Feeling Like a Nurse – Self Defining the Moment

Contributor: Isla A. McKenzie-Henry, MSN, RN,
CNE-cl, NEA-BC (EdD Candidate)

This is the last in a series of posts about a nursology study conducted by a student-faculty group from the Online Nursing Education (ONE) program at Teachers College Columbia University. The study, “Use of Foundational Concepts in Program and Course Descriptions: An Analysis of Prelicensure Baccalaureate Nursing Programs in the United States,” looked at the use of four nursing concepts, context, holism, health, and caring, in program descriptions and the first three nursing course descriptions of 300 BSN program websites.

In the Spring 1999, I inserted a foley catheter into a 19-year-old male patient with multiple sclerosis (MS). I’m not sure if I maintain my recollection of this experience, more than three decades later, because I was also 19 years old at the time or because it was the first task in nursing school that made me “feel like a nurse”. It has been my experience as a student, a practicing nursing professional, and nurse faculty that nurses reflect on the moment they finally felt like a nurse. For me, this feeling came as a student in clinical rotations. For others in our nursing community, the experience may be similar or varied.

Being part of the “Concepts Study” research experience allowed me to really analyze the term “nursing knowledge” and align it with what it means to not only “be” a nurse, but “feel” like I am a nurse (student). Is it the knowledge we obtain in school from our theory courses or is it the tasks that we perform in clinical practice? It is now a steadfast belief of mine that nursing knowledge in my experience has been historically aligned with clinical tasks such as catheter insertions and medication administration. I can go even further and say that as a licensed practical nurse who became a registered nursing (LPN-to-RN), I was only able to differentiate my advance in the profession the first time I administered blood products or changed a central line dressing. It almost always comes down to task orientation for most of us and this is a real issue for me as I look to impart knowledge on future generations of nurses. What is the working definition I should pass on to nursing students who ask what it means to be a nurse? Are we guiding nursing education through task orientation or through conceptualization? In terms of nursing knowledge research, I have realized that we are so much more than the tasks we conduct in our daily workflow. If anything, this study has given me more unanswered questions about what guides nursing practice today, one of significance being the definition of “nursing”.

I reflect on the fact that this study revealed that only one-third of the nursing program descriptions included the concepts context, holism, health, or caring. I appreciate the universal nursing adage that if “it is not documented, it is not done”. By this premise, if nursing schools are not disclosing that key nursing concepts are standards in their program, whether via program description, course descriptions, mission statements, or value statements, I think it is fair to deduce that two-thirds of the schools we analyzed probably aren’t teaching nursing concepts.

The next step for nursing research is to utilize evidence-based literature, such as our nursing concepts study publication, and gain perspective on how to restructure nursing education. We continue to evaluate program success based on NCLEX pass rates. I believe we should start looking at graduates from programs that give students strong foundational knowledge based on the key concepts, compare them to those that don’t, and evaluate how these new graduates are navigating being novice nurses.

Research that looks at nursing education allows academic leaders and nurse faculty to reflect on the very question that has been yearning for a definition since the days of Florence Nightingale: What is Nursing? How can nursing research assist our professional community in attaining a universal definition conceptually and practically for furthering the profession? If we can’t address this, how can we stop the drift away from aligning nursing values with foundational nursing knowledge? This study has highlighted several unanswered questions for me while sparking inquiry to find the answers. I believe the sooner our students understand the foundational concepts of nursing the sooner they can begin to build a knowledge base that defines nursing. I want students to reflect on feeling like a nurse when they learn about concepts-not when they master bedside tasks. Once you have mastered a task, nothing is left to improve upon. You simply move on to the next task. But when you learn concepts of a profession such as nursing, growing on this knowledge, expanding inquiry and research, promoting advocacy, and becoming a voice for quality improvement and brand development (yes, nursing is a brand) becomes realized.

About Isla A. McKenzie-Henry

Isla began her career in healthcare in 1999 as a certified nursing assistant (CNA). In 2000 she successfully transitioned to a License Practical Nurse (LPN). She received an Associate of Applied Science Degree in nursing from Helene Fuld College of Nursing (2009) and completed both her BSN (2013) and MSN (2016) in Nursing Administration with Informatics at Molloy College in Rockville Centre, NY.

Isla has over 20 years of clinical and leadership experience in nursing. In the Fall of 2019, she will begin working full time as undergraduate level nursing faculty. Her research interests are diversification of the nursing profession and mentorship.

5 thoughts on “Feeling Like a Nurse – Self Defining the Moment

  1. Very thought-provoking work, Isla!
    Your final statement is everything!
    Thank you for sharing and I look forward to reading more of your work!

  2. I told my students for years, and continue to tell anybody who will listen, that you are not in nursing school to learn what they mislabel in learning lab as “skills.” Those are tasks, and as noted in this article, once you master a task there’s no way to improve on it.
    You’re in nursing school to learn to think like a nurse. This is why we pound nursing theory and nsg diagnosis into your curriculum.
    Of course they don’t really get that for a long time, as you can observe any day of the week by overhearing the chatter in the cafeteria: “Ooooh, you’re so lucky, you got to do a …. today! I’ve never done a …. even in ‘skills’ lab!” Etc., etc. They don’t believe me when I tell them that a year after graduation (and maybe sooner) intubating a bladder, sinking a Salem sump, or cannulating a vein isn’t going to be such a big deal in itself, but knowing the whys will be why they hired you.
    Think like a nurse. Without doing that, you aren’t one, no matter how good you are at “skills.”

    • Hi wendihowland, thank you for your response. It is an uphill battle for nurse faculty to provide a conceptual-based definition for our profession vs the current “skills-based” characteristics of what society think nurses should be. I agree that the skill is just that and they lose their “flair” after performing them at least twice.

  3. Thank you for this work and for making it public. For those who are asking themselves, ‘what can I do to advance the study of NURSING in my nursing program?”, Dr. Rudolf Cymorr Martinez has an answer, a “first principles” answer. His video starts off with a question that strikes at the core of the issue – a question that I challenge all interested in nursing education to consider. For all who are interested in putting NURSING into nursing education programs, please view this video and share it widely: https://drive.google.com/file/d/1cZv11OBzDnpr4hgYXT4vNsXK6uvgkH-S/view

    This video is posted on the Anne Boykin Institute for the Advancement of Caring in Nursing website, under Caring Science Resources. There are multiple resources posted to this site that, for those who want to put the nursing into nursing education, is a treasury!

    In caring,
    Savina Schoenhofer

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