My Personal Nursing Philosophy

Two weeks ago, we were assigned a paper describing our personal nursing philosophies.  The paper was limited to three to five pages and the final draft I turned in was short some of the better 'stuff'.  I'm posting my philosophy here for other nursing students to find when they frantically Google "personal nursing philosophy" for their own assignments.  It's not a masterpiece, but it is personal and meaningful to me.  So here it is....

My Personal Nursing Philosophy

Brandman University

March 2012

Embrace the Past...Engage the Present...Envision the Future

Nursing is a practice discipline with multiple, interwoven theories sharing similar concepts, but lacking a singular defining nursing philosophy.  Individual nurses develop personal philosophies to govern their own practices creating a philosophy of nursing rather than defining philosophy of nursing.  Nursing philosophy can be understood as “an attitude towards life and reality that evolves from each nurses’ beliefs formed in three elements:  conceptual analysis, assessment of argument, and concern with metaphysical and epistemological questions" (Edwards, 1996, p. 2). 

            The first step in identifying a personal nursing philosophy is defining nursing.  Nursing as defined by the American Nurses Association is the “protection, promotion, and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” (ANA, 2012).  Understanding what nursing means to the individual nurse is a deeply personal journey.  Defining nursing is relatively simple; embodying nursing is difficult. 

Building upon the definition of nursing, the nurse explores her personal philosophy through recognition and refinement of her personal belief system, ethics, career goals, experiences, the experiences of other nurses, and nursing theories.  The personal nursing philosophy becomes an articulation of these.  The task of gathering theories used in practice, concepts of evidenced based practices, examples of instructors and respected peers, and personal beliefs to organize and record for others to read is daunting.  I have identified the personal nursing philosophy that most closely aligns with my own to start.  Virginia Henderson stated, “Nursing is rooted from the needs of humanity and is founded on the idea of service.  The nurse is temporarily the consciousness of the unconscious, the love of life for the suicidal, the leg of the amputee, the eyes of the newly blind, a means of locomotion for the infant, knowledge and confidence for the mother, and the mouthpiece for those to weak or withdrawn to speak” (Roberts, 2012, p. 1).  In this philosophy, the nurse is essentially an advocate for all patients, significant others, and the community.  Advocacy is a main element of my personal nursing philosophy.  In addition to advocacy, my philosophy addresses five other concepts:  knowledge, equality, economy, continuity, and unity.  

Advocacy – Patient advocacy is any activity that benefits the patient from competent, compassionate, bedside care to actively legislating for improvements in health care systems or processes for patients.  “Nurses act to change those aspects of social structures that detract from health and well being” (ANA, 2010, p. 2).  Patient advocacy is not merely the defense of patient rights and the safeguarding of patient privacy.  Advocacy stems from a philosophy in which nursing practice is the holistic sustainment of the patient, ill or well, to promote his or her total well-being as understood by that individual.  Advocacy may take the form of finding reliable, timely information, financial aid, or appropriate referrals for patients.  Advocacy includes protecting the patient from “incompetent, unethical, illegal, or impaired practice by any member of the health care team…or any action on the part of others that places the rights or best interest of the patient in jeopardy (ANA, 2010, p. 7).  The nurse recognizes an ill and vulnerable patient cannot be a strong, self-advocate, is unfamiliar with the health care system, and unaware of his or her individual patient rights.  Nursing advocacy is a continual process in the implementation of nursing care.  Nursing advocacy requires critical thinking skills, appropriate assessment, and intervention, providing culturally sensitive information and education to the patient and significant others, ensuring equal access to care, and supporting the patient and family’s decision for care.  At times, the nurse must have courage to be a voice for her patient within the interdisciplinary team maintain collegiality, but ensuring the responsibility to maintain the nurse-patient relationship above all else.  In the past, advocacy consisted of ensuring the patient complied with the doctor’s orders.  Today, nursing advocacy represents a new paradigm addressing issues not formally considered nursing concerns.  I will listen to my patient and have the courage to advocate on his or her behalf.

Knowledge -  The responsible, ethical nurse informs her patients about the issues, seeks new knowledge and best practices, and maintains credentials.  Not only should the nurse actively seek new information, she should be excited to educate her colleagues and patients, offer solutions to identified problems, and to effect changes in practice to deliver better patient outcomes.  The advancement of nursing practice relies on every nurse as an educator.  I continually will seek knowledge whether formally or informally and share appropriate information with patients and colleagues. 

Equality – Patients are human beings.  Black patients, Jewish patients, and female patients are not inferior human beings by any genetic measure; only cultural biases place human beings on a scale of worth.  As Virginia Henderson admonished in 1955 to “get inside the skin” of patients, I continue to do so today.  In my practice, kind and quality of care is not determined by age, color, creed, religion, rank, or status.  Triage determines treatment and urgency.

