th e r categ o ries o f n u rses

•

•

• th e p ro fessio n al n u rsin g g ro u p is an o rg an ised g ro u p in th e c o m ­ m un ity w ith a co m m o n goal • th e m e m b e rs o f th e n u rsin g p ro ­ fession show subco n scio u s as well as conscious aw aren ess o f id e n ­ tity w ith o th e r m e m b e rs o f th e gro u p . T h ey a re an in-group • th e re is a su b stan tial level of u n i­ form ity in th e w ay in w hich the m e m b e rs o f th e g ro u p view the final o b jectiv es o f th e ir role (n u rse-clin ician s, n u rse-ad m in istr a to r s , n u rs e -te a c h e rs and n u rse -re se arc h e rs all have one final e n d in view fo r th e ir service — b e tte r h e a lth care fo r th e peo p le o f th e ir c o u n try an d for o th e rs b ey o n d th e b o rd e rs of th e ir co u n try seek in g th e ir care)

•

•

• the n o rm s a n d eth ics of th e group are d e v e lo p e d by th e g ro u p • th e p ro fessio n is su b jectiv ely r e ­ cognised by its ow n m e m b e rs an d legally by P a rlia m e n t, because th e public is willing to accep t the o ccu p atio n as a p ro fessio n . B e­ cause o f its im p o rta n c e to the co m m u n ity , th e pub lic g ra n te d it -^co g n itio n an d sta tu s a n d , at the sam e tim e , d e sire d to c o n tro l it. It reco g n ised th e sta tu s o f the p ro fessio n by vesting this co n tro l in th e p ro fessio n itself. T h e p ro ­ fession is also reco g n ised by o th e r p ro fessio n s an d is m e n ­ tio n e d in a v ariety of A cts o f P a r­ liam en t d ealin g w ith h ealth legis­ latio n as a p ro fessio n w ith special d u ties • th e re is an obvio u s se n tim e n t th a t th e p ro fessio n al n u rse b e ­ longs to an exclusive g ro u p th a t m ust m e e t th e high sta n d a rd s of p ractice. O n ly th o se w ho have co m p lied w ith th e sta n d a rd s of 6

•

adm isiion are ad m itte d to the g ro u p th e m e n b e rs of the profession have prescribed m eans o f a d m it­ ting new n e m b e rs to th e p ro fe s­ sion. O n c tth e m e m b e r has been accep ted irïo the g ro u p she is ex ­ p ected to observe the norm s and ethics o f the group and to assum e special respo isib ilities to w ard s co lleagues, clicnts, p a tie n ts, and th e public at large as a re tu rn fo rth is o b se rv a n ce of th e g ro u p n a m s , the m em b e r m ay o b tain i p ro te c te d title, w ear c ertain irsignia and use c e r­ tain lette rs alter h e r n a m e; all this en su res a certain statu s th e reco g n itio i o f the g ro u p as a profession by th e law has re ­ sulted in the celegation o f rights an d privileges to th e g ro u p ; in th e use o f the services o f the g ro u p to th e exclusion o f o th e rs w ho wish to re id e r th e service; in official re c o g n tio n as a se p a ra te service g ro u p in re q u e sts for advice from the g ro u p ; and in aw ard s o f special statu s sym bols, titles and honours th e p rofession has a stro n g p ro ­ fessional association to organise and d e v elo p ; to act as th e voice o f th e profession; to e n su re p ro ­ fessional standards; to regularise th e a p p ro a ch to th e p ro b lem s of th e p ractice of the p ro fessio n ; to act as watchdog o v er the progress o f th e law , reg u la tio n s and a d m in istrativ e asp ects as a m a tte r o f public d u ty ; to advise on th e system tfising o f train in g , th e rationalising o f selec tio n , and th e fo rm ing of a basis fo r d e ­ v elo p m en t within th e p rofession itself th e p rofession is co n tro lled by th e p ro fession itself, u n d e r d e le ­ g ated responsibility from P a rlia ­ m en t th ro u g h :he S outh A frican N ursing C o u n :il, in resp ect of th e critical elem ents o f p ro fe s­ sionalism, namely: prescribing ad­ m ission stan dards, e d u c a tio n , an d syllabi, approving and in ­ specting n u rsin j schools, e x am in ­ ing c o m p e te n t; reg isterin g and p rescrib in g the reg u latio n s re la t­ ing to professional p rac tice, and d isciplinary control. T h e South A frican N ursing C ouncil like the S o u th A f r ic a n M e d ic a l a n d D e n ta l C ouncil is o n e o f th e su b ­ CURATiONIS

