Is nursing a STEM discipline – Does it matter and what can we do about it?

Abstract

As we approach 2020, the year of the nurse and midwife, we have a lot to think about and have a pressing need to prepare for the future. There is a strong imperative to reflect on the history and evolution of nursing as a professional discipline. This is particularly important as we identify opportunities to navigate the complex and often-choppy course that lies ahead of us. Globally, we face potential pandemics, a rising burden of non-communicable diseases, fiscal constraints and population ageing (Jamison et al., 2018). These pressing health needs call for a nursing workforce that is competent, confident and credentialed (Davidson, Daly, & Hill, 2013). The increasing technology in health care, and the unique focus on the intersection of biomedicine and technology, align with the term, Science, Technology, Engineering and Mathematics (STEM) (Kuenzi, 2008). This label is used to define disciplines that draw upon the intersection of domain knowledge and to define information that surpasses disciplinary boundaries to create a unique way of knowing. Nurses have unique skills in assessment, analysis, problem-solving and decision-making, and draw upon a range of data from the health and social sciences. This sets the scene for the discussion of nursing as a STEM discipline – an issue that is contested and debated. If there ever was a profession called into existence by the real needs of humanity, it is nursing…No one will dispute [this], yet it is true that if ever a profession had to contend with misunderstanding, misrepresentation, antagonism and exploitation, it is nursing (Parsons, 1917). This is a quote from Sarah Parsons, President of the National League of Nursing Education speaking at the American Nurses Association Convention in May 1917 and later published in the American Nurses Journal. Yet in 2019 and across the world these words are real and cautionary and evoke the questions where have we gone wrong?; and how have we failed to ensure our profession is credibly presented and advanced? The ambiguity and misunderstanding of the nursing role is hard to fathom but is heavily embedded in a story of money, sex and power (Steinberg, 1990). Failing to address each of these issues places our profession and the individuals and communities we serve in a position of peril. The term STEM, describes education policy, teaching and learning strategies and curriculum choices from pre-school to post doctorate that drive a pedagogy of an integrated curriculum. This approach is intended to foster innovation and promote competitiveness in science and technology. Being designated as a STEM discipline has implications for workforce development, funding and immigration policy. In the United States (US), the acronym began to be used in education and immigration debates to address the perceived lack of qualified candidates for the emerging demands of technological positions. In the US, the Bureau of Labor Statistics includes nursing as a STEM field and STEM-adjacent—but the Department of Commerce's Economics and Statistics Administration does not. In the United Kingdom (UK), STEM is STEMM, with the extra 'M' referring to medicine likely to incorporate a critical healthcare discipline in the scientific realm. The National Science Foundation in the US, uses a broader definition of STEM subjects including chemistry, information technology science, engineering, geosciences, life sciences, mathematical sciences, physics and astronomy and the social sciences (anthropology, economics, psychology and sociology) (Oerther, 2018). The term, Science Technology Engineering Arts Mathematics (STEAM), has also been adopted to describe an educational approach incorporating the arts into the STEM model (Gunn, 2018). STEAM programs can include visual or performing arts and writing. Some individuals find this nomenclature constricting and a regression to a biomedical approach that excludes more humanistic approaches. But beyond the nomenclature the debate of whether nursing is a STEM discipline is more fundamentally philosophical. Thomas Friedman, uses the term 'STEMpathy' to identify occupations that combine STEM knowledge and competencies with empathy (Oerther, 2018). As there are some nuances in the definition of STEM – people have prioritized nursing as a secondary or an adjacent STEM field. Regardless of the definition, nomenclature and jurisdiction, the terms STEM and STEAM have social, political and economic consequences. The categorization of nursing as an applied discipline is a two edge sword; importantly it allows us to truly embrace a person-centred, integrated agenda. But the holism, drawing on a range of disciplines, can be perceived by some as being a 'jack of all trades and master of none.' These perspectives also provide a dividing line between the hard and soft sciences, and valuing of disciplines that are determined meritorious and deserving of funding and recognition. Many write about the science and art of nursing as two distinct perspectives, but probably, they are in fact encapsulated in what is expert clinical practice- an educated, intelligent, curious and resourceful nurse who is both empathetic and caring. This requires drawing on a range of scientific disciplines, professional values and personal