There are different ways of knowing things. Some are priveleged over others.
I've just been rereading Donald Schön's work on artistry in practice (http://books.google.com.au/books?id=FLJfQgAACAAJ). He says that artistry is embedded in skilful practice and that people use this artistry to help them act in "situations of uncertainty, uniqueness and conflict." Sometimes people can't explain why they do the things that they do, but it can be recognised in competence and making good decisions. Schön says that this presents problems for universities that prepare professionals (like nurses) as the preferred ways of knowing are systematic and scientific.
I'm not sure that this is any longer the case with nursing. Nursing literature acknowledges different forms of knowledge and acknowledges that for nurses to engage in safe and thorough practice they must draw on multiple perspectives and discourses. See for example Barbara Carper's work and the many authors who have drawn upon her ideas (http://en.wikipedia.org/wiki/Carper's_fundamental_ways_of_knowing). Thinking across multiple discourses and drawing on different ways of knowing is alive and well in nursing education.
I think the problem sits more with the health care industry and the community. I think that Schön's assertion that the scientific knowledge is priveleged over other, important ways of knowing rests more within the expectations of the world outside universities. I think it arises because nursing is not well understood or articulated.
I have thought this for a while but two things recently came up to reinforce it for me. Firstly, I had a long conversation with a nurse who's role it was to support newly graduate nurses. The conversation went along the lines of how he felt gradutes needed to be better prepared for practice. He believed that graduates needed more scientific, biomedical knowledge regarding the specific clinical area that they will be working in. This is fair enough I suppose but the problem that I have is that nothing else that the beginning practitioners offered was valued and no other strengths were acknowledged or considered important. Graduates are checked for competence across a range of clinical tasks with a biomedical focus.
When the current graduates were students, they were deemed competent by the university and the Nursing and Midwifery Board of Australia. I'm not convinced that they have a deficit in biomedical knowledge but that maybe the employers of new nurses have a focus on this one type of knowledge. I'm not saying that biomedical knowledge is not important, it most certainly is, but that other ways of knowing are important and that new graduates come prepared with a suite of skills that are unrecognised or undervalued. Further (and a bit of a side note), I believe that students are well prepared to find out what they don't know and that an environment that asks practitioners to be intrinsically accountable for their own knowledge and practice is an environment that fosters excellence in which the former students will thrive - even with regard to biomedical knowledge.
The second thing that I wanted to mention was that I recently posted a response to an article "Overhauling Nurse Education" on Nurse MedPulse (http://www.medscape.com/viewarticle/736236?src=mp&spon=24 - you might need to sign up or log in). I was a little bit staggered at the number of responses that went along the lines of "there's too much critical thinking being taught we need nurses who are good at finding a vein".
It seems to me that whether or not universities are able to lead students to artistry in their practice, it is a very narrow band of knowledge that is valued, or even recognised by the world at large.