Economy – Resources are limited; wants and needs are unlimited.  This is the economic law of scarcity.  As it applies to health care, improved medical technology, the belief of entitlement to care, and the coming change in the age structure of the population has increased the demands for health care (Mariner, 1995).  Health care resources are finite, a belief the American populace cannot accept.  Many believe all individuals are morally entitled to unlimited longevity and good health at any cost and believe denials of services by providers or insurers are unfair or arbitrary.  Unless a shortage occurs and rations are necessary as was the case with H1N1 vaccine, Americans do not appear likely to accept the fact of scarcity of health care resources.  I will not order or cause to be ordered unnecessary tests or treatments and if uncertain will seek the opinions of collaborating health care providers to protect valuable health care resources. 

Continuity – Continuity of care is “the process by which the patient” and provider “are cooperatively involved in ongoing health care management toward the goal of high quality, cost effective medical care” (AAFP, 1983, p. 1).  Continuity of care is more than maintaining adequate nursing documentation and records.  Continuity is more than collaboration with interdisciplinary professionals such as doctors, therapists, dieticians, social workers, chaplains, and case managers.  Continuity of care involves ensuring the patient is able; mentally and physically to follow through with referrals and to provide self care upon release.  Assessment of the patient’s needs and abilities allows the nurse to determine what interventions the patient needs to be successful.  In my practice, this has meant signing up a chronically ill patient up for a free, guaranteed ride home program from work to calling a patient to remind him to schedule an appointment with the cardiologist.  Not as an enabler, I will empower the patient to make necessary changes and seek follow-up care to grow and be well.

Unity – Nursing is not for the weak stomached or weak spirited.  Nurses are strong, dedicated, flexible, and empathetic.  Somewhere, perhaps to gloss over the bodily fluids and pounds of flesh, the idea of nurses as angels of mercy was popularized making nurses ethereal, otherworldly creatures.  Satisfied patients hold to the nurse as angel ideal while nursing students may describe some seasoned nurses as openly hostile.  Sadly, nurses eat their young is a common phrase used to characterize this relationship.  “A major issue in nursing is our failure to achieve unity…From a feminist perspective; the real issue involves divisiveness and fragmentation that sustains oppressive relations in an industrialized, patriarchal medical system.  Remaining divided from one another serves the interests of the dominant group.  Rather than benefiting us, fragmentation in nursing serves to confuse us, to keep our minds and hearts focused on the dominant system for solutions that never materialize” (Edwards, 1996, p. 1).

First as a Registered Nurse, now as a doctoral student, and eventually as an Advanced Practice Nurse, I will strive to incorporate the concepts important to me:  knowledge, equality, economy, continuity, and unity, in my life and in my practice and always remember:

 The Army Nursing Creed

“My patients depend on me and trust me to provide compassionate and proficient care always.  I nurture the most helpless and vulnerable and offer courage and hope to those in despair.  It is a privilege to care for each of these individuals and I will always strive to be attentive and respectful of their needs and honor their uniquely divine human spirit.”

- LTC Leigh McGraw 2012

References

American Academy of Family Physicians.  (2010).  Definition of continuity of care.  Retrieved from http://www.aafp.org/online/en/home/policy/policies/c/continuityofcaredefinition.html

American Nursing Association (2001).  Code of ethics.  Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf

American Nursing Association.  (2012). What is nursing?  Retrieved from http://nursingworld.org/EspeciallyForYou/StudentNurses/WhatisNursing.aspx

Bartholomew, K. (2008).  Why nurses eat their young:  A look at nurse-to-nurse hostility and why it occurs.  Retrieved from http://www.realityrn.com/more-articles/nurse-relationships/why-nurses-eat-their-young%e2%80%a6/542/

Edwards, S.  (1996).  What is philosophy of nursing? Retrieved from http://www.ruth-s-coleman-college-of-nursing.com/What_is_a_philosophy_Edwards_Art.pdf

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Jarrin, O. (2007).  An integral philosophy and definition of nursing.  Retrieved from  http://digitalcommons.uconn.edu/cgi/viewcontent.cgi?article=1049&context=son_articles&sei-redir=1&referer=http%3A%2F%2Fsearch.yahoo.com%2Fsearch%3B_ylt%3DA0PDoX29vIRPZBEAEiuJzbkF%3Fp%3DJarrin%252C%2BO.%2B%25282007%2529.%2B%2BAn%2Bintegral%2Bphilosophy%2Band%2Bdefinition%2Bof%2Bnursing.#search=%22Jarrin%2C%20O.%20%282007%29.%20An%20integral%20philosophy%20definition%20nursing.%22

