Paradigms of Practice: a dilemma for nurse educators

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Abstract
In the United Kingdom's newly reorganised National Health Service (NHS), Regional Health Authorities (RHAs) currently have responsibility for purchasing education services from colleges or, increasingly, universities. This purchasing relationship is the key element in a new market for education which has replaced the bureaucratic control of the old NHS. In making purchasing decisions RHAs are acting to secure workforce supply (and/or professional development services) for the newly autonomous employers (NHS Trusts) who through hospital or community services provide for the health care needs of the public. This paper analyses the market for health care education in terms of the distribution of power between key players. It argues that the local purchasers (currently Regions) and recipients of the products of nurse education (NHS Trusts) now exert levels of control which are unique in the field of post‐compulsory education and training in the UK. As universities pick up the business of nurse education the nurse teacher is simultaneously drawn in various directions. It is argued that the reconciliation of new tensions in the role of the nurse teacher is not simply a function of the philosophical compatibility of competing priorities. Rather, the location of power in the hands of relatively small numbers of large purchasers and employers may effect a radical change towards instrumentalist Ideologies, at the expense of orthodox approaches to education. From an analysis of various models of the nurse teacher, it is postulated that the currently established ‘paradigm of practice’ may be threatened by an Incipient new paradigm, which, while it may be more suited to the market, is incompatible with current professional values.