Developing a visible critical mass

Abstract

Wherever I am these days, interviewing, teaching in clinical practice, researching ways of improving care, I’m confronted by the notion of ‘developing a critical mass’. Having used the term myself in recent years, I have begun to question this now much used phrase, some might say platitude or rhetoric. I understand the term to mean a group of individuals with passion and vision, working towards the same aim, sharing similar ideals and importantly, the willingness to act upon their own convictions (even when this means standing out from the crowd and advocating for others). In fact, in my mind, being visible and audible is actually a fundamental objective and outcome of developing a critical mass. Critical mass is a term that is used frequently in regard to research, Pearson (2004) refers to it in his dialogue concerning evidence-based practice as bringing together cognate groups, which work to minimize duplication of effort, set priorities and increase infrastructure. Whilst this sort of description speaks directly to the mass, it is interesting to reflect on what the term ‘critical’ means in this context. I raise this because I recently read Barker & Buchanan-Barker's (2005) earnest response to the question: ‘What is nursing worth?’ I quote: ‘. . . mental health nursing has something of a professional esteem problem. Nurses find it hard to believe that they are important’. Dismayed at the lack of protest from mental health nurses regarding their lack of inclusion, indeed marginalization from involvement in the NICE guidelines, Barker & Buchanan-Barker (2005) argue that ‘mental health nursing needs to be clearly championed, ensuring that its message is heard’. They raised similar concerns in 2004 this time making explicit reference to the notion of visibility (and perhaps audibility). My last editorial also focussed on the way in which mental health nursing is portrayed, not usually by mental health nurses themselves, within the media and socio-political arena (Freshwater 2005). Their voices are sadly lacking, yet mental health nurses and nurses in general are a critical mass, surely? Few would argue that nurses enter the profession with a passion and a vision; they may not be able to articulate the concept of caring (something that the profession continues to struggle with), but they come with conviction and enthusiasm. Many of the novice (and post-registration nurses) I have taught are only too happy to share their opinions and views about nursing, daring (and dying) to be heard; they need little motivation to voice what is important to them. Put another way, in my experience as an educationalist, I have not found nurses to be particularly subordinate, least not in the classroom. Once in the profession, having made the choice to focus on an area of nursing that excites and illuminates them, the fervour that accompanied the junior nurse is often, although by no means always, dampened. Writers have invariably related such phenomena in the literature to the socialization of nurses, subsequent disillusionment and of course oppression, usually by the medical professional, although occasionally nurses are recognized as eating their own. Like Barker & Buchanan-Barker, authors locate, to some extent, the problem with nurses’ ambivalent relationship to autonomy, fear of success and low self-esteem (Freshwater 2000). The main research in this area focuses on the individual rather than the universal or collective, i.e. the esteem of the profession, but, and without generalizing too much, it is fair to say that the esteem of the profession is probably fairly reflective of the professionals within it. Moreover, members of our own profession, who can sometimes be too quick to criticize and damn the efforts of their colleagues inappropriately and without consideration, perpetuate such doubts and fears. Whatever the cause of professional low self-esteem, it is fair to say that the voices of mental health nurses are quietened or subdued. It is paradoxical that within a discipline that has caring and advocacy for others as its main focus, it is not always able to advocate and care for itself. Beyond all this, we know that the mental health profession has several (significant) messages and champions, each working to achieve a critical mass and make a contribution to the improvement of practice and education. What would it take for the profession to begin to experience itself as a cohesive body, a mass of critical professionals, who recognize the critical nature of the everyday work they are engaged in.