integrity. Although Florence Nightingale is proudly recognized as the founder of contemporary nursing, it is also important to recognize other nursing luminaries, such as Mary Seacole in the UK and Rufaida Al-Aslamia in Saudi Arabia, and to note that in fact nursing has a long history since the beginning of time (Almalki, FitzGerald, & Clark, 2011). Traditionally, men in ancient times took care of the sick but as the religious took the lead in taking care of the infirmed, a sense of selfless service and a culture of feminization was created that has been very hard to shake. Florence Nightingale certainly set a course for nursing to move from an uneducated and unpaid workforce to a professional and regulated discipline. Nevertheless, as a profession, we have long grappled with our identity and nursing has often been described as a profession born in the convent and raised in the army. This description outlines the paradoxes of our identity and potentially explains the pervasive bullying, divisiveness and also anti-intellectualism we see in our profession and our critics. Applying a critical lens to our history can cast a light on contemporaneous perspectives. For example, from 1901 to 1955, only women could serve in the US military as nurses, again underscoring the feminization and ancillary nature of nurses, while at the same time, being recognized as a vital force in the healthcare workforce (Evans, 2004). The critical aspect of caregiving has been ascribed to feminine characteristics and as an extension of the caretaker role of women. Because of our highly feminized image, the nursing profession receives regular assaults and attacks of anti-intellectualism (Clark & Thompson, 2019). In the UK, nursing is under constant pressure to move back to tradition hospital training models (Meerabeau, 2001). There is no doubt that in the early days of modern nursing prior to Florence Nightingale, nurses were not well-educated, along with many other professional groups, but this is hardly the case in current times. Fortunately, the move to interprofessional education and team science is breaking down the silos and medical dominance, but we still have a long way to go. The presentation of nursing in the media has been the subject of much discussion, and is recognized as being highly feminized and often sexualized. The representations of both nurses and nursing are often highly stereotyped (Kress, Godack, Berwanger, & Davidson, 2018). Recent highly publicized events, such as challenging nurses wearing of stethoscopes, reflect public perspectives that are ill informed. The highly feminized nature of nursing has probably hindered nursing being considered as a STEM discipline. The feminist movements of the 1960s and beyond have radically shaped opportunities for women across many professions and have provided multiple career options. While emancipating for many women, in some ways this has led some to consider even less of nursing. For example, why would you not want to be a physician rather than a nurse? This represents a failure to understand the work of nurses. Automation, artificial intelligence and machine learning will change the future of health care and many professions (Davenport & Kalakota, 2019). Nursing has been identified as a profession more protected from mechanization than others, but this will not mean that the work of nurses will stay the same. Current economic, social and political challenges emphasize that education is even more critical today than it has been in the past and that cognitive problem-solving skills will be more important than ever. Fostering deeper learning skills in conjunction with discipline perspectives are currently important- as well as emphasizing technology to connect subject areas (Guerriero, 2017). For nurses, fuelling innovation, creativity and social skills will be equally as important as knowledge of anatomy and physiology. Conversation and debate around nomenclature can only take us so far, as can philosophical and epistemological discussions about the nature of nursing. Scholarly inquiry about the nature and significance of knowledge has been shaped by disciplinary traditions and priorities that define 'knowledge' differently and may result in often disconnected and conflicting perspectives. But we cannot deny the social, political and economic factors that have defined our past and will determine our future unless we are proactive, thoughtful and intentional. The pragmatic issues of status and representation cannot be ignored nor can the considerations of money, sex and power in both education and health care. We need to continue to argue for the knowledge, skills and competencies associated with a minimum of baccalaureate education for nurses globally. Moving the concept of STEM from a laundry list of disciplines to a meaningful integration of knowledge, skills and competencies to educate the nurses for the future is important in determining the viability of our profession into the future. So yes, defining nursing as a STEM discipline is important if it determines the validation of our profession as a scientific discipline, attracts the brightest and best students and ensures the flow of resources to advance the role of nurses in policy, practice, education and research. No conflicts to disclose.

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