This letter is a rebuttal to Linda McGillis Hall's commentary on my paper, "The Relative Value of Nursing Work: A Study in Progress" (Canadian Journal of Nursing Leadership, 16(2)).

The focus of the paper was to develop a method of assigning relative value based on education, work environment and value added to the work. These three variables find their manifestation in type of work, difficulty, job complexity and experience. The premise of the work is based on the fact that different types of nursing work exist. In the project, the authors identified work performed between specialties and within specialties. That, by itself, is a complex subject.

It is true that this type of model is used in the real world for remuneration. In Canada, however, remuneration depends upon the ability to pay and a negotiated settlement in each province. The relative value of nursing work remains constant among the provinces.

The paper did not deal with the issue of importance, which has sociological implications (such as the importance of a nurse to the public) that I did not intend to address. The issue and importance of generalists, also not addressed in the paper, are currently being studied in another project. The issue of generalists and their importance in healthcare has economic significance. A system must have generalists to fill gaps. For economic purposes, there must be a continuous supply of generalists. While they are important, one must look at the development of specialists in the healthcare system. These are economic issues.

Relative value is a fact of life in nursing. Upon hearing the words relative value, many nurses recoil and think divisiveness. Rather than divisiveness, why not think recognition and career paths? Nursing is a knowledge-based profession, and knowledge is the profession's software. Why are nurses so hesitant about tackling this issue?

Thank you for the opportunity to provide this rebuttal.

About the Author

Gloria Joachim, RN, MSN
Associate Professor, University of British Columbia School of Nursing, Vancouver, British Columbia