Reflections on Identity

But I Teach Now

Anne Butterworth

I’m a nurse…

This is what I say when I meet people.

I don’t say I’m a lecturer.

I don’t say I’m a researcher.

Sometimes I add, …but I teach now

The lanyard knitting jumble on my shelf at home illustrates my multiple identities. Jack of all trades, master of none? A traitor to some; an imposter or interloper to others.

Have I lost my way? One foot in both camps, not fully accepted by either.

Am I spread too thinly and doomed to fail? Or am I the cat that’s got the cream?

My main job titles over the last few years tell me I am an academic, who also practices clinically. So why do I not feel like a real academic?

I’m a Nurse…

My identity as a nurse is well-rooted and cannot be disentangled from me. How I think, behave, feel reflects the knowledge, attitudes and values of my profession; and my experiences caring for patients and relatives. A nurse can spot another nurse at 20 paces, we give ourselves away. Communication nuances—medical language, levels of knowledge and nods of understanding. We can try and hide it, but invariably we’re found out.

…but I teach now…

Teaching has always been part of my role as a nurse—through mentoring students and junior colleagues. It is an expected, integral part of practice, but seemingly an irritation to some. For me, the look of wonder and enlightenment in the eyes of those you have taught is a reward akin to the gratitude of a patient for care received. I can rationalise that teaching a number of healthcare students can exponentially impact on patient care, beyond my own individual capabilities to provide a good service. So why can I not leave practice alone?

Perhaps because clinical currency is a valuable commodity—a unique selling point within academic schools that have lost touch with practice-realities

But I know that students feed hungrily on my clinical stories; that narratives weave themselves through their interpretations and translations of their own emerging professional identity. They bring practice alive, make it meaningful and worthwhile, remind us why we are here. They trigger memories of shared experiences, enable connections between the theoretical and the practical. They promote professional values, and aspirations to make a difference and provide the best possible care. They highlight the human elements—patient and family experience; nurse experience. What happens when things go wrong, when we make mistakes (as we all will). For there is little within the text books to prepare you for this.

There is a reason why hearing first-hand experience is so powerful. Why ex-addicts make the best mentors for those working through their dependency problems. It’s because the rawness and detail and emotion in retelling, no, reliving your relevant experiences makes you believable and people want to listen. You are then offered wisdom status and respect.

But this status is fragile and easily lost if the experience is not deemed to be relevant, or you are not seen to be believable.

Some of my colleagues who have not practised in a long while also tell stories; but there is always a concern that old tales become outdated anecdotes—interesting to hear, but not necessarily translatable to the rapidly changing healthcare landscape of today and tomorrow. I am wary of this and selfishly do not want to lose my practice wisdom status… and so I continue to nurse.

I don’t say I’m a researcher.

When I apply this logic to my research role, I already know I have no standing in this arena.  I joined the party late, prioritised practice and small scale audit projects, failed to engage with academic audiences and make myself known.  With eminent colleagues all around me, I can only hope to slowly chip away and learn as much as I can. I have a lot of catching up to do.

It is hard to adjust back to junior status with years of senior practice behind you. And how strange it seems that academic roles are so very different despite the homogeneity of grading bands, titles and job descriptions. ‘Lecturer’ can mean mainly ‘teacher’ or mainly ‘researcher’ with their accompanying organisational positioning (researcher as more highly regarded). Indeed, in a previous ‘teaching practice-focus’ post, we worked entirely separately from those with a research-focus and were institutionally denied the right to research through unmanageable teaching workloads which did not acknowledge time for scholarly activity. Researchers were protected by their teaching-light contracts and did not have to witness their colleagues’ marginalisation and exclusion. On the other hand, perhaps we were spared the competing stresses involved in a more evenly distributed teacher-researcher role, as in other HEIs.

Perhaps this experience is partly what motivated my PhD studies—to have what I couldn’t previously have. Or simply the desire to become a legitimate academic—as a researcher, a more highly regarded member of the team; am I seeking to climb the academy class ladder? Nurse done good and becomes a doctor…

I don’t think that’s it. Well it’s certainly not the main reason.

As a nurse, I still enjoy the new things I learn every shift. Just as I love telling stories, I love hearing them too, as wide-eyed as one of the students in my classroom. From patients, relatives, colleagues… and it reminds me why I’m there, with aspirations to make a difference.

Now imagine that I can transmit the first-hand experiences of patients and their families to a much wider audience. It’s not just my experience now, being translated by my students to try and develop their individual practice, but multiple voices from practice harmonised together and heard on a greater scale with the aim of effecting broader change.

This may well be a romanticised view and a vast over-estimation of possible impact. But the transitions between my different roles of practitioner (micro), teacher (meso) and researcher (macro) have shown me that different levels of activity have the potential to not only improve at that individual level, but to cumulatively inform.