o rd in a te legislative a u th o ritie s of th e c o u n try w hich p rescrib es p ro ­ fessional p ractice re q u ire m e n ts. W hilst th e ab ove crite ria e s ta ­ blish that nursing in South Africa as a c o rp o ra te en tity w a rra n ts th e reco g ­ n ition P arlia m en t has b esto w ed on it in the N ursing A c t, it m ust be said th a t n u rsin g , like teach in g , social w ork and the p a ra m ed ic al o ccu p a­ tions, is in varying stages o f d e ­ v elo p m en t in m any c o u n trie s. T he statu s o f w o m e n , e d u c a tio n a l b a c k ­ g ro u n d of e n tra n ts to th ese p ro fe s­ sions, th e social origins o f the m e m ­ b e rs, so ciety ’s n e ed fo r a p artic u lar service and n u m ero u s social and legal c o n strain ts all affect th e e v o lu ­ tion of pro fessio n s. T h e a u th o r is the first to ad m it th a t nursing does n o t w a rra n t th e d esig n a tio n p ro fe s­ sion universally, b u t sh e, lik e so m any law yers a n d sociologists in S outh A frica, has no d o u b t ab o u t its full p ro fessional statu s in this country.

PROFESSIONALISM H aving sta te d th a t nursing as a co r­ p o ra te en tity in S outh A frica is a p ro fessio n , th e q u estio n m ust be raised as to w h e th e r all n urses are p ro fessio n al? Being a profession, and having all m embers acting as professionals are not necessarily synonom ous. It has b ee n m ade clear th a t th e id ea th a t professionalism re q u ire s p riv a te p ra ctice is o u t­ m o d ed . T his c o n c ep t n eg ates the p rofessional co n cep t in socialist co u n trie s and in situ atio n s w here th e p erso n is in salaried em p lo y ­ m e n t, be he m in iste r o f th e ch u rch , d o cto r, law yer, arc h ite c t, e n g in e er and the like. In th e c o n tex t o f w orld d ev elo p m e n ts in th e 20th C en tu ry the co n cep t o f being in charge o f one's ow n practice can be in te r­ p re te d in a d iffe ren t w ay. H e re lies th e crunch. O f co u rse every r e ­ g istered n u rse in S outh A frica is in charge o f her ow n practice. N ot a priv ate fee-for-service practice but a practice in th e every d ay h ea lth team situ a tio n where she, and she only, accepts personal responsibility and remains accountable for all her actions. Only she can decide whether she is able to or should carry out a particular aspect of nursing. She is accountable for how she relates to other team m em bers, how in a joint VOL. 5 NO. 3

responsibility with the doctor she will share in the patient’s diagnosis and treatm ent and accept responsi­ bility for care. W hen she accepts a patient into her charge, she becomes jointly responsible for him with the doctor. She controls her practice in relation to this patient. Neither she, nor the doctor is an autonomous practitioner for such a practitioner does not exist, both are responsible to the patient, their registration authority and the law of the land. They are accountable and if one is accountable, one cannot be autono­ mous! She is th e re fo re solely re ­ sponsible for h e r ow n practice w h eth e r this is in a fee-for-service situ atio n o r in a salaried situ atio n w here she has to accept resp o n sib il­ ity fo r a n u m b e r o f p a tie n ts sim u lta­ neously. T his is th e basis o f h e r p ro ­ fessional p ractice in S o u th A frica — she is acco u n tab le for h e r p ractice and h e r decisions. H e re in S outh A frica th e re is no lim it to w hat th e nurse m ay d o as a nurse such as th e re is in co u n tries d o m in ated by tra d e u nions. C ir­ cum stan ces, social n e e d , th e co n ­ science, th e k n o w led ge, th e skills and the acco u n tab ility o f th e n u rse, and above all th e im m ed iate n eeds o f th e p a tie n t, m ust decide w hat she shall do an d w h ere, how and w hen she shall do it. In every o n e o f these aspects she is held acco u n tab le. B ut how m any reg istered nurses accept th e ir respon sib ility in this way? H ow m any o f th em have tu rn e d them selves in to th e h a n d ­ m aiden o f th e d o cto r? If you feel nursing is not a p ro fessio n th e re is a screw loose so m ew h ere. You are not being a professional in the way the law permits you to be one. L et us tak e a n o th e r p o in t — are th e re not som e n u rses w ho see th e clim bing of th e ad m in istrativ e la d d e r m ore im p o rta n t th a n clinical nursin g , the core o f o u r p ro fessio n alism ? T he fact th a t a d ifferen t uniform is w orn once o ne e n te rs th e ad m in istrativ e n u rs in g h ie ra rc h y sh o w s th a t ad m in istratio n an d teach in g are co n sid ered as being m ore im p o rta n t th an clinical nursing.

