Consider the current crisis in nursing. From 1987 to 1994, the number of those entering training in Britain fell by 39%. The unions blame poor pay.

But there is an alternative diagnosis, one that has implications for other professions and their patients and clients throughout Europe and the U.S. In a study my organization published this week, "Come Back Miss Nightingale," nurse Janet Warren and physician Myles Harris argue that what we are witnessing is part of a wider crisis in professionalism. The crisis is one of morale--not only the morale of the nurses leaving the profession, dropping out of training courses or not entering the profession at all, but also the morale of patients. In some hospitals patients are washed; in others they are neglected. The sight of a patient lying in bed surrounded by the very latest in diagnostic equipment but with food congealing on a plate at bedside is commonplace. Patients and staff are turned over at a furious pace in a system called "hot bedding."

Care can be fragmentary. One patient told the authors: "I had two major operations in four days, then they decided I needed a bath. I was lowered into the bath on a chair, then I was forgotten. I was too weak to pull the cord. I was covered in bedsores." A relative of an 88-year-old patient is quoted: "I seriously think death will be a less painful way out. I certainly do not wish to ever again enter an English hospital."

To understand what has happened, you have to remember the origins of nursing, associated with Florence Nightingale. It is modeled on a sort of monasticism. Nurses obeyed rules of silence, obedience and duty. They wore uniforms. They were arranged in ranks. They were committed to formality, discipline and service. Long hair and jewelrey were banned. They were not expected to marry while in training. The climate was one of seriousness, calm, modesty and purpose. And the main purpose was service--the washing, turning, feeding and looking after of patients too sick to look after themselves. Nurses learned this semimonastic role by an apprenticeship system at the bedside, in a hospital, not at a university. They also learned loyalty to their hospital and to their calling.

One only has to rehearse these words to see why nursing was not allowed to remain as it was. They offend every modern sensibility. On the "right," they offend against rational, efficient management. It was rational to make experienced nurses managers, to remove them from the bedside so they could issue protocols rather than give orders, and do so from a distant console or office. "Hot bedding" is the rational use of scarce resources to maximize output. At its best the new regime did indeed provide an efficient service. But, as one patient reports, "I was very well serviced, but not nursed." On the "left," ranks and orders offend against egalitarianism and individual professional autonomy, as do old-fashioned and rank-distinctive uniforms. Silence and the use of surnames offend against the cult of informality. Above all, the ideal of self-effacing service offends against the position of women demanded by feminism. So too does the position of the nurse--the female nurse--as junior to the male doctor. So more status had to be found for nurses. It was not to be sought in demeaning service but in expertise and managerialism. In pursuit of expertise, training was removed from the bedside to the university. Theory replaced practice. Loyalty to knowledge replaced duty to vocation. The irony is that it has not increased recruitment. But it has severely damaged the true professionalism of nursing.

The story is not, alas, a new one. Teachers were 20 years ahead of nursing in committing professional suicide. In that case too it did not come from the ordinary members of the profession but from unions, gurus of theory and ideology. But much more worrisome is that quite different professions such as academe and law are also experiencing the same problems.

At first sight nothing seems further from the practice-led profession of nursing than the expertise-led life of the university professor. Except that the latter was not until recently thought to be about expertise; it was thought to be about wisdom and judgment. Like nursing, it too was a calling to a certain life and character. The lawyer also had his twin responsibilities, to his client and to the calling of law itself. Law now thrives as a commercial venture, but how much of the old collegial profession remains?

Professions have several characteristics. One of them, expertise, is currently assumed to be the defining element: The more expertise, the better state the profession is in. Well, nursing today has more expertise than ever before, and so do law and academe. But professionally, they are in trouble. For becoming a nurse, professor, lawyer or doctor is not about acquiring a bunch of expert tricks but about becoming a certain sort of person with certain virtues. Those virtues Ms. Warren and Dr. Harris remind us of: service, quiet, formality. Indeed it's even more than that. It is about entering a community, a college of others with the same character.

The late 20th century has tried to have professions without virtue,