Just as practitioner wisdom provides currency in the classroom, it also oils the cogs of the research process. A foundational understanding of the field of practice can provide much needed insights in the planning of a research project—from idea inception (what needs researching?) through to what types of data could be obtained, and how (how could we know/find out?). Researchers must make relationships with others in order to conduct research, perhaps not dissimilar to the therapeutic relationships made in practice. You need to connect to others to find out things about them—the process is called assessment within clinical practice, and data collection within research, but their intents are the same.

My own preferred methodology, ethnography, relies on making connections ‘in the field’ in order to make sense of the ‘everyday’ experiences of others. ‘Living’ amongst them (through participant observation), clearly requires acceptance, but a level of cultural knowledge can help to ease the way. Practitioner wisdom might then act as my passport, helping me to negotiate access through the fortressed borders of healthcare research. Might it also act as membership ID when recruiting research participants (‘ah, we can trust you, you’re one of us?’). Time will tell…

The Urgency of Practice

Today I have really started to understand the potential devastating impact of Covid19, and my loyalty is swung immediately back to nursing. Family members, friends and colleagues look to me as a clinician—to give them answers, to translate, to predict. But I am as baffled as they are, obsessed with crumbs of information emerging from whatever media I can consume. I want to say bugger off to my studies and my teaching job at the minute. I want to roll up my sleeves, wash my hands for 20 seconds, put on PPE and get stuck in. What am I waiting for?

…Because I can’t. I made my choice and I’m committed to other things. Things I know I do really believe in, things I really want to succeed at. But over the course of a few weeks the world has changed…is changing. And I need to play my part, be useful.

Now I need to be a legitimate nurse, the adaptable citizen that contributes the correct skills at the correct time. I’m on a seesaw and the balance is tipping the other way.

Here I go…

…and ‘Ouch!’

I have banged my head against the restraining walls of my academic life—but can’t they see what’s important right now? I need them to let me go… my professional governing body (the NMC) has put the call out… Your country needs you…

Practice… that’s what’s important now. Students of healthcare are being recalled back into practice, ‘all hands on deck’ to help the sinking HMS NHS. The teaching and research can wait (since I don’t have the skills to research Covid19 cures).

…and so I campaign until I’m released. Some colleagues are supportive, and some are irritated with my choice and my persistence. I have a month. The hospital is still bleeding whilst my usual out of hours practice area is coping well—all primary care is telephone based now and not seeing patients face to face has freed up some slack in the system. Locums have no clinics to run, so pick up extra out of hours shifts. They are well staffed. They don’t need me there. I’ll help at the hospital.

…but… ‘Ouch!’

I have banged my head against the protective walls of the NHS—but can’t they see what’s important right now? I need them to let me in! Why does it take so long, applications, HR processes, mandatory training… I have 24 years experience as a qualified nurse! But my clinical currency does not extend to acute hospital wards where this war is being raged. It’s 20 years since I worked on a hospital ward, so of course they need to check my credentials. And so I follow the processes, with a gentle nudge here and there, and undertake the ‘Covid skills for qualified nurses’ training week.

Back as a novice (junior status again), alongside newly qualified student nurses and those returning to practice I refresh my knowledge of the trade. Once on the wards, I am gently guided by some experienced and battle-weary colleagues who accept my presence but cannot understand the choice I have made to return to practice. Patients are curious—I am a rare specimen, an oddity—and they feel the need to thank me for being there (though they never see my face beneath the blue mask and laboratory goggles). Yet it is I that gains the most from my return. I bear witness. I see. I hear. I feel. I share. I try to ‘do’.

But I act with a different level of freedom than my nurse compadres. They have a fear of the new, the unknown …‘I’ve never done that before…’ They are socialised through initiative-inhibiting policies that reduce the risk of negligence and liability. This limits the art of their practice but also protects them through offering the security of clear boundaries. Where gaps occur in competency and skill in my field of vision, I can offer a bridge—experience as an advanced practitioner and a teacher has given me a different view of the unknown. Rather than fear it, I embrace it as learning opportunity. I can quickly judge potential risks and mitigate these as needed, adapting practice to meet the presenting need. So this is how I help during my pandemic NHS leave. At micro level, but using both my clinical and academic skills—a hybrid, an adaptable practitioner.

As researcher, I observe.

As teacher, I facilitate.

As practitioner, I do.

As human, I feel.

I need to be all these things.

My journey is not from practitioner to academic. There is no end-point destination here. Yes, I am spread too thinly at times (expert at none!). My multiple identities make me an oddity and I am not a fully-fledged member of any one group. I know this compromises me—I cannot reach the dizzying heights of either clinical or academic expertise because I am flitting between disciplines. My ego will just have to accept that. Instead of feeling inferior in either arena, I will try and hold my head high, knowing that I offer something different—the expertise of generalism and the ability to transition and translate between different worlds. Academics are increasingly having to ‘justify’ their art through not only research-excellence frameworks, but through teaching-excellence and impact agendas. Maybe there will therefore be a greater need for those who can cross borders between practice and academia. A place where I can belong.

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But I Teach Now by Anne Butterworth is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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