Nurses in the UK have experienced a period of unprecedented change over recent years. The health service in which they work has been reorganized so often that the process has been described by some analysts as ‘continuous revolution’; a term normally associated with Maoist China (Webster 2002). At the same time, nurses have been under intense pressure to take on new roles and responsibilities in a government-inspired programme of workforce reform aimed at breaking down traditional occupational boundaries and creating a flexible labour force (Department of Health 2006). The same is true for many allied professions and for nurses in many other parts of the world. For many individuals caught up in it, this process has been bewildering and many have feared that nursing will lose its professional identity (Shields & Watson 2007). Policy and commentary on nursing range from the government’s optimistic promises to ‘liberate’ nurses (Department of Health 2002) to the deeply pessimistic forecast by some nurses of the ‘demise’ of nursing (Shields & Watson 2007). What are ordinary nurses to make of all this?

At the same time, it has been suggested that the needs of patients are changing. The government has a very clear narrative about what patients want in a twenty-first century, consumerist society. This narrative supports their political project and includes concepts such as choice and flexibility. However, political rhetoric is constantly changing and does not always reflect reality (see Chapter 7). We also live in a society marked by an ageing population as well as deepening inequality, where considerations of equity may arguably be as important. How are nurses to know whether the decisions being made about the care that they offer are based on evidence? How are they to evaluate the evidence offered to support a particular set of policy choices?

Nursing is a profession that has too often been shaped by other people. Political decisions about healthcare are often made without very much thought being given to the impact on nursing. Traditionally, nurses have just been expected to ‘cope’ and to get on with the job. Nurses have been educated to apply their knowledge and skills to the care of individual patients and sometimes, this has obscured their vision of the wider context of their work. Big decisions which have affected nursing have thus sometimes been made behind nurses’ backs (Hart 2004).

Nursing draws on knowledge from a variety of subjects, such as the biological sciences, sociology, psychology, politics and ethics. In a crowded curriculum, nurses sometimes wonder why they study sociology and the Making a Difference reforms (Department of Health 1999) have threatened its future in some institutions. Our ideas about nursing are situated in a particular social and historical context and we need to understand the way in which that changing context influences current conceptions of our occupation. The authors of this book believe that nurses need to understand the context in which they work in order to practise effectively and in order to have a voice in the future of nursing. Sociology offers an important means to understand this context.

Since the 1990s, there has been lively debate in the nursing press about the role of sociology in the nursing curriculum. This was, in part, instigated by one of the authors who suggested that sociology offered nurses a means to look critically at their own occupation (Cooke 1993). In response, Keith Sharp (1995) suggested that sociology was an unsuitable subject for nurses to study and that while sociologists should study nurses, nurses should not study sociology.

According to Sharp, sociology is multi-paradigmatic; by which Sharp meant that sociology is characterized by a variety of different theoretical standpoints and ways of seeing reality. As a result he said, sociology is a reflexive discipline; by which he meant that sociologists continually question the grounds upon which sociological knowledge is based. This according to Sharp meant that sociology was an unsuitable subject of study for nurses, since nursing was a practical activity and what nurses needed were ‘recipes for action’ not questions for debate.

Sharp’s papers offended a good many nurses.To paraphrase his arguments, he seemed to imply that sociology was just much too complicated and difficult for nurses who needed to be told what to do and how to do it. Porter (1995) in particular took Sharp to task for his ‘old fashioned’ and patronising conception of nursing. Porter suggested that Sharp saw nursing as ‘women’s work’ requiring ‘little thought or skill’. According to Porter, reflective practice was essential to good nursing and required a knowledge of sociology (1997).

Porter 1995 and Porter 1997 offered three criteria which nurses could use to evaluate the usefulness of sociological knowledge to nurses:

In the following sections, we consider what might distinguish a sociological viewpoint from other ways of looking at the world.

Some years ago, a colleague of one of the authors said that she hoped that teaching sociology offered student nurses ‘built in crap detectors’. Good sociology should equip students with the intellectual tools to critically question ‘official’ versions of reality. Too often official versions of reality are presented as natural, inevitable and unquestionable. Official discourse frequently appeals to conceptions of ‘human nature’ or the ‘real world’ in order to justify the actions and choices of powerful people. For example, in a recent study, a manager told one of the authors, ‘in the real world nurses cannot expect lunch breaks’, while another said that it was ‘just human nature’ for some managers to bully nurses (Cooke 2006). Cowen (1994) suggests that the assertion that something is ‘just human nature’ is frequently summoned in order to have the last word on the subject. Just like the invocation of the ‘real world’, it justifies the inevitability of the status quo and fends off demands for change.

According to the sociologist Erving Goffman (1964, cited in 1983), sociology has an important role to play in questioning ‘official’ versions of reality. This is what he calls the sociologist’s ‘warrant’.

C. Wright Mills (1959) used the term the ‘sociological imagination’ to describe the ‘promise’ of sociology. For Mills ‘the sociological imagination enables us to grasp history and biography and the relations between the two in society. That is its task and its promise’ (p. 12). Mills explains this in terms of the relationship between private ‘troubles’ and public ‘issues’. ‘Troubles’ occur within the lives of individuals and their immediate social world. ‘Issues’ transcend the individual and have to do with public institutions and the larger structures of social and historical life. Too often, people blame themselves for their troubles and fail to see the wider issues involved. This makes people feel powerless. For example illness is a very personal trouble but studies of the social determinants of health have demonstrated that our chances of getting ill are often determined by social circumstances which can be changed (see Chapter 6).

Giddens (1986) says that the sociological imagination should involve an historical, an anthropological and a critical sensitivity. The sociological imagination is historical in that it allows us to understand the distinctive nature of our present society by comparing it with the past. It is anthropological in that it allows us to see the ‘kaleidoscope’ of different forms of social life that exist in the world. These two dimensions lead us to the third dimension of ‘critical sensitivity’. The sociological imagination shows us that existing social relations are not fixed and unquestionable. According to Bauman (1990), sociology has an ‘anti-fixating’ power.

and thus it expands our consciousness of the different possibilities for the future.

By its very nature, sociology deals with issues that are very pressing to us all and about which many people (not least journalists and politicians) have vociferous opinions. It confronts problems which are often subjects of major controversy in society such as the relationship between social class and illness, the changing role of religion, the rising divorce rate and the changing nature of work. Perhaps because of its subject matter sociology ‘raises hackles that other academic subjects fail to reach’ (Giddens 1995: 18). Maybe because we all have our own cherished views on such controversial topics, sociology is often derided as jargon ridden. If commentators agree with it however, it is ‘just common sense’.

However sociologists are concerned with understanding society in a ‘disciplined’ way (Berger 1966), involving both a theoretical understanding of social issues and empirical investigation bound by explicit rules of evidence.

According to Bauman (1990: 12):

Bauman also says that sociology also differs from common sense by the ‘size of the field’ from which the material for judgement is drawn. Most of us make judgements based on our own life experiences. Sociologists test their theories about the world by collecting empirical data using both qualitative and quantitative research methods. Qualitative methods involve a variety of methods of data collection, such as observations and in depth interviews which allow the researcher to describe the world from the point of view of social actors. Quantitative research is concerned with measurement and with analysing numerical data from sources such as surveys and official statistics which can tell us about wider patterns in society.