The life history of the care worker, including her experienc-es and knowledge, form her subjective context for learning.
New demands, challenges and circumstances must fi t in, be rejected, or change her knowing and life historical orienta-tion. Experiences from the life history, not only as individual but as part of social and historical contexts shape the individ-ual’s horizon of expectations and knowledge,, forming her ap-proach to work, working culture, learning and the workplace, i.e. forms her professional identifi cation. Her experiences may be included or excluded in the culture, the organisation, the knowledge base of the actual work process. Her subjective ho-rizon of experience will in part become meshed with the col-lective horizon of experiences and learning (Lorenzer 1980), that is, the collective ‘ways’ of doing, refl ecting and develop-ing practice, for instance of how to cope with death or han-dle an emergency. This will also include shaping common or generalised experiences and expectations: of what the nursing standard should be, about the meaning of welfare for patients and on the relation between care workers and politicians etc.
Learning in the workplace will therefore include both adapta-tive and transformaadapta-tive processes, and the learning space can be seen to be more enabling or constraining learning (Ellström et al. 2008). Learning in the work place thus always has both an individual and a collective side.
In the following, I present analysis of life-historical inter-views with three nurses. Examination of these three different
horizons to care work helps me to highlight the crisis of learn-ing and professional knowledge from different angles.
IDENTIFICATION AND A REFLEXIVE COMMUNITY
Birthe who was interviewed in 2006 belongs to the one third of the nursing working population who is between 40–49 years of age (FTF 2007a). When Birthe became a nurse in the 1970s nursing was in a rapid process of professionalization, helping nurses to acquire a strong position on the labour market. For Birthe, adaptation to nursing practice and to the nursing community became intertwined with the building of a personal professional identity. Even though her learn-ing process occurred in the context of an emancipatory proj-ect to improve the terms of employment for nurses, Birthe’s identifi cation with her occupation was ambivalent, as a re-volt against the still central discourse of the occupation as a calling.
The professional discourse of the time was full of tensions and contradictions, claiming a high level of professionalism both at the level of skills and in terms of moral and ethics and in the nursing school that Birthe attended both sides were emphasised. Teaching bound theory together with practice so that theoretical themes were linked to specifi c areas of nurs-ing work. Teachers in the nursnurs-ing school had a mentor role for students, and apprentice-based learning played a big role.
The relation between teachers and students was close and oc-cupational identifi cation was built up as something similar to educational identity. The object of learning and work was the same, and work was introduced to students as a learning en-vironment with no borders to school. This affi nity of educa-tion and work helped Birthe to almost ‘slide’ into working as a graduate. She did not experience that transition as especially challenging or threatening.
We were in the ward and we were one or two days in school, and what we learned in the classrooms, i.e. if we learned about the liver, then the teachers knew that it was related to other things and
tried to tie it together so we could relate to it, and then we learnt that on a specifi c ward and section there was a patient, whose condition was like this and this, and we could go down and look around…
‘The time it takes’ was a guideline for how much emphasis should be given to showing students the processes of work and giving students insight into patients´ own experiences of illness. The latter were to be acquired by listening to the pa-tients, implying a practice of locating patients whose condi-tion would illustrate the theme the students worked on in the classroom. Birthe built a strong identifi cation with her work, portraying herself as a ‘craftswoman’. It is a part of her pro-fessional thinking that practice always has to be adequate to the task and the need.
A carpenter will not saw crooked because he is in a rush, because then it won’t fi t into the next notch, will he? You have to, I think, for yourself, you owe to do a good piece of work and get a good result out of it…
Birthe’s words illustrate the viewpoint of a strongly identifi ed nursing worker who learns through the community of prac-tice she is in, and who stresses profi ciency in specifi c tasks, problems, methods of working, i. e. particular manners of working that are perceived to be the right way etc. This style of learning has been identifi ed as adaptative learning (Ellström et al. 2008) Although Birthe is an example of a learner formed through the older, more adaptive educational system, she has been able to continuously incorporate her own experiences, i.e. involving herself in transformative learning. She reacts against the contradictions in work, i.e, the discrepancy be-tween the discourse about the important role of the patient, and the factual indifference towards the patient as a person and citizen. She fi nds it a big challenge to include patients, and will not accept asking patients how they feel, without time to do anything with the answer. In her early identifi ca-tion with the occupaca-tion she learned always to connect words
with action. Therefore her biography is full of examples of workplaces she has criticised and left, and things she has tried to change in everyday practice.
In Birthe’s experience, a regrettable change has occurred in her work situation.
