Neoliberalism and the government of nursing through competency‐based education

Abstract

Competency has become a key concept in education in general over the last four decades. This article examines the development of the competency-based movement with a particular focus on the significance it has had for nursing education. Our hypothesis is that the competency movement can only adequately be understood if it is analyzed in relation to the broad societal transformation of the last decades-often summarized under the catchword neoliberalism-and with it the emergence of managerial models for Human Resource Management (HRM) for the reorganization of social services. Classical professions, which were characterized under welfarism by an esoteric knowledge based on ethical norms, have now become marketable commodities that can be evaluated in the same way as other commodities. We want to underline that while this development is still under way, it is the concept of competency that was the decisive political instrument enabling this profound change. With the widespread implementation of competency-based education that now governs nursing knowledge, the development of a critical, oppositional perspective becomes more challenging, if not entirely impossible. We will be focusing primarily on nursing education in Canada, although we maintain that it has relevance for nursing internationally.

Neoliberalism and neoliberals: What are we talking about?

“…From this mass of publications, I here focus on Foth and Holmes’ () Neoliberalism and the government of nursing through competency‐based education . This work advances a series of intriguing and stimulating points, and while I disagree with several aspects of what is said, the following discussion of the role that neoliberalism plays in the paper ought not to be misconstrued as an ad hominem attack on Foth and Holmes.…”

Psychiatry, risk and vulnerability: The significance of Robert Castel’s work for nursing

“…Castel's ideas concerning the categorization of the assistance zone and the professionalization/specialization of disciplines over time are relevant to nursing. Some authors have used Castel's work on these themes, for instance, Foth and Holmes (), who adopted Castel and Foucault's poststructuralist perspective to study the development of expert discourses on nursing.…”

“…Foth and Holmes () affirm that neoliberalism, based on the values of competition, performance and profitability, has also led to a restructuring of nursing interventions rooted in new managerial imperatives (e.g., cost‐effective nursing practices, economic decision‐making and new management strategies in nursing). In our opinion, nurses need to consider how precariousness and mass vulnerability affect people's behaviour, and how this new reality affects the dispensation of health services.…”

“…As previously discussed, Castel's work is being used by researchers to reaffirm the importance for nursing practice of the principle of social justice. Not only are nurses direct witnesses to these injustices, but their practice itself has been undermined by the increasing austerity of public health systems (Foth & Holmes, ). We would also suggest that there is an untapped potential in Robert Castel's work to further elucidate us on the ambiguous nature of the role of nurses who, despite their claims of advocacy and social justice, are also agents of control and surveillance (Holmes, ) in contemporary control‐based societies.…”

Nursing professionalization and welfare state policies: A critical review of structural factors influencing the development of nursing and the nursing workforce

“…Following this logic, it has been argued that nursing is a welfare state profession (Evertsson & Lindqvist, 2005). Further, given their involvement in the identification and solving of social and health problems, together with the administration and/or the rationing of relevant resources, such professions can become an essential part of governing (Foth & Holmes, 2017). Not surprisingly, given that more than one occupational group is often involved in the provision of such services, competition among groups may arise (Pavolini & Kuhlmann, 2016) and, as a result, such groups become involved in political activism to obtain and secure their profession's authority and power over other groups (Björkman, 1982).…”