Ethics and Democratic Professionalism in Nursing

Our current featured article, titled “Discourses of Social Justice Examining the Ethics of Democratic Professionalism in Nursing” by Janice L. Thompson, PhD, RN is a thought-provoking article that challenges all nurses – in practice, academics or research – to contribute to social justice in health care.  Dr. Thompson has shared this

My article “Discourses of Social Justice: Examining the Ethics of Democratic Professionalism in Nursing” was written between December 2011 and  May 2014.  I’m very happy to see this paper published in the current issue of ANS.  In this instance like others, as the manuscript developed, my writing progressed to a finished product that addressed other outcomes than I originally intended. I’m forever thankful to my colleagues for inviting me to begin a writing project on the topic of emancipatory philosophies and practices of social justice in nursing, and for their support in suggesting a re-direction of this manuscript for publication in ANS.

    Here I want to acknowledge the help and influence of three scholars who offered important comments and suggestions during the composition of this essay. As always, Peggy Chinn provided insightful meta-analytic perspective, helping me to remember the importance of thoughtfully balancing the work of intellectuals in nursing and philosophers in other fields of study. Similarly Paula Kagan offered important and welcome support in collegially inviting me to consider emancipatory interests in nursing. Her helpful comments on the relevance of the work of Cornel West were most welcome.  Finally, Richard Pattenaude’s critical reading helped me to recognize the centrality of the concept of democratic professionalism in my analysis. His thoughtful suggestion provided important affirmation, helping me to recognize a recent turn to questions of democratic professionalism in my work.

    I write from a position that considers professional formation in nursing. I do this with a background and context of having practiced now in the U.S. and in Canada. I’m employed as a professor of nursing at the University of New Brunswick in Fredericton, New Brunswick, Canada. There I teach undergraduate and graduate students in nursing and interdisciplinary PhD students. My teaching and research examine the ethics and epistemic conditions of social justice and caring in nursing and health care. I consider practice with marginalized populations from a critical theoretical perspective in transcultural nursing.  I foreground the importance of anti-racist, anti-colonizing and feminist post-structuralist analysis in my research.  And I use theories of nursing in an interpretive (hermenetic) interface with interdisciplinary work to understand the formation of nursing as a profession. I recognize that these phrases mark me as an academic , although I hope I am still an organic intellectual in nursing.  

     I’ve practiced as a registered nurse for thirty eight years, first in the United States and more recently, in Canada. My work includes 31 years as an educator in nursing and interdisciplinary studies in public universities. My permanent residence is in the United States, in the state of Maine. This lifestyle arrangement carries with it a fair amount of border crossing (literally and symbolically). I maintain registration as a nurse in Canada and the U.S. For the last eight years, I’ve worked and resided temporarily in Canada while retaining my U.S. citizenship.  I maintain active connections with nursing educators on both sides of the Canadian and U.S. border.   These life choices have produced a growing “border subjectivity” with deepening recognition of the similarities and differences between Canada and the United States and with growing appreciation for nursing practice internationally.

    Increasingly, I’m noticing the historical influence of nursing leaders from Canada and the United States who worked together, sometimes as close friends, to address issues related to the formation of our profession.  I’ve become somewhat preoccupied with thinking about those nursing leaders who engaged important transnational issues of professional formation at the turn of the twentieth century. It’s been important for me to see how American and Canadian nurses have worked together as leaders, frequently in friendship, to address common concerns. Adelaide Nutting and Lavinia Dock are examples of Canadian and American women who provided “wicked” strong leadership to ensure the formation of professional nursing practice in North America during the early decades of the twentieth century. Their collegial influence as global citizens and global thinkers inspired a larger vision of nursing education and regulatory authority, influencing what nursing could be as a unique profession.  Similarly, scholars Bertha Harmer and Virigina Henderson worked collaboratively finding common ground in North  America by focusing on core knowledge of the profession. And of equal interest, nurses on both sides of the U.S. – Canadian border learned together in the early decades of the twentieth century to engage practice and policy in the settlement house movement –addressing urban health equity for immigrants and refugees.

    What is common for me in these examples is the willingness of Canadian and American nurses to engage together and to learn from each other, despite important differences in the way our political economies have organized the delivery of health care. These collaborative experiences were bound by strong commitments to social justice and health equity. They demonstrated a kind of leadership that remains highly relevant, in practices that were guided by commitments to a common model of democratizing professional ethics, despite cultural differences. That model of ethics in professional practice, found in our history and today, is different from one shaped only by social trustee professionalism.  As I’ve suggested in my article, democratic professionalism sees nurses working collaboratively with each other and with others in activity that shares power and empowers citizens and communities, improving access to care and improving health outcomes in marginalized communities by addressing the social determinants of health.  This kind of democratic professionalism, in hospitals and in other community contexts, operates with a complex constellation of ethical capacities, with a keen sense of local, regional, and transnational politics, fully understanding the importance of correcting injustices in the political economy of health, and tending to policy level innovations that correct health disparities in advanced post industrial capitalism. These sensibilities include an understanding of contradictions that occur when the ethics of health care systems are organized in privatizing ways within market economies .

    Democratic professionalism has been practiced historically and is alive in North America. In nursing and in other professions in the early decades of the twentieth century, it was closely tied to the scientific vision of practice found in the philosophy of North American pragmatism. That model of professionalism and that philosophy of science had much to offer North America in the first decades of our growing democracies. Its contemporary revisions in critical American pragmatism continue to have important relevance  today.  

    My essay explores some of these ideas.  I’m interested in critical American pragmatism as  a philosophy that provides coherent epistemic, ethical and ontological connections  between a model of scientific activity and a democratising ethics in professional practice. I’m interested in understanding how professional commitments and the formation of nursing as a profession can be helped by a democratizing model of practice and how that model of practice can support the health of my American democracy.  As I reflect, I think perhaps my essay may be informed by a maturing sense of love for my profession, despite its flaws. Understanding it now from a different place-with more appreciation for cultural and transcultural influences, and with an abiding faith in the healing influence of professional formation of nursing, I take inspiration from generations of nurses who also have seen themselves as “organic intellectuals.”            

Please visit the ANS web site and download Dr. Thompson’s manuscript while it is featured!  We welcome your responses and ideas – let’s have a lively discussion of the issues and possibilities that Dr. Thompson unveils!