The Power of Normal

There is a drive within each of us towards normality. What is usual, typical, standard, average, natural, regular or conventional shapes our lives in many varied and important ways. We have laws, regulations, codes, guidelines and rules (written, spoken and unspoken) that specify in detail what constitutes normal behaviour. There is often a degree of comfort associated with this, even a sense of safety. As nurses we assess growth and development, indicators of health and well-being, and presenting symptoms against established norms. We can describe performance and outcomes statistically using terms such as deviation from the mean on a normal distribution curve. Normality is central to our lives in so many ways and we value the status quo; when it is challenged we tend to want to ‘get back to normal’. Normality then is a powerful construct embracing everything and everybody (Rabinow & Rose, 2003). Institutions and groups to which people belong require their members to behave in particular ways. Professional groupings (not only in health contexts) require their members to conform to established norms through regulatory means and the judgement of their peers. Disciplinary measures, both formal and informal, are exercised on members for deviation from accepted practice (Dreyfus & Rabinow, 1983). These measures are essential for a safe and quality health service, but create particular challenges when it comes to transforming the workforce to meet burgeoning population health need. In New Zealand a patient’s normal expectation and experience of first contact primary care is to be seen by a general practitioner (GP). It’s an expensive model characterised by periodic consultations with attempts at curative medicine and perhaps once did meet most people’s immediate health needs. Over recent decades, however, the new normal of population health and socio-economic inequalities has left the traditional GP model wanting. The norm patients should experience for integration of complex health and social needs, is a multidisciplinary approach in which nurses play a central role. Yet where it does exist (usually servicing deprived populations) and where it pushes traditional boundaries, it is tolerated as innovative and subject to funding mechanisms that lack longevity.