A View From the “Ivory Tower”

I remember one of my first post-RN classes at the University of Alberta when the professor introduced herself in what seemed a very snooty way…”Hello. I’m Doctor Jane Smith” (for the record, Jane Smith was not the professor’s real name). Oh, yes - there was a very definite emphasis on that title. The high ruffled collar and stiff upper lip presentation added to this almost comical moment but there was no doubt as to the power dynamic that had been created. And it pretty much set up an adversarial tone that would last the rest of the semester because a good portion of the class, like myself, were from diploma RN programs and most of us had already started practicing in the “real world” of clinical practice where this snooty attitude was reviled. Reviled…and resisted.

Reviled, because there was already a tension between diploma institutions and the “Ivory Tower” given the perception of a detached reality in the hallowed halls of academia. Part of this was due to the hierarchy in nursing education it created that, sadly to this day, still exists between university and college programs. I was educated in a hospital-based program (Misericordia Hospital Edmonton) that had a real feeling of community, that was very practical in nature, and which had a genuine sense of humanity. I know - humanity in nursing and something I believe is lost in the impersonal walls of a large university. In our diploma program we were on a first-name basis with our instructors, had exceptionally good relations with (most) of them, and were treated more often than not as a partner in learning. And all of our instructors had years of hands-on clinical practice - they knew what it was like to work in the “real world”. In contrast, university professors often had little, if any real nursing practice, (seriously…some still get into the academic ranks with none!) before climbing up the ladder. And, if professors did have any nursing practical experience, were decades from when they last provided care direct care to a client. It may come as a surprise but, unlike physicians and other healthcare professionals who are required to do a minimum number of clinical hours each year to maintain their registration, nurses have engineered a licensure system where that does not have this requirement. Hence, the disconnect that occurs between academia and reality of nursing clinical practice.

Then there were the products of pure university education, where there was a focus on theory and critical thinking rather than actual clinical practice. This has been a long-standing historical difference in focus between universities and either hospital-based or college programs. It was not lost on us, as diploma grads, that many university-prepared nurses looked down their nose on our credentials - almost as if we lacked the capacity to think critically. But when it came to being able to function at graduation we were ready to transition into the workforce and, quite frankly, were more desired for hire in many areas. This difference was underscored by Doctor Jane Smith when, in one of the next lectures, she declared that “Nurses should be thinkers, not doers.” 🙈 Gauntlet thrown…challenge taken.

As it happened, that very weekend after Doctor Smith made her statement the Klein layoffs of nurses in Alberta began (Fall 1992?) and the first wave of nursing cuts from the Royal Alexandra were announced. You can imagine in the next lecture there was lots to discuss with the professor - one brazen (and, maybe, slightly cheeky) student raised their hand and, literally, said “Yo, Jane! Did you hear about the 75 thinkers that were just layed off?” And all eyes were on Doctor Smith to hear a thoughtful response but, with no clinical experience, her starting point was “Well, that is not the right attitude to take,” followed by something like nurses need to work smarter not harder…can’t get much more condescending than that to frontline nurses. And this would not be the last time such discordant pronouncements and putdowns would come from the ivory tower. When Douglas College became the first degree-granting college in Canada and the first degree was nursing, the overt push-back (a 10 page letter) that came from nursing "leadership" spearheaded from the University of British Columbia was pretty harsh in trying to undercut the legitimacy of college degree education. As it happened, it was Douglas College at this time when I began my journey in academia.

Fast forward 30+ years in my career, I can honestly say not a whole lot has changed. Still the same tension between universities and degree-granting colleges in terms of registered nursing graduates but, also now an added layer with hierarchy in relation to registered/licensed practical nursing. As one who has taught at a community college in a degree-granting nursing program, two smaller comprehensive universities, and two U-15 programs (the U-15 group are considered research intensive), I can honestly say that the best education and preparation of graduates happens at the smaller scale institutions. First, there is not the same ego to feed (and the U-15s are pretty full of ego and pretentiousness) - the college degree programs and smaller comprehensive universities are, in my view, much more grounded, practical, and student-centered. Second, U-15s are more likely to fast-track undergraduates through to PhD to groom them for a research focus and not require or value practical experience…yup - that’s actually been encouraged in many institutions. Third, there has been an adopted “grow your own” attitude whereby graduates, even if they have some practical experience, are groomed for hire - in most cases knowing nothing outside of their immediate health and academic environments. This latter phenomenon amounts to, what is often referred as, “academic incest” - something I will explore further in a future post.

From the parapet of the ivory tower I am currently employed in, the view inside and outside is not a glamorous one for the profession of nursing. As I share in the coming months, this has become one of the reasons I have decided to resign my current position.