Nursing Ethics

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Nursing as Vocation
Karolyn White
Nurs Ethics 2002; 9; 279
DOI: 10.1191/0969733002ne510oa
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NURSING AS VOCATION
Karolyn White
Key words: care; nursing; vocation
In this article the author argues that nursing is best understood as a vocational occupation. Using Blums model of vocations it is argued that such occupations are socially
expressed within practices embodying traditions, norms and a range of meanings: industrial, social, personal and moral. Vocational workers are those who identify in certain
ways with these traditions, norms and meanings.
One problem with the vocational model, as it has historically applied to nursing, is
that it has been articulated through concepts of motherhood. Nursing was a vocation precisely because the character of the nurse was identified as feminine. The author argues
that the vocational model for nursing can be conceptually disentangled from its identification with ideals of motherhood and femininity. It is nursing work and the identification with the moral and social meaning of nursing that give nursing its vocational status,
not the feminized character of the nurse.

Introduction
The discussion of nursing as vocation, while somewhat out of vogue, is nevertheless practically and ethically important. Not only does the vocational model
provide a framework within which best nursing practice occurs, but vocational
motivations and actions are pivotal to understanding the concept of care in
nursing.
However, while I argue that the vocational model best allows for the expression of nursing work and nursing care, it is not unproblematic. One difficulty
with the vocational model, as it has been historically applied to nursing, is
that it has been articulated through concepts of motherhood, altruism and ideals
of femininity. I will argue that this is not sufficient reason to jettison the vocational model as an appropriate one for nursing. Nevertheless, nursing as a vocation needs to be conceptually disentangled from its identification with these
ideals.
In this article I want to focus on two central issues. The first is to clarify the
concept of vocation. I will primarily use Lawrence Blums work on vocational
motivations and actions to explore the concept and ascertain its relevance to nursing. It can be shown that nursing is vocational work, although not every nurse
will engage with vocational motivations and actions. The second is to consider
Address for correspondence: Karolyn White, Faculty of Nursing (MO2), The University of
Sydney, Sydney, NSW, 2006 Australia. E-mail: kwhite@nursing.usyd.edu.au

2002from
Arnold
10.1191/0969733002ne510oa
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K White

the construction of vocational ideology particular to nursing.

Before discussing these issues, however, it is useful briefly to examine the evidence of vocational concerns and issues that emerge for, and are experienced by,
nurses.

Vocational concerns
Nursing care requires a duty to care for patients, which implies more than the
mere legal notion of a duty to care. The importance of this primary concern to
nursing is borne out by research in both nurses and patients. 1,2 Evidence suggests that patients value the kind of care given to them by nurses who are sensitive and responsive to their needs, not care in the professional sense of providing
competent treatment, but care in the personal, vocational sense.3 Benner and
Wrubel cite studies that assess how patients experience nursing care; noncaring
behaviour was viewed as the nurse just wanting to get the job done. This distant treatment made the patient feel dehumanized, devalued, angry, and fearful (p. 5).4 Oakley provides a personal example of the importance of the caring
and commitment of nurses to patients; nurses serve to humanize the impersonal,
routinized (professional) treatment received in hospital.5 Research on those who
have been mechanically ventilated confirms the importance of nurses to patients.
Jablonski reports that patients view good nurses who enjoy their work, they
like people . . . as competent, friendly, warm, kind, supportive, and trusting (p.
201); bad nurses were described . . . as judgmental, mean, incompetent, and
mechanical . . . Bad nurses were also described as being task oriented and putting
procedures before patients (p. 201). 6

Vocation
The vocational model of work has lost currency in modern western societies over
the last century. The introduction of radically different modes of production during the industrial revolution, the rise of science and the hegemony of liberalism,
in part explain this change. Thus the older model of vocation has been largely
replaced by models of work that are more compatible with market imperatives.
However, the notion of vocation has not completely disappeared. What is striking about the present concept is that, although there are some considered appropriate for men, vocations tend to characterize certain work properly performed
by women. Teaching and nursing are the most evident examples.
Before discussing the particular model of vocation as it is applied to nursing,
the concept of the general model needs to be elucidated. In one sense, vocation,
profession and job have identical meanings: that of an occupation or habitual
employment. For example, vocational guidance counsellors are those who assess
ones propensity for certain types of work; vocational aspirations are what a person wants to work at, or, once in employment, refer to their future goals in that
or any other occupation. Nursing may broadly be described as a job, a vocation,
and a profession, as can any occupational category. However, these notions also
have narrower and conceptually more specific meanings.