There is no education at the moment. Everything has gone out, everything is back to zero- no courses…there isn’t any money to continue developing anything right now. I mean right now we are standing still, we are standing absolutely still …and maybe there are some things, where you could say, could that have been avoided, if we hadn’t had to dash on like that
The phrasing is symbolic, drawing the picture of stopped movements (standing absolutely still), but also of time stand-ing still (back to zero) and light that has gone out, implystand-ing that her present situation, as well as that of her colleagues, was best characterised by darkness, as expressed by the no-tion ‘professional black-out’ that she uses in the quote. At the same time there is a lot of dashing for something else, discon-nected to learning and development. The rest of the interview conveys that she links this experience to changes in the work-place of more tasks and more complexity, larger work areas and self-fi nancing units, as well as more hierarchical manage-ment. These new organisational and economic measures are framing work, and getting the care workers to move too fast, while at the same time they experience standing still in their own development.
From a learning perspective, Birthe and her colleagues are presently not part of a refl ecting community, and their ex-periences of the changing situation are individualised and not shared. As a learner, Birthe is highly dependent on an enabling learning environment and when she is faced with a lack of expectations to maintain high quality she is at a loss, unable to keep the new experiences inside her horizon of experiences. Her own high standards and experience of making words into action are slowly pushed away from her perspective on everyday work. She feels constrained by the
experience of a professional standstill. Neither the organisa-tion, nor the care worker collective are able to secure her the experience of providing good care. Birthe expresses her fear that nurses in hospitals currently work under a too heavy time pressure. This fear contributes to the forming of her horizon for expectations of the future. She fears that work will be-come undignifi ed. The space and time for learning are disap-pearing for her.
LIFE HISTORICAL EXPERIENCES CLASH WITH WORKING LIFE EXPERIENCES
The second nurse is Nanna who graduated in 1999. She was interviewed in 2004. She is one of the 12 % of the working nursing population who is under 30 years of age (FTF 2007a ). Nanna was building her professional identity at a time of big transformations in social and health care work, and at a time of increasingly severe recruitment crisis. She remains among the two thirds of nurses who did not dropout during education or during the transition to work. She even wants to continue to work. Nanna is engaged both in her work and in her family and life outside of work. She interacts dynami-cally with her work, the patients, colleagues and the organisa-tion and takes part in the transformaorganisa-tion of the health sector, not just being reactive, but proactive. Like in many other life histories of young nurses, an open professional identifi cation process can be identifi ed in Nanna’s account.
Commonly in life-historical interviews, informants use phrases that suggest identifi cation with some of the impor-tant professional roles in nursing. In a previous study, we identifi ed four common narrator positions expressing nurs-ing roles: ‘the very carnurs-ing nurse’, ‘the housekeeper’, ‘the med-ical assistant’ or the ‘organiser and manager’ (Andersen et al.
2004). Rather than positioning herself in this way, Nanna po-sitions herself against such images:
It’s usually nice girls, that become nurses… well I do consider my-self a nice girl, but I am also quite coarse, you know I trample on
people, and they fall straightaway. And of course I apologize if I have molested them, but you know, I haven’t got that, I don’t know if it’s because I don’t have that feeling of things… I really have that with the patients, there I am really very, but if I have an opinion about something, then I say it… but nurses are nice girls who say the right things and smile at the right places… and that’s never really been my style, it’s probably true, I am not really the epitome of a nurse.
Nanna confounds here two Danish proverbs:1) trampling onto people’s toes, and 2) people fall for me straight away2. In other words, she is coarse and hurts people, but she is also close to people and they like her very much. The linguistic mix-up ex-presses her experiential mix-up. She feels pressure to conform to the role of the nurse, which to her means rejecting the way she ‘really’ is. Nanna refuses to be a ‘nice girl’, but at the same time, from her own perspective, she is an intimate and a good person and carer. Thus, she can preserve her dignity by po-sitioning herself against the ‘obvious’ positions for nurses in the context of the hospital as patriarchal institution, while at the same time constructing a professional identity that meets professional standards.
Nanna’s ability to transform the relevance of gender in the context of the hospital is possible only because she em-ploys her life history as a context. She creates a transformative learning space at work by bringing in her societal experiences as a young woman and by drawing from the changed gender socialisation of her generation. Nanna is building a work role and a professional identity in an innovative and transforma-tive way, without taking any professional identity for granted or as a preconception.
The ‘nice girl’ is a gendered stereotype that strongly has an impact on Nanna. Even though Nanna does not explicitly identify it, the symbolism of the ward as a home where the chief physician is the father and the workers are daughters is the ‘missing link’ here. Patriarchy of the health system is however a strong and open reference in other parts of Nanna’s
story. From this perspective, Nanna is trying to do away with the ‘nice daughters’ in the hierarchy and establish a coun-ter-professional identity. Nanna has three strong narratives of fi ghting against the hierarchy. The longest of these accounts is a story about protesting against management and organis-ing a strike, the other two stories are about resistorganis-ing male doc-tors. In these situations, Nanna articulated her expectation of being recognised as a party in symmetrical relations at the workplace, but she was met with offences. One situation was an open professional argument that took place after a doctor had strongly corrected Nanna in front of a patient who they had been working with. Nanna experienced the doctor’s ex-pectation that she would submit herself to his authority as next-to a violation that for her was beyond acceptance.
