Whilst the study suggests a growing confidence in identity on an individual and collective basis, there is still a challenge around public identity as the image of nursing remains fixed on the ‘traditional’ notions of nursing, compounded by images of uniforms and hospitals. The media portrayal of nursing today includes social media, an area in which nurses have also been able to generate social capital through links with other nurses. Public perception, however, remains focused on nursing as a low paid, female-dominated profession, based in hospitals. This negative image is reflected in learning disability nurses’ self-image that in turn is then reflected in the nurses’ presentation of self-influencing public perception. While learning disability nurses describe themselves, as ‘not proper nurses’, society will assume the same. Many of the nurses in my study highlighted public perceptions in their narratives, their families, friends, other nurses, all represent the public view of learning disability nursing. In the early stages of choosing learning disability nursing many reported negative views
Understanding identity from both an individual and collective perspective allows for diversity, it is ok to be different within a collective, and therefore this is the case for learning disability nurses within learning disability nursing and for the collective of learning disability nursing within the wider family of nursing. The narratives within this study have offered individuals an opportunity to negotiate their identity, to present an image of themselves for acceptance by another. Identity as a learning disability nurse was clear in the narratives, but these were being listened to, read and interpreted by someone from within that collective with a shared understanding. Individual nurses know who they are and what they do, however, the public know
less and, as a profession, there have been difficulties articulating the learning disability nursing identity.
Social Identity Theory offers a framework on which to consider the professional identity of the learning disability nurse. The findings in this study suggest that the professional identity of learning disability nurses is shaped through the following:
• Individual identity • Training and education • Working lives
• Collective identity
Individual identity was articulated through the values and beliefs suggested as held by participants but also the reasons and justifications suggested for choosing learning disability nursing as a career. Training and education is a key influence in the creation of professional identity, and narratives of the participants in this study describe challenges and reaffirmations of their choices of learning disability nursing as a career. The working lives of the participants when taken as a whole represent a diverse range of employment within and outside the NHS, and the suggestion of a tension within the perceived identity of a nurse and that, more specifically, of the learning disability nurse, which was highlighted in the numbers of participants who describe themselves as ‘not a proper nurse’.
The participants also embed within their narrative notions of collective identity, identifying the key relationships with other learning disability nurses but also using a common language to describe themselves. The creation of this new learning disability nursing identity takes place in a historical context of change; changes in service provision, in employment opportunities, in education, and in the way in which society perceives people with a learning disability. The past 30 years have seen significant change in all of these areas, making it timely to reconsider the identity of the learning disability nurse. Recent report Strengthening The Commitment suggests the values of the learning disability nurse (UK Chief Nursing Officers, 2012) but does
not suggest an identity model which could provide a framework for recruitment, education and employment, of learning disability nurses across the UK.
Understanding the learning disability nurse through their narrative facilitates an understanding of components of identity and through this we are able to interpret the meaning of being for learning disability nurses. Previous identity models have focused on a ‘hidden’ profession and oppression and marginalisation, with some associated stigma (Goffman, 1968). It is suggested that the learning disability nurses participating in this study, whilst highlighting elements of marginalisation, narrate a strong identity around advocacy, empowerment and facilitation. Fig 5 represents this transition in identity over the past 30 years that is highlighted by my study.
Fig. 5 Identity transition
Inclusion identity
Empowerment Advocacy Facilitation
Reshaping of nursing idenPty
Roles Health facilitation Community nursing residential Relationships Based on respect empowerment more equal power base Service Provision Diverse environments in health and scoail care independant living inclusive Practice In diverse settings multi disclinary teams inclusive settingsStruggling roles
Empowerment Advocacy FacilitaPon
Historical IdenPty Imposed marginalised idenPty Roles insPtuPon based nurses NHS employees Rela(onships 'nurse as the oppressor' Service provision InsPPonal care in long stay hospitals Prac(ce Service driven/rules, rouPnes and group care