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The modern concept can be traced back to Luther,7,8 who argued that a vocation (ones calling, station or office) was necessary to overcome a persons natural nihilism. Vocation included a mans [sic] occupation, his biological order
(father, husband, son), and any other office held, for example, being a master of
servants. It was through and because of these stations that man was compelled
to be responsible and to serve others, in other words to be ethical. 8 Vocations are
ethically significant. Luther maintained that all occupations were vocations
because it was through working that man renders useful service on earth, and
further, experiences and bears his crosses (p. 167). 8
Lawrence Blum9 analyses the concept of vocation within a broader project of
articulating and developing a moral psychology for communitarianism. Blum is
concerned that the current assumption of a dichotomy between the personal and
the impersonal in ethics restricts our understanding of moral actions and motivations. He maintains that, while most philosophers have rejected Kantian moral
theory, they implicitly accept Kants moral psychology, and the idea that motivation is either personal the desire for happiness (nonmoral) or impersonal
(moral). The demands of the impersonal always override personal considerations
of good. Against this assumption, Blum maintains that there are inter alia five
actions and motivations that cannot be captured within the personalimpersonal
framework. The examples of actions and motivations provided by Blum are
expressed in the concepts of friendship, vocation and community.
Although Blums broader project does not directly concern us here, his work
on vocations is well worth considering in greater detail. His explanations of
actions and motivations stemming from vocational ideals, the personal identification and understanding of what constitutes vocational work, are applicable to
nursing. Furthermore, Blums use of care, as a category of vocational action, is
pertinent to, and illuminating for, nursing.
According to Blum, the concept of vocation includes certain types of work (e.g.
missionary work) and the attitudes, actions and motivations of vocational workers. A lawyer may competently carry out his or her job as a lawyer, fulfilling the
job description or role as a lawyer, and yet not be a vocational lawyer. Law as a
vocation commits the practitioner to being a certain type of lawyer who demonstrates the values or virtues appropriate to the practice of law, who identifies with
those values, and is an excellent legal practitioner. The category of work termed
vocation includes an industrial meaning or the type of work, a social meaning,
which implies responding, in this case, to a client as a lawyer, a personal meaning or an identification with the expectations and norms of the occupation, and
a moral ideal,
Blum uses Herbert Kohl10 as an example of a vocational teacher. Kohl worked
as a secondary school teacher and, after a request by the parents, agreed privately
to tutor an illiterate 14-year-old boy. The child was described as difficult, and Kohl
did not like the boy at any stage of their relationship. Blum argues that Kohls
decision to tutor the boy was because:
[H]e responded to, was moved by, the particular boys plight, namely his being 14 years
old and unable to read. Kohl experienced this as a terrible condition for the boy himself and was aware how damaged the boy would be if the schools system continued
to be unable to teach him to read. Perhaps Kohl was moved also by sympathy for the

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parents distress and despair. It is to the particular boy that Kohl responded, not to an
impersonally derived value generating a reason for all (p. 177). 9

The teacher, Kohl, is moved to act because he identifies with the social and
moral meaning of teaching. In Blums words he acts specifically as a teacher in
that only as a teacher could he fully appreciate the implications of illiteracy for
this particular boy.
In bringing this category (teacher) to bear on the situation, Kohl in a sense invokes the
entire structure of social meaning and tradition within which the concept of teacher
gets its significance. He sees that significance as involving certain values and ideals
promoting the intellectual growth of his pupils, teaching them habits of mind and a
love for learning, which, as he sees it, will serve them in certain ways within society
(p. 177). 9

