This blog is an extension of one that I posted on nursology.net in December, 2018 (Fawcett, 2018). In that blog, I asked what specialties could be considered legitimate for our discipline and proposed that nursology specialties should be based on the concepts of each nursology conceptual model (see the Models and Theories Gallery).
A traditional approach to nursology specializations is evident in Peplau’s (1965/2003) paper, “Professional Specialization in Nursing” She wrote about nursology specialists, explaining that “With specialization the focus tends to become narrowed upon a piece of the field, which allows greater development of depth of such a piece or the focus is a recombination of a piece of one field with a piece of another field—so that relations among specific phenomena can be studied and formulated” (Peplau, 2003, p. 4). Peplau identified 10 potential areas of specialization for nursologists:
- areas of practice (e.g., public health nursing)
- organs and body systems (e.g., cardiac nursing)
- age of the client (e.g., adult nursing)
- degree of illness (e.g., acute illness)
- length of illness (e.g., long-term nursing)
- nurse activities (e.g., medication nurse)
- fields of knowledge (e.g., interpersonal nursing)
- sub roles of the work role of staff nurse (e.g., nurse therapist)
- professional goal (e.g., rehabilitation nursing)
- clinical services (e.g., medical, surgical, pediatric, maternal, and psychiatric nursing).
Peplau (1965/2003) claimed that specializations initially arise from
“the patterning of specialization [that] is determined by avant garde workers in the particular field who see or sense a great need to move—in depth—in a particular direction. With regard to the profession of nursing, at first particular nurses move in a direction that interests them or toward which they have an immediate opportunity. Over a period of time some of these directions survive and some of them don’t. Survival of a particular direction is dependent upon many things, no[t] the least of which—in the case of nursing—is the necessity of interesting masses of nurses to accept and support such new directions. . . . The work of the “pioneer,” however, must be subjected to the survival test—if it is to become either a part of generic nursing or a specialized aspect of nursing. Masses of nurses must become aware of individual efforts, learn enough about them to debate their merits, and give them sufficient support so that creative and constructive innovations can continuously be flowing into professional nursing”.(Peplau, 2003, p. 4)
Current nursology practice specialties are many and varied and, in some ways, represent the areas identified by Peplau (1965/2003). For example, the American Nurses Credentialing Center (https://www.nursingworld.org/our-certifications/)) has identified these areas of specialization:
- Adult Gerontology Clinical Nurse Specialist
- Adult-Gerontology Acute Care Nurse Practitioner
- Adult-Gerontology Primary Care Nurse Practitioner
- Family Nurse Practitioner
- Pediatric Primary Care Nurse Practitioner
- Psychiatric-Mental Health Nurse Practitioner
- Ambulatory Care Nursing
- Cardiac Vascular Nurse
- Case Management Nurse
- Gerontological Nurse
- Informatics Nurse
- Medical-Surgical Nurse
- Nurse Executive
- Nursing Professional Development
- Pain Management Nursing
- Pediatric Nurse
- Psychiatric & Mental Health Nurse
Specialties also emanate from various nursing associations and societies. One example is the Transcultural Nursing Society, which has identified specialization in basic or advanced transcultural nursing (https://tcns.org/tcncertification/).
Specialization in nursing education is also possible. For example, the National League for Nursing has identified these specialties:
- Certified Nurse Educator (CNE; https://www.nln.org/certification/Certification-for-Nurse-Educators/cne)
- Certified Academic Clinical Nurse Educator (CNE-cl; https://www.nln.org/certification/Certification-for-Nurse-Educators/cne-cl)
- Certified Academic Novice Educator (CNEn; https://www.nln.org/certification/Certification-for-Nurse-Educators/cne-n)
Rogers (1973) may be considered “avant guarde” (Peplau, 1965/2003) in her recommendation that specialization be in one of the seven behavioral subsystems of Johnson’s (1990) behavioral system model–attachment/affiliative, dependency, ingestive, eliminative, sexual, aggressive, or achievement (see https://nursology.net/nurse-theories/johnson-behavioral-system-model/). However, Rogers’ (1973) recommendation did not survive, although there are some current specializations that are similar to some of the behavioral subsystems. For example, the eliminative subsystem can be found in urological, enterostomal, and renal nursing specialties. In addition, elements of the aggressive/protective and sexual subsystems can be found in the forensic nursing specialty.
Now I ask, what would happen if our specialties were based on the conceptual model or theory to which each nursolgist subscribed? One answer is chaos, as each conceptual model and each theory would represent a different specialty. For example, some nursologists whose work is guided by Roy’s adaptation model might claim their specialization is adaptation nursology, whereas other nursologists might claim their specialization is Rogerian Nursing Science, guided by Rogers’ Science of Unitary Human Beings. In contrast, another answer is that specialization based on a conceptual model or a theory would not be chaotic but more clearly within the context of nursology knowledge.
Rogers’ (1973) approach may be considered at the micro level of a conceptual model or theory, that is, the conceptual model or theory concepts, whereas this proposal is at the macro level, that is, the entire conceptual model or theory. In conclusion,
“Although the proposal that specialties should be within the context of each nursological conceptual model and theory may be regarded as preposterous, at least some nursologists have understood the value and importance of labels for specialties that differentiate the discipline and profession of nursology from other sciences and especially from the trade of medicine”.(Fawcett, 2018).
Of note is that designation of existing and potentially possible future recognized specialties in nursology practice and education is an “alphabet soup” of credentials that may not be recognizable to other than the holders of these designations. Therefore, I encourage readers of this blog to add their knowledge of the meaning of the diverse credentials for various nursology specialties in the comments section of this blog.
Fawcett, J. (2018, December 4). What are Legitimate Nursology Specialties? nursology.net https://nursology.net/2018/12/04/what-are-legitimate-nursology-specialties/
Johnson, D. E. (1990). The behavioral system model for nursing. In M. E. Parker (Ed.), Nursing theories in practice (pp. 23–32). National League for Nursing.
Peplau, H. (1965). Specialization in professional nursing. Nursing Science, 3(August), 268-268. (Reprinted in Peplau, H. (2003). Clinical Nurse Specialist, 17(1), 3-9. doi: 10.1097/00002800-200301000-00002
Rogers, C. G. (1973). Conceptual models as guides to clinical nursing specialization. Journal of Nursing Education, 12(4), 2–6.