What does it mean to be a nurse?
KU School of Nursing is at the center of a national discussion on professional identity
What does it mean to be a nurse? What do nurses value? What does the academic discipline of nursing hold dear?
Those questions and more are front and center in a national conversation on the professional identity of nursing, and the KU School of Nursing is at the epicenter of that conversation. An invitation-only think tank last fall kicked off the conversation as about 50 nurse leaders and nurse educators from all over the nation convened in Kansas City to discuss professional identity in nursing.
Nelda Godfrey, Ph.D, RN, ACNS-BC, FAAN, associate dean of innovative partnerships and practice, launched the think tank last year. It’s an idea Godfrey has explored for years as she has taught professional identity courses in the KU School of Nursing and researched the concept of professional identity formation. The purpose of the think tank, Godfrey said, is to advance from concepts and ideas to putting professional identity into conversations and ultimately, into nursing curricula, across the nation.
Why explore professional identity? Because it’s time the profession matured.
“Nursing is a very old profession but a very young academic discipline,” Godfrey said, noting that leaders in nursing have only been able to get doctorates in the field since the 1970s. Previously many nurse educators had advanced degrees in education.
Inviting representatives from every major nursing organization across the country and beginning the dialogue last year was an important first step in the process. Those efforts will continue this fall as a similar group gathers to move the conversation forward.
“If you ask a group of theologians, a group of doctors or a group of attorneys what their academic discipline thinks about a particular issue, everyone has an opinion. They might even explain that the discipline is torn over competing ideas,” Godfrey said. “If you ask a group of nurses what their discipline thinks about a particular issue, you probably get crickets.”
AS NURSING HAS CHANGED, NURSING EDUCATION HAS CHANGED
As with many milestones in nursing, the understanding of who nurses are and what they value can be traced back to Florence Nightingale, who led a group of women nurses assisting soldiers in the Crimean War. With those efforts, Nightingale was credited with the establishment of nursing as a respected profession and with the establishment of the first professional nursing school at St. Thomas Hospital in London. The daughter of a wealthy British family and the recipient of a classical education that included studies in mathematics, German, French and Italian, Nightingale might also have been the first person to contemplate a professional identity for nurses.
“She took her classical education and understood the nurses needed to be more than just task masters,” Godfrey said. “She established a formal process for their work, and for their education.”
Over the years, nursing education has evolved from training classes based primarily in hospitals to a full-fledged bachelor’s degree, master’s degrees and multiple doctorates, with some focused on clinical care and other focused on research or teaching. The career paths of nurses have similarly evolved, and nurses in 2019 can choose from bedside care in a wide range of settings, research, education and even health care management. Nurses are sought after as health care executives who understand the realities of patient care and the requirements of governmental regulators. Advanced practice nurses can provide yet another level of care that may include prescribing medications and treatments.
Americans agree that nurses are an important part of the health care team, and an annual Gallup poll consistently ranks nurses as one of the most respected professions, earning high marks for honesty and ethics. Godfrey hopes the profession will take that trust and formalize many of those ethical standards.
“As nursing has evolved, we must evolve how we think about our academic discipline and the preparation of future nurses,” Godfrey said.
Godfrey also noted that in examining nursing at the bedside, it can be tempting to focus exclusively on patient outcomes, forgetting that nurses are thinking individuals who can make choices to improve care for a specific patient. Checking a box on an electronic medical record is only part of their work. Using all of their skills, observational powers and on-site analysis of the situation, nurses can make recommendations and initiate consultations that can make a difference between life and death.
“Nurses are more than just task-doers,” Godfrey said. “If we focus only on patient outcomes, and if we focus on only whether a task is done in a certain window of time, then we are missing the broader picture of nurses and their contributions to the health care team and to society.”
Maureen “Shawn” Kennedy, RN, FAAN, the editor-in-chief of the American Journal of Nursing, was one of the think tank participants in 2018. Kennedy points out that this conversation on professional identity is important and timely.
“You’ve likely seen the headlines regarding clinical burnout and suicide,” Kennedy said. “Nurses and physicians are grappling with how to work in agencies with policies that contradict what their professional ethics dictate regarding caring for all who need it. (It) doesn’t matter whether patients have legal standing or (our) same beliefs or insurance ‒ we’re supposed to give care to those who need it.”
FROM CONVERSATIONS TO CURRICULUM
Godfrey has a working definition of professional identity that she’s used in publications, and that definition is now updated thanks to the work of the first think tank: professional identity in nursing is “a sense of oneself, and in relationship with others, that is influenced by the characteristics, norms and values of the nursing discipline, resulting in the individual thinking, acting and feeling like a nurse.” Godfrey also likes to emphasize the four pillars of nursing professional identity: values and ethics; knowledge; leadership; and comportment.
Those who gathered for last year’s think tank have now been organized into volunteer task groups that have undertaken efforts to continue the conversations and further disseminate the ideas, as well as figuring out more ways to advance the ideas into nursing curricula.
A $5,000 innovation grant from the KU School of Nursing will assist with a demonstration project planned for two or three hospitals in Kansas.
Godfrey’s vision is for professional identity formation in nursing to emerge as a distinct component of nursing curricula, using data gained from the think tank to guide the discussion. Next on her wish list is that every health care facility creates the space for its nursing staff to discuss what professional identity means, both generally and at their facility specifically. Finally, she would like the key components of professional identity to be “used in evaluation, recognition and overall communication regarding how nurse professionals think, act and feel like nurses.”
Guiding how an entire profession thinks and talks about itself is a tall task, but the conversation has begun.
“This is critical work for the profession and for those to whom we provide care.” Kennedy wrote in an editorial last year in in the American Journal of Nursing. “A professional identity creates a sense of belonging to a group that holds the same values; it can provide colleagues an opportunity to touch base with when decision-making guidance is needed in stressful situations. For those in our care, it can foster confidence that they will be dealt with in a professional manner by someone who adheres to a code of ethical conduct.”
Godfrey’s more practical definition works just as well.
“It’s about being, doing and thinking like a nurse.”