Vocation is a much richer concept than role. Blum explains that there is a personal identification and personal engagement with the values and ideals suited
to a vocation. Because one identifies with and owns these values, a moral pull is
experienced. These values are discretionary, so each agent will experience differently the moral pull (dedication) in particular situations. Agents do not pursue
values because it is good for them; rather, they respond to values external to themselves and appropriate to the occupation. Response to external values, Blum
argues, is not impersonal in the generally accepted senses. He introduces another
sense of the impersonal to distinguish the characteristic motives of vocational
action: that which is regarded by the agent as a response to some external, objective, or real value (p. 181). 9 It is a transcendence of the personal in the name of
the vocation. These values and ideals form part of the agents identity as, say, a
nurse.
Three things motivate vocational action: care, generality, and specific relationships. Vocational care is specific care. Each vocation will be characterized by different virtues and sensitivities and a distinct moral character appropriate to the
particular circumstances in which vocational care is given. Vocational care, however, is not only dispositional; caring abilities and certain types of knowledge and
skills are necessary to care. In the case of nursing, the knowledge and skills necessary to nurse include providing for the physical needs of another. Nursing work
is evidently and necessarily caring work in this sense; nurses spend much of their
time attending to the physical or bodily needs of their patients. This aspect of
nursing is obviously important. Patients who cannot physically care for themselves need others nurses to do it for them. Continuous with, and included
in, the physical care nurses provide for their patients are other types of care,
including monitoring patients, observing their health status, and procedural and
technical skills. To provide physical and technical care, nurses must have a knowledge of anatomy and physiology, microbiology, disease processes and nursing
procedures, and have an understanding of the technology used in the care and
treatment of patients.
In the dispositional sense, nurse vocational care is best understood as a personal and moral disposition or attitude to particular others in a nursing context.
It is caring about particular patients as a nurse, showing that they matter, by being
sensitive and responsive to their specific needs and the meaning and experience
of illness (dependency, loss, grief, etc.) in their lives. Common to all vocations

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and, I would argue, especially nursing, is care of a persons totality or

overall good, as opposed to instrumental care. All vocational care, then, involves
virtues, sensitivities and knowledge, although their application, kind, etc. will
differ.
Generality or general norms provide a reason for acting. The general norms of
a vocation (e.g. teaching) lay down the requirements for being a good teacher and
prescribe the general kinds of action that a good teacher ought to preform. As a
teacher one ought to act to ensure that one is doing what one ought for the pupil
and for the sake of the pupil. In addition to general norms, there are particular
requirements deriving from specific relationships. These requirements come from
the particularities of the relationships in question. Some charges will require particular and different treatment, as did Kohls illiterate student. Blum does not
deduce particular care from generalized norms; rather, reasoning starts with
appreciation of the particular in question.
Specific relationships refer to the claims that specific persons (patients, different friends) will have on an agent. In the case of a vocation, those receiving care
will have separate and different needs and requirements from others.
Kohl was clearly a vocational teacher. His commitment to his pupils, even those
he did not personally like, was exemplary. Indeed, some may argue that Kohl
acted, in his role as tutor for the illiterate boy, above and beyond occupational
norms and expectations. However, I would suggest that Kohl acted not above and
beyond the call of duty, but as a teacher because he identified and was engaged
with the social and moral meaning of teaching. The boy needed to learn to read
and the only way Kohl could assist him was to tutor him after school hours. Not
all teachers, even vocational teachers, will feel the moral pull of teaching in the
same way as Kohl. Vocations do not require practitioners to act above and
beyond occupational norms; they require a commitment to, and identification
with, the virtues and values of the occupation.
Blums model of exemplary vocational actions and motivations applies directly
to the case of nurses. Good nurses are vocational; they embody the values and
ideals of the occupation; they are motivated by care, generality and the specific
needs of specific patients.

The vocation of nursing

The image still carries force with both the public and nursing.11 To have a nursing vocation is to be dedicated and committed to assisting another who is disadvantaged in some way on the basis of need and because of what is genuinely
best for them. To give succour in this way involves being a person who possesses
the virtues of compassion, care and concern. Vocations and those who enter them
have different aspirations and a different focus from instrumental occupations.
This, it seems to me, is vital, particularly for nurses whose purpose is to care for
the sick and needy.
Florence Nightingale popularized the notion of nursing as a vocation. She
argued that vocational duties require nurses to care for all aspects of patients, perhaps especially the messy, dirty, nontechnical bits. Not to do so is not to care or
be a good (vocational) nurse.

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[I]f a nurse declines to do these kinds of things (emptying chamber utensils) for her
patient, because it is not her business, I should say that nursing was not her calling.
I have seen surgical sisters, women whose hands were worth to them two or three
guineas a-week, down upon their knees scouring a room or hut, because they thought
it otherwise not fit for their patients to go into. I am far from wishing nurses to scour.
It is a waste of power. But I do say that these women had the true nurse-calling the
good of their sick first, and second only the consideration what it was their place to
do and that women who wait for the housemaid to do this, or for the charwoman to
do that, when their patients are suffering, have not the MAKINGS of a nurse in them
(p. 22). 12