Mariner, W. (1995).  Rationing health care and the need for credible scarcity: why Americans can’t say no.  Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1615628/

McGraw, L.  (2012).  Army nursing team creed.  Retrieved from http://armynursecorps.amedd.army.mil/assets/home/NursingCreed.pdf

Roberts, K. (2012).  Virginia Henderson:  A contemporary nurse 1897-1996.   Retrieved from http://www.contemporarynurse.com/archives/vol/5/issue/3/article/3027/virginia-henderson-a-contemporary-nurse-18971996

Simply Week 5

Another example that change is a "good thing"! (Thanks Levin & Martha Stewart)

Week 5 already!  This class has flown by.  Once again, I'm shocked at how much I am learning and equally shocked how delighted I am with the knowledge.  Pursuit of the ASN was difficult and demanding, but everything was new, bloody, and if I was lucky, disgustingly fascinating.  In contrast, the BSN degree was more administrative than clinical.  The BSN prepares the RN for management and leadership roles, much needed education and experience in nursing, but so vanilla.  Every day, I relish my choice and opportunity to attend grad school, to chase that terminal degree.  Unlike the BSN where the majority of the learning occurs in the classroom, the DNP forces the nurse learn.  A nurse will get from this degree only what she puts in, much like an Easy Bake Oven.  Put in a mud pie, no magic light bulb is going to turn dirt into chocolate.  Your instructors can't force the knowledge and enlightenment on you, but they will show you the path.  (BTW, they make EBO in purple floral now!  And no light bulb!  I'm indignant for the 70's era kids that endured the Pepto-pink, hand searing model.)

This week I am working on my personal philosophy of nursing.  I’ve been working on it for two weeks, but I could wax philosophical and say I’ve been drafting my own personal philosophy of nursing my entire nursing career.  On a subconscious level, all nurses are developing their own nursing philosophies.  Nursing philosophies, a compilation of personal beliefs, what we have evidenced in our own practices, sometimes the experiences of other nurses, and the nursing theories taught in school are fluid.  Nursing philosophies change as we expand our practices and grow richer, more complex. 

I believe it is important to write down your personal philosophy.  If you are a continual student like me, draft a personal nursing philosophy the beginning of every new degree.  Evaluate it periodically and make changes PRN.  I’m looking forward to grounding my practice and reminding myself of my personal, core nursing values through this week’s exercise. 

One Team, One Fight

"You will either step forward into growth or you will step backward into safety." 

- Abraham Maslow

One Team, One Fight - Four words issued by our COL guaranteed to halt any disagreements among our team members.  We are from different backgrounds, opinions, and viewpoints, but we're on the same team fighting the same battle.  Like soldiers,  nurses struggling to gain acknowledgement and respect from their interdisciplinary peers are one team with one fight yet we waste precious time and energy bickering among ourselves.  With the precision reserved for describing decubitus ulcers, nurses differentiate among their own:  ASN vs. BSN, MSN vs. DNP, DNP vs. DON, floor vs. clinic, clinic vs. academic, ICU vs. ED.....  The ways to categorize are many and the separating of ranks is the reason MDs are able to pass legislature restricting DNP practice.

I was reminded of this simple truth this weekend during a group project exercise.  Conflicting personalities and opinions hindered the group's efforts necessitating multiple phone calls, texts, and emails.  During one exchange, a group member referred to me as a "psych nurse".  I corrected him and asked why he thought I was in psych.   He assumed I was a psych RN as I am pursuing the mental health nurse practitioner track and had an unspoken attitude regarding non-psych nurses specializing in mental health.  Many teams, many fights.  Psych nurses have the extensive background and experience to be mental health providers.  Tactfully, (brownie points for the former Brownie!) I let that go. 

I have yet  to form an opinion whether having a strong background in psych makes a better mental health provider.  There are pros and cons with this argument.  A psych nurse works closely with the future patient population but in the scope of nursing practice, not advanced nursing practice.  However, I firmly believe all patients are psych patients.  The type of care received depends on the nurse.  Does she treat only the physical symptoms or does she acknowledge and ameliorate the emotional ones?  Does he pursue comments made and follow up with a referral to behavioral health when appropriate?  The young woman newly diagnosed with breast cancer, in addition to physical diagnoses, may have inadequate coping mechanisms, fear, acute anxiety r/t her new diagnosis, and risk for situational low self esteem.  The employee seen for transient elevated blood pressure c/o stressful commutes and long work hours.  He may suffer from anxiety, ineffective coping mechanisms AEB elevated BP, and a disturbed sleeping pattern.  The military wife at her newborn's two month check up is not the patient, but she has acute fatigue, impaired social interaction, loneliness, fear, anxiety and parenting role conflict r/t the prolonged absence of her deployed spouse and treatment of the baby involves emotional care of the parent. 