He had simply put me in a situation which was deeply disgrace-ful… where I confront him with it and say to him: you will never do that again in front of a patient, I will simply not allow it, I think it’s so fi lthy… And point was taken, so actually it did better the re-lation to that doctor greatly.
Her action against the male doctor is a signifi cant moment for Nanna, and as a learning experience it is an experimental practice that transcends ‘normal’ practice. Experimental prac-tices take place in order to create a new balance between the desirable and non-desirable sides of a challenge that threat-ens subjectivity. Acting in a new way requires that one fi nds inner energy to do so. This sort of practice and experience can transform professional identity, and seems to have done so for Nanna. The story is thus one of her turning points, a sig-nifi cant experience of transformative learning, which has in-fl uenced her practice and her professional identity. However there are other aspects of working life in which Nanna does not fi nd it so easy to act in order to restore imbalances. She is confused as to how she should understand the importance of her professional work, when following a strike against bad working conditions, the management forced the employed back to work. Here Nanna expresses her irritation with the
double-sided messages about the value of care work that she perceives to be dependent on the context.
I think it ought to be valued as highly as they actually do, when we are in a crisis… I mean then we are really indispensable… we shouldn´t strike, because that won’t do in relation to our patients, because actually you are really, really necessary in order to make this run. But on the other hand, [we] shouldn´t be so necessary that you need to get any money for it. That’s a lot of bullshit!
The many positions and rationalities active in the workplace are present as voices in the inner dialogue taking place in Nannas narrative. Work is positioned as a thing it, and this, but it is also a we, as working identity. Nanna even expresses a threatened professional identifi cation through the discrepancy between you and it, as she is giving voice to the management.
Nanna’s account conveys ambivalence and dilemma of identifi cation with her work. Which version of ‘work’ should she identify with? With the work that has high value for her personally, or with the low value her work is given in terms of salary? Or should she identify with the views of her pa-tients? For Nanna it is necessary to work with patients, but in her view the management, the politicians and the public do not share the responsibility. The patients are thus constructed as the domain of the workers, ‘your’ patients. Nanna’s state-ment makes visible the gravity of the problems of the profes-sionals when they, reacting to the double-sided messages of the management, fi nd the different understandings of their work incompatible. Taking responsibility for the patients in a professional way may mean doing work of high value, in ad-equate conditions and frames, but it may also imply working with a concept of necessity, that is not professional and has low value. This type of paradox actively frames the learning space and shows how diffi cult it is to learn under such condi-tions. It upsets professional identifi cation.
The importance of expansive and transformative learning spaces in the workplace is evident in Nanna’s story. Currently, the context of care clashes with many of the expectations
of care workers. Such clashes are made even more severe by the fact that the potential for learning is currently ne-glected. Assuming gender as well as professional symmetry, young nurses expect to have equal opportunities and rights.
Furthermore, they expect opportunities for personal develop-ment and space for being, at the same time, an individual and a care worker. Nanna provides us an example of how, in this
‘life-strategic’ perspective, professional learning and knowl-edge in the workplace involves managing and creating con-fl ict. Young care workers are met by contradictory demands for socialisation, in work and outside work The imbalance be-tween these incompatible demands from the working culture and institutional context does not encourage the nurses or care workers to learn and create transformation.
CONTRADICTIONS IN WORK CREATING DILEMMAS OF LEARNING Ditte who is a nurse in her thirties is one of the 30 % of the nursing working population between 30 and 39 years of age.
She was interviewed in 2007. Ditte did her basic occupational education in the 1990s and has since taken two specialist edu-cations in nursing and a number of long continued education courses, in all, amounting to seven years of professional nurs-ing education. She is innovative in her approach to nursnurs-ing and in learning and identifi es with specialist as well as general tasks in nursing. She is an example of the young, well-educat-ed nurses who are focuswell-educat-ed on developing nursing profession-ally in practice and not as research. However, she draws on the existing professional knowledge base:
I will say as ordinary nurse, it demands, it really demands, that somebody sits down and keeps up with recent development, and reads the new PhD thesis. I don’t think it is very interesting to work if your attitude is: we have never tried that before, it won’t work. No, we have got to, we have got to develop ourselves and otherwise I don’t fi nd it interesting to be an employee.
Ditte has chosen to work as a basic nurse, with no special-ist functions, because she identifi es professionally with the
clinical and basic elements of nursing (i.e. observation, mo-bilisation, communication and everyday hygiene):
I have learnt [so much] about general care in the medical ward,
I have learnt [so much] about general care in the medical ward,