Nightingales point is that, changing wet beds, feeding elderly people, cleaning bottoms etc., are necessary in the care of sick and disadvantaged people. It is
putting them first, seeing to their physical and emotional needs.
I am not advocating that nurses turn themselves into handmaidens (or manservants), drudges, or martyrs. On the contrary, I view what nurses do as of the
utmost importance and it is for this reason that the vocational aspects need to be
retained. The salient point is that caring for people (nursing) frequently involves
exactly those tasks that are considered menial, unpleasant and intimate, 13 and it
is precisely for these reasons that nursing is thought of as a vocation. People usually shy away from the messy, the diseased, and the underprivileged, the emotionally disturbed, the frightened, and anything to do with pus, urine or faeces.
To work willingly with all of these things is to be virtuous. The type of work that
nurses do (i.e. nursing) is somehow ethical, so nursing is a vocation in the industrial sense.
In its social sense, a vocation carries a certain range of expectations with regard
to the person who has the vocation. Thus the concept of nursing carries with it
the expectation that nurses will respond to patients qua nurses. Only by acting as
nurses can they appreciate the impact and meaning that ill health (or disease,
incapacity, etc.) has for their patients. The identification of the nurse with nursing uniforms and certain styles of relating to patients are (some) of the ways in
which nurses affirm the social meaning of nursing as vocation. The recipients of
nursing care and the wider society must also share the social meaning of the vocation of nursing, to some extent. Clearly, this is the case because patients expect
and allow nurses to nurse them even though nursing care requires a breach of
otherwise accepted cultural norms and taboos.
The personal meaning involves the idea that the possessor of a vocation will,
as a person, identify and engage with its social meaning (i.e. the values, traditions and ideals associated with that vocation). In Lawlers study,13 nurses drew
upon the traditions and ideals of nursing (social meaning) and were thus moved
to respond appropriately to the needs of particular patients: their specific expression of situated dependence and their experience of illness. Moreover, the nurses
responded not in their own interests, but for the patient and for the sake of the
patient. The personal identification with and, indeed, the claim of ownership of,
the social meaning of nursing, helps to structure the identity of the nurse and
thus creates the moral pull that nurses feel towards tasks involved in caring for
patients. The personal meaning of a vocation requires a commitment to act in the
appropriate ways and, insofar as the commitment is conceived to be a moral one,
the personal meaning passes over into a moral one.

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The following story is an example of vocational nursing. I have chosen this case
specifically because it is controversial; not all nurses will view the actions of the
nurse as right. Secondly, it demonstrates how the moral pull of vocational work
is discretionary. The case concerns a very experienced nurse caring for a patient,
Sue, who is terminally ill.
My patient was a 64-year-old woman admitted in the terminal stages of breast cancer.
Sue was well prepared for death. This was her third admission to my ward, but she
regretted her poor relationship with her daughter. She had not spoken to or seen her
daughter in five years. As she became sicker she became more desperate to see her
daughter again.

The nurse suggested that they should ring Sues daughter, Michelle, and find
out whether she would be prepared to visit her mother. This involved calling
London, UK, where the daughter now resided. Happily, Michelle wanted to see
her mother and bring her 3-year-old daughter. The nurse explained to Michelle
that she would have to fly to Australia quickly, as her mother was critically ill.
The nurse recounts:
Sue desperately wanted to see Michelle again. She was really nervous before we
rang; I thought she was going to vomit. Thankfully, Michelle was just as anxious to
meet and talk as her mother was. It was wonderful to see Sue so happy because she
would see Michelle before she died, and so thrilled to be able to meet her granddaughter.
Sue kept talking about Michelle. She even asked me if she could go down to the hospital gift shop and buy a present for her granddaughter. Unfortunately she was too
sick, so I went down and picked up a pink teddy bear for her. She was so excited and
at the same time so worried. She was worried she would not live to see Michelle. I can
remember her asking me whether she would live to see them, and I remember answering that I hoped she would.

Before Michelle arrived Sues condition deteriorated. She became very confused
and agitated, and slipped in and out of consciousness. During her last conscious
period Sue mistook the nurse for Michelle.
I just felt terrible. She so wanted to see her daughter. So I came and sat by the bed and
held her hand and said Im here Mum. I just talked to her as if I was Michelle. It must
have helped because Sue became less agitated and more peaceful. I dont believe in
lying to patients, but I could not tell her I wasnt Michelle. She was unconscious when
Michelle finally came and she never regained consciousness.

The nurse in the above story, like Kohl, was motivated by vocational concerns.
She demonstrates the values and virtues appropriate to and for nursing. These
include the provision of skilled nursing care and concern with the patients health
and well-being, and she is morally disposed to care.