Show me a patient and I'll show you a mental health referral.  No, I'm not being flippant and certainly not lumping all patients together [patient individuality is huge in my PPN (personal philosophy of nursing)]. Being human means being subject to the human condition.  None of us are immune to the very human state of human emotions, wants, needs, and desires.  Maslow told me so.  Emotions unexpressed, wants and needs unfulfilled lead to mental distress.  No one has everything he desires; no one is exempt from mental or behavioral health issues.  Every patient is a psych patient, even you & me.

Hx of This Student

This blog fulfills a requirement of my current course, Transitions in Practice:  The Advanced Practice Nurse as DNP.  The course calls for a "reflective journal" to be completed at least once a week throughout NURU601.  This is my second course in Brandman University’s BSN to DNP program and I continue wrap my head around the concept of Carrie the Doctor.  It's Happening!

Many roads lead to an RN.  Mine started with an ASN from Keiser University (Shout out to Keiser Melbourne and all my nursing school friends for life - Anna, Stacy, Lisa, Kim M., Deanne, Kim, J.R....!)  For many nurses, that first step is the initial hazing, a comparative shut-up-and-drive-or-get-out-of-the-fast-lane style of nursing instruction.  We entered with various backgrounds and skill levels and left competent, qualified nurses.  My first job as a GN was in the ER so complete was my training.  (I've since mentally blocked my Intro to Nursing instructor's name just so you know.  She was one scary combination of Jean Watson-sy theory and Attila the Hun.) 

From the initial ASN, I plowed my way through the obligatory BSN.  I chose University of Phoenix online for the support provided to the military and for the flexibility afforded to a busy, working mom.  If asked my opinion and I rarely am, the ASN is a practice focused degree while the BSN is a management focused degree.  Everything I know (to this point), I learned in ASN school.  (An aside – this is why you need your BSN, better patient outcomes.  http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-workforce )

So you've completed your BSN, what's next?  Okay, after going to Disney World (literally, took the kids because we had a house near Orlando); I looked at my practice and wondered where I was headed.  I had graduated with an ASN and hit the ER like a tornado later fizzling out with a 300+ pediatric caseload in the Department of Health.  Moving from Florida had many disadvantages.  Primarily, I moved FROM Florida.  I had to wait a year, enlist help from my Congressman, and call the Board of Nursing daily to obtain my MD license. Awesome.  During a recession, that and a can of Coke bought me a $28 dollar an hour job in the heart of the inner city handing out condoms to high schoolers and dodging flying metal detectors.  Sometime ask me the antidote to pepper spray.  I now know.

Eventually I found my way into a job with a government agency (that I love) with people (that I love), but there's another group of people I love just as much and they are hurting.  In 2009, I took my fancy, new nursing degree and traded it in for a pair of ACUs and a lifelong (seemingly) commitment.  AHA Moment!  She knows what she wants to do with her life.  The best way for me to help my fellow soldiers is through mental health care.  There is a shortage of mental health providers.  I am currently pursuing a degree in Family Mental Health.  My capstone project involves PTSD (more to come on that!)

Now you know the who-what-where-why, I’m free to discuss what I’ve learned.  Our introductory class was the first time in my nursing education and nursing career that nursing theory made sense.  Not only did theory make sense, I’m using it in my practice!  There are three theories I’m incorporating into my advanced nursing practice:  Maslow’s Hierarchy of Needs, Kolcaba’s Comfort Theory, and Roy’s Adaptation Theory.  Best Parts???  I can intellectually defend my choices AND I care about them.  That’s a long way from the nurse who made fun of “sacred space” and “singing bowls”.  The three I have selected genuinely benefit the patient base I’ve chosen to target.  Theory Rocks!

The current class explores the history of doctorally prepared advanced practice nurses, regulatory issues, conceptions and misconceptions, etc… all issues that affect DNPs.  Apparently, there are quite a few physicians bothered by our use of the term “Doctor”.  I think they prefer if we enter the examination room and introduce ourselves, “Hi, I’m Carrie.  I’ll be your server today.”  There’s even a list of states in which I am barred from calling myself a doctor even though I’ll have earned a doctorate of practice.  Honestly, if we just pooled our monies and bought the loudest protestors Porsches would that ameliorate the insecurities?  No one is usurping their doctorieness.  Calling doctorally prepared nurses, pharmacists, or psychologists “Doctor” does not detract from their authority or achievements.  I have yet to find a valid argument for their fear of the Nurse-Doctor.  I’m not scary; I'm geeky smart and tell funny stories.  I’m the least threatening person you know.  Until you tell me I can’t have something and then I’m simply determined.  Dr. Nurse.  Yes, that sounds just right.