SEPTEMBER 1982

T h e fu n ctional assignm ents so b e ­ loved in m any institu tio n s indicate th a t th e re are nurses w ho are not thinking professionally, th ey are th in k in g a b o u t things an d jo b s, not a b o u t th e p e rso n -to -p e rso n total responsibility th a t is in h e re n t in a p r o f e s s io n a l p r a c tic e s i t u a t i o n . D oes fu n ctional assignm ent not d e n o te a facto ry -flo o r app ro ach ra th e r th a n a professional a p ­ p ro ach ? In a crisis th e professional responsibility is to en su re th e g re a t­ est good fo r th e g re a te st n u m b er and fun ctio nal assignm ents then have a place in nursing, b u t still, the n u rse ’s p rofessional role and re ­ sp onsibilities are d e n ig ra te d to the level o f th e factory-floor. It is not im plied th a t factories a re u n im p o r­ ta n t — only th a t th e ir m e th o d s are industrial to suit th e ir ends. N ursing is p ro fessio nal to m e et the n eed s of hu m an beings — th e p a tie n ts. F u n c­ tio n al n ursing is an industrial m o d el, n o t a professional m odel. Q u ality p a tie n t care ca n n o t be achieved, nor can th o se w ho have fallen by th e w ayside in th e p ro fe s­ sional h an d ling o f th e ir practice see them selves in charge of th e ir own professional p ractice unless nurse lead ers reprofessionalise nursing practice w h erev er th e industrial m odel has p e n e tra te d . If they en su re th a t nurses use th e concepts of th e n ursing process (o r scientific m eth o d a p p ro a c h ), and th a t such m od alities o f nursing care as patient allocation, team nursing o r even p ri­ m ary nursing a re p ractised ; if they cut dow n on som e o f th e ir reg u la ­ tions w hich tells the nurse, all the tim e w hat she has to d o ; if they e n ­ cou rag e th e individual reg istered n urses to m ake th e ir ow n decisions, to recognise th a t th ey are jo in t p a rtn e rs w ith th e d o c to r in th e care of th e p a tie n t, w ith an eq u a l level of acco u n tab ility , w hilst resp ecting his lead ersh ip ro le; if they ensure that nurses know that personal profes­ sional practice and personal account­ ability legally takes place in every nursing situation in our country; the you n g er m em b ers o f the profession will n o t n eed to d o u b t, as som e in­

CURATIONIS

evitably do now , w h e th e r th ey are professionals in th e d e e p e st and richest m ean in g o f th e w ord. H ave they n o t p ro fessed th e ir know ledge and skill of n u rsin g , th e ir b elief in the m eaning o f this im p o rta n t occu­ p atio n and th e ir co m m itm en t to its cause w hen th ey to o k th e pledge of Service at th e L am p C erem o n y ? W hat has gone w rong, an d how do we p u t it right? Should every regis­ te re d nu rse n o t com m it h erself anew by rep ro fessionalising her practice by accepting a o n e -to -o n e relatio n sh ip with h er p a tie n ts, by providing individualised c are for which she is acco u n tab le an d by epitom ising th e co n cep t o f th e early professions? T h e p ro fessio n al p ra c ­ titio n e r is a g en tlem an o r a lady in the w idest sense o f th e w o rd , she is one w ho has p rofessed, w ho has m ade an o p en o r public sta te m e n t o f h e r beliefs and in ten tio n s as a nurse. H e r public sta te m e n t can now be describ ed as th e way she enacts h e r role as a n u rse — w hat sort o f role m odel she is, how m em ­ bers o f th e m ulti-disciplinary h ealth tea m , th e p a tie n t an d p ub lic, the stu d en t nu rse an d fellow nurse p ra ctitio n ers see h er. In fact does she p ro je c t an im age o f a p rofessed nurse? T his is th e crux o f th e w hole issue!

References and General Bibliography M illerson, F T he qualifying associations R o u tled g e & K egan Paul L o n d o n 1964 D arley, W The p rofessions an d p ro fessio n a l p eo p le N ursing F o ru m I 1961 Tow le, C h a rlo tte The learner in education f o r the pro fe s­ sions U niversity o f C hicago Press C hicago 1954 Strauss, S A ; S try d o m , M J D ie S u id -A frika an se Geneesku n d ig e Reg V an Schaik B e p e rk P re to ria 1967 The British N ursing Record V olum e I A p ril 1, 1888 B ern ard , J; T h o m p so n , L Sociology — nurses and their patients in m o d ern society C V M osby St L ouis 1966 S earle, C T estim ony to fifty years o f service 1914-1964 S A N A P reto ria 1964 The M edical an d P harm acy A ct, 1891 (A c t 34 o f 1891) (R e ­ gistration o f M edical P ra ctitio n e rs, A p o th e c aries, D en tists, C hem ists a n d D ruggists, M idw ives and N urses) The N ursing A ct, 1944 (A ct 45 o f 1944) The N ursing A ct, 1978 (A c t 50 o f 1978,) as a m ended The M edical, D ental a n d S upplem entary Health Service Pro­ fessions A c t 1974, (A ct 56 o f 1974), as am ended.

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