Objections to nursing as a vocation

Historically, the concept of vocation has been used to limit nursing, because it has
been linked to ideals of femininity. This has at best circumscribed the legitimate
occupational aspirations of nurses and at worst rendered nurses invisible. This in

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K White

turn has compromised patient care and the nursepatient relationship. It has
hindered nurses ability to care. I want to develop a concept of nursing that retains
certain important aspects of vocations and rejects the subordination of nurses.
Historically, femininity, which is constructed in the private sphere, masculinity
in the public sphere, has informed the social role of the nurse. The feminine
virtues, appropriate to the private sphere, inform or act as a moral constraint on
the social role, so that the ascribed personal attributes of the nurse have informed
the social expression of the role. Motherhood has been crucial here. Not only have
motherhood and nursing been characterized similarly, but the jobs are also similar. Nurses do in the public sphere what mothers and wives do in the private
sphere. In fact, nursing has been described as the professionalization of the
domestic.
I would agree that the construction of the identity of mother is important in
understanding the notion of vocation as it applies to nursing for several reasons.
Nursing and motherhood are constructed in much the same way; both are conceptualized as vocational in the sense that mothers and nurses are naturally suited
to their respective tasks, which are considered to be vocational. It is the character of the nurse and/or mother that gives the work vocational status.
It is because of the historical connection between the notion of nursing as a
vocation and ideals of motherhood that some nurse theorists have urged that the
vocational model should be abandoned. It is argued that the notion of vocation
based on feminine ideals of altruism, service, caring and nurturing is central
to the exploitation of nurses.14,15 While there are some similarities between nursing and motherhood, I also argue that the concept of nursing as a vocation can
and should be disentangled from its historical association with concepts of
motherhood.

Altruism
A common misconception in the nursing literature is that altruism is problematic because it implies self-sacrifice (p. 72).16 The problem with the notion of
altruism as it has been used to characterize nursing and motherhood is that it
presupposes that motivations are either altruistic or egoistic, so that all otherregarding virtues and motivations are conceptualized as altruistic. Given this way
of understanding altruism, it is not surprising that the notion of vocation as a
mode of work (and vocational actions and motivations) would be regarded as
central to the exploitation of nurses (and mothers).
However, as Poole has argued, the notion of altruism is inappropriate to motherhood (and nursing) because the identity of a mother (and a nurse) is defined
in terms of her contribution to the well-being of others so that achieving the good
of those specific others does not involve a sacrifice, but is a way of achieving her
own good (p. 54).17 The identity of the mother is relational and expressive in that
other-directed behaviour becomes an expression of self. That it is expressive is
necessary if it is to achieve its object. Therefore to be a mother is to express those
behaviours that will ensure the good of specific others; these include caring, nurturing, love, empathy, particularity and so on. It is only by loving and caring for
members of her family as unique individuals that the good of those others is
guaranteed.

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The good of the family (or the patient in the case of nursing) cannot be
guaranteed by self-sacrificing behaviour; it can be guaranteed only by caring for
them out of a deep sense of commitment for their welfare. In the case of nursing,
caring is an important manifestation of womens expression of love of others,
and thus integral to the female sense of self (p. 199). 18 Caring here does not
involve self-sacrifice; it is a means of self-expression.4

Motherhood and nursing

The construction of the identity of mothers has been important in making sense
of the notion of nursing as a vocation. The identity of the nurse has been closely
aligned with motherhood and its appropriate morality. To be a good nurse means
to embody certain moral qualities, which are other-regarding and identical to feminine virtues associated with the private sphere. Nursing has been constructed to
express the kinds of behaviour (kindness, patience, humility, love and so on) that
will ensure the good of specific others: the patients. Moreover, the expression of
other-regarding, caring virtues is integral to nursings identity. Nursing holds a
privileged position in the community precisely because it is vocational; the good
of the patient matters to the nurse because of the kind of person he or she is.
The connection between the construct of mother and nurse is not accidental.
Gamarnikow 19 and Vicinus20 maintain that, although reformed nursing was identified and constructed consistent with traits necessary for women, there was an
ideological shift, at the turn of the nineteenth to the twentieth century, which
changed the idea of good nurse equals good woman, to nurse equals mother
equals housewife. Nursing was depicted as a moral crusade against sin, dirt and
immorality, and, consistent with this, military metaphors featured in the struggle.
Combined with the military idea of waging war on sickness and sin was the
notion that womans nature, her inherent and superior morality, was vital in order
to exert a sanitizing and humanizing influence on the ill and the morally
bankrupt.
The nursing equals good woman paradigm was also an attempt to carve out
an acceptable occupation for single respectable women and an attempt to elevate
the status of nursing to a vocation. In this endeavour, Florence Nightingale and
other reformers were (eventually) largely successful. The changed demographic
patterns in which women outnumbered men a cause for consternation for the
Victorian middle classes (p. 39)21 new ideas about work, the suffragette movement and reformist notions, assisted nursing reformers in their aim. However,
nursing had to compete with other occupations that were opening up for women.
What attracted women into nursing was its exclusivity, status in the special role
accorded to the nurse, superiority, and to be one of a select group of women with
special characteristics, who were somehow ordained to become nurses (p. 15).21
The ideological shift to nurse/universal mother can be explained in part as the
attempt of nursing to elevate its status further. The nursing the room aspect of
nursing, consistent with Nightingales theory of disease, was made redundant by
hiving off those more menial tasks to domestic staff. Nursing then took on more
responsibility for carrying out doctors orders. Gamarnikow has argued that this
move further subordinated nursing to medicine, as the focus switched from
hygiene (the autonomous sphere of nursing) to patient care (under medical

