Abstract
In 1997 Singapore marked the achievements of a century of nursing with the publication of a celebratory book entitled ‘More than a Calling’. I was given this book on a visit there in 2006 and it has remained important to me ever since – not only as a souvenir but also as a reminder that nurses must articulate what the ‘more’ in that phrase really means and how it translates into improvements in care.
There are plenty of published papers, books and reports showing what nursing is and what nurses do; plenty of media accounts of both the good and the poor elements of nursing; plenty of stories and case studies of how nursing impacts on people; and plentiful representation in places of power where the nursing narrative can continue. Although many observers, from patients to policy-makers, still believe that our skills and knowledge stem mainly from pure natural ability, all those accounts demonstrate repeatedly that confident and successful practice requires much more than inborn talent. It requires, at a minimum, the critical collection of appropriate knowledge and skills to suit the myriad situations that nurses find themselves in; the selection and fine tuning of the right knowledge and skills to meet the needs of the client within specific contexts and resource limits; the integration of knowledge and skills with those of the many others, lay and professional, involved in care; and being a role model of best practice from which others can learn.
Take the example of service improvement, in which nurses can and should be the front runners because our proximity to service users and their families and carers gives us insights that others may miss. Unlike improvements on a factory production line, improvements in health and social care are about convincing people to do things differently with other people and for other people. For nurses to be able to identify and instigate necessary improvements requires a collective repertoire of many skills including technical, soft and learning skills (Gabbay et al., 2014). The technical skills, in this instance, largely focus on knowing and understanding the best improvement methods and picking the best one for the improvement and its context. The soft skills are needed to make the improvement methods work and to convince people to change; they include talking, listening, persuading, negotiating and influencing. The learning skills help those involved to learn from each other’s experiences of, for example, how best to do things in this situation, why things work or not in the current context and what can be adapted and how. Success is brought about by blending the three sets of skills to suit the context within which the improvement is being made. A deficit in any one of these skill sets will mean that improvements may struggle either to get off the ground or be sustained. But such skills are not merely the results of a calling; they need to be learnt and continually honed.
Transforming a vocation to a profession requires nurses to use their scholarship and skills to make improvements in care, service delivery, management, education and research. This issue of JRN features examples from different parts of the profession, which show just how this can be done. Taken together, the special collection editorial, papers and reviews in this issue highlight the impact that education, research and practice make and how neglecting any aspect of these can compromise progress; they show how reviewing and integrating knowledge helps to improve care and how studying what we do is central to refining the practice and the politics of care. In sum, they give us some insights into how nursing can be ‘More than a Calling’.