Pensamiento critico

Nursing has a long history; the sick and infirmed have always needed care and historically, this was provided by family members and charitable organisations. The arrival of five religious nurses of the Catholic Sisters of Charity in 1838 and Nightingale-trained nurses, under the supervision of Lucy Osborn to New South Wales in 1868, marked the official beginning of Australian nursing history (Godden and Helmstadter 2004; Lumby and Osmond 2006; Nelson and Greehan 2006). Historically, nursing was ‘women’s work’, and thus, a low status occupation (Smith and Allan 2016:73; Zadoroznyj 1998). Work was tedious, remuneration was low and the majority of young women entering nursing were acquired from the lower classes. Nurses were expected to be obedient to senior nurses, and all were subordinated to the direction of the medical profession (Jasmine 2009; Lundmark 2007). Nursing training was located within the hospital setting in an apprentice-style system and governed by the needs of the medical practitioners. Nursing was ritualised and task based; training fostered instrumental skills as opposed to providing a theoretical basis for task performance (Graham 2010; Nelson and Greehan 2006).

The questionable working conditions, the emphasis on discipline, and the requirement for nurses to live on-site during training, facilitated the

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development of solidarity among nurses (Brennan and Timmins 2012; Keleher 2014). This sense of unity supported the development of a collective nursing culture; a learned system of shared beliefs, attitudes, values and expectations about appropriate ways to behave in certain situations (Madsen et al. 2009). This informed their identity as nurses, which traditionally included the acceptance of the medical profession’s control over nurses (Nelson and Greehan 2006; Water et al. 2016).

The early movement of Australian nursing from an occupation controlled by the medical profession to an established profession in its own right can be traced to the turn of the 20th _{Century (Keleher 2014; Zadoroznyj 1998).}

In Australia, this is evident in the initial formation of voluntary nurses’ registration boards, such as the Australian Trained Nurses Association (in New South Wales) in 1899 and the Victorian Trained Nurses Association (VTNA) in 1902 (Keleher 2014; Lumby and Osmond 2006; Nelson and Greehan 2006). These organisations regulated nursing practice through the formal registration of trained nurses, thus excluding untrained workers from practising nursing. Yet, these State-based regulatory bodies were not given political recognition until the early 20th _{Century (Keleher 2014;}

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State-based nursing organisation played a crucial role in providing momentum towards the attainment of professional status, particularly after the release of The World Health Organisation’s Chittick Report (1968). This report called for urgent reforms to nursing, including introduction of more acceptable working conditions and higher remuneration. In response, nursing leaders, State-based nursing

organisations and nursing unions collectively lobbied for political change. Their endeavours, however were frequently constrained by the male domination of the medical profession and hospital administration (Kanisaki and Johnson 2002; Keleher 2014).

During the 1970s, and into the 1980s, nurses became further resistant to subordination to the medical profession, and their less than ideal working conditions. They continued to collectively lobby for control of nursing education, training, management and working conditions, and became increasingly more ‘militant’ (Zadoroznyj 1998:20). By the mid-1980s, nurses had taken industrial action in four Australian States and one Territory, culminating in the six week Victorian State Nurses’ strike of 1985-86 (Willis 2004). Advanced professionalisation followed and nursing looked to achieve professional status by emulating the professional

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practice as separate from the medical profession, and thus, establishing a ‘professional claim’ (Andrew 2012; Hughes 1963:656; Willis and Parish 1997).

The argument of nursing’s expert knowledge as unique to the specialty practice of care provision was central to moving out from under the shadow of medicine (Wilkinson and Miers 1999). The knowledge and practice of nursing is distinguished from that of medicine; medicine’s focus is curative, whereas nurse’s focus on the provision of holistic care, thus not initially legitimised by medicine (Johnson 1961; Nightingale 1969; Treiber and Jones 2015). The holistic care of nursing involves building ‘therapeutic relationships’ with patients and considering beyond the purely corporeal view of medicine to encompass ‘the whole person’, that is, the psychological, social and cultural aspects of individual’s lived experiences (Allen 2014:131).

State recognition of nursing as both scientific and distinct from medicine was a central movement for nursing’s professionalisation, and this was heralded by the Australian Federal Labor Government’s Minister for Health, Dr. Neal Blewett (1984). From this, Australian nursing training

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rapidly transitioned to tertiary education institutions, and this was a catalyst for the introduction of an evidence- based, as opposed to

traditional task-based approach to practice (Kanisaki and Johnson 2002). Control of nursing knowledge enabled development and on-going expansion and extension of specialty nursing roles and accompanying postgraduate education for nurses, including the establishment of nursing institutions, such as the Australian College of Nursing (previously Royal College of Nursing Australia) (Keleher 2014).

Since mid-1980s, the professionalism of nursing has developed and evaluated tertiary nursing education curricula (Coombs, Chaboyer and Sole 2007; Grealish and Smale 2011), improved working conditions, and increased remuneration for nurses (Zadoroznyj 1998). These evolutions have accompanied the expansion (widening within the limits of nursing education, theory and practice), and extension (widening outside the limits of nursing into the practice of other health professionals) of the traditional nurse’s role (Carver 1998; Magennis, Slevin and Cunningham 1999). While this reshaping is argued to result from increased levels of nursing education, an alternative account suggests it emerges from shortages of medical staff (Coombs, Chaboyer and Sole 2007). Whichever the reasoning, the professionalism of nursing signalled the introduction

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and advancement of postgraduate education courses which encompass a widening array of nursing specialties, as well as the creation of specialist, or advanced nursing roles (Appel, Malcolm and Nahas 1996; Ross, Barr and Stevens 2013; Sheer and Wong 2008). These courses sit in conjunction with the recently introduced necessity of continuing professional

development for Australian nurses so as to maintain currency and continuation of registration (Ross, Barr and Stevens 2013).