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K White

orders).19 In order to maintain discipline and to rationalize the new functions

family metaphors were utilized. 20
Maggs argues that the imagery of the family was so pervasive and, since more
women were not fulfilling their true functions as wives and mothers, contemporary commentators had to extend the construct of the family to the whole of
humanity. He quotes Saleeby:
It is not necessarily argued, by any means, that marriage and motherhood are to be set
forth as the goals at which every girl is to aim; such a woman as Miss Florence
Nightingale was a Foster-Mother to countless thousands, and was only the greatest
exemplar in our time of a function which is essentially womanly, but does not involve
marriage (p. 14). 22

Nursing, because of its vocational image, the shortage of marriageable men,

and the construction of femininity, became a viable alternative to marriage. Nurses
opted for the service of mankind rather than of a man (p. 17).20 Whether to maintain this image or for other reasons such as ensuring that the young women who
went into nursing were well supervised, certain restrictions were set in place to
ensure that women either married or nursed. For example, the preferred age of
the probationer was that which corresponded to the marriageable age of women.
Apart from the bar on married women entering nursing, the long hours nurses
had to work, and the insistence that nurses live in, further discouraged married
women from applying.
I would argue that vocational work has been misunderstood. Historically, nursing was seen as vocational, not because of the work involved but because of the
privatized character of the nurse. Well-disposed women made a private choice to
nurse. The privatization of this disposition gave nursing its vocational status. I
have argued it is nursing work that is vocational. Nursing work is the skilled and
educated provision of service to those in need and not merely an elaboration of
wifely and motherly work. It is the identification with and sensitivity to particular needy people that gives nursing its vocational status. This also means that
men can nurse.
Blums concept of vocation, a personal identification with the social and moral
meanings and values of (in this case) nursing work, liberates nursing from its historical connection with idealized femininity and constructs of motherhood. Yet
Blums construct retains the centrality of care to and for nursing work.

Conclusion
The notion of nursing as a vocation has been associated historically with motherhood, which has made it difficult to arrive at a proper understanding of what
nursing as a vocation really means. This is a good reason for disentangling the
notion of nursing as a vocation from motherhood; it is not a good reason for rejecting the vocational model. The notion of vocation is crucial to nursing if nursing
wants to continue to accord primacy to caring or at least take seriously the notion
of caring about patients. Blum shows the values inherent in the concept of vocation through his illustration of teaching and Kohl:
by drawing on a certain tradition and interpretation of what it means to be a teacher

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and by being able to root that understanding in his personal sense of values, Kohl has
secured for himself a kind of self-realization precisely in serving others, within the vocation of being a teacher (pp. 19596). 9

The construct of nursing as vocation, however, is not without difficulties.

Although the model clearly recognizes what is best for those who are sick and
disadvantaged, cultural subordination of the feminine ethical character undermines and devalues this ideal. I do not mean to imply that feminine traits and
character should be uncritically celebrated; these traits, behaviours, etc. have been
formed through exclusion and suppression. What I do point out is that the direct
result of the subordination of the feminine ethical character has meant that nurses
are not given proper recognition or reward. Womens work is devalued; nursing,
as paradigmatically womens work, is therefore devalued.
Vocation involves providing what is best for people; therefore the community
also owes proper reward and recognition to those who are performing vocational
work. It is not the vocational aspect of the work that is subordinating; it is the
lack of community awareness of its obligations to its members that undervalues
vocational work. The excessively individualized or subordinating uses of vocation are therefore ill-founded.

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