Contributor – Robin R. Walter PhD, RN, CNE
Picture this: A room full of nurses from all over the world is discussing nursing and what it means to be a nurse. Their goal is to reach consensus on global definitions of ‘nurse’ and ‘nursing.’ A huge elephant quietly dominates the center of the bustling room, but is not acknowledged by any of the nurses. The elephant in the room is a metaphor for theory as foundational to our identity and practice. A consensus approach might be more popular and pragmatic- certainly more democratic- than a theoretical approach to defining nursing. However, I argue that consensus-based definitions are too often the lowest common denominator of disciplinary thought, identity, and action. Invisible in plain sight, the elephant in the room bears silent witness to the consequences of dismissing the epistemologies, ontologies, and patterns of knowing that define us collectively and individually as nurses.
This blog problematizes the International Council of Nurses’ (ICN) newly released definitions of ‘nurse’ and ‘nursing’ by acknowledging and engaging with the elephant in the room. Specifically, I will examine what is omitted, diluted, or oversimplified by language in the ICN’s consensus-based definitions, and how a theory-based focus might strengthen them. I will be using emancipatory nursing theory to reflect on the limitations of the ICN’s new definitions.
At first glance, the ICN’s definition of a ‘nurse’ appears to reflect the depth and breadth of the role. However, the elephant in the room suggests that this definition attempts to describe what nurses do without addressing how they think, why they do it in a certain way, or how contextual, social, political, and organizational forces impact those processes. Discipline-specific theoretical and conceptual frameworks are critical foundations if we want to avoid definitions that better serve institutional goals and systemic hegemony rather than those of our profession and those we serve. The ICN offered additional notes on some words/phrases, to assist readers to “…understand the thinking behind the choice of specific wording within the definitions” (ICN, 2025, p.46). Unfortunately, since the ‘thinking behind the choices’ (p.46) was driven by consensus rather than theory, the elephant remains.
A ‘nurse’ is described in the first sentence of the definition as a professional who is “…educated in the scientific knowledge, skills and philosophy of nursing” (p.45). These phrases should not be taken at face value. The ICN’s notes on ‘scientific knowledge’ reify the epistemological hegemony of scientific knowledge over other types of knowing that theoretically ground what it means to be a ‘nurse.’ The ICN’s notes on ‘skills’ broaden actions to include more than technical proficiencies, but become oversimplified by using generalized healthcare descriptors that dilute the uniqueness and complexity of what nurses do. Omitted from the definition of ‘skill’ is a nurse’s responsibility to challenge and dismantle oppressive social and political power structures; and to do so for purposes broader than ‘improving’ health outcomes (p.45). As an emancipatory nursologist, I was looking for more— perhaps: ‘transforming lives and systems toward human flourishing’. The ICN describes the ‘philosophy of nursing’ as the ‘core values and principles underpinning nursing practice’ (p. 47). The elephant reminds us that there is more than one philosophy of nursing, and all are grounded in ontological and epistemological assumptions rather than normative or trendy descriptors.
Philosophies of nursing guide more than nursing practice. They guide research, education, and policy engagement, and collectively offer a paradigm and worldview that differentiate nursing from all other health disciplines. The first sentence closes with a nurse is ‘regulated to practice nursing based on established standards of practice and ethical code’ (p.45). This is at once technocratic, bureaucratic, and possibly paternalistic in tone. Most regulatory frameworks for nursing are derived from colonial systems imposing Western, biomedical expectations on our discipline. Practice standards and ethical codes are not universal, not neutral, not always determined by nursing…but they can act as forms of social— and professional—control. An emancipatory theoretical approach would call for definitions in which nurses are critically conscious practitioners, charged globally with reclaiming locally grounded, culturally responsive modes of nursing regulation and ethics. How can we ‘be’ transformative when consensus models infer we need only ‘be’ compliant?
The ICN’s definition of ‘nursing’ is well-intentioned and broadly conceived, emphasizing professional values such as equity, cultural safety, collaboration, and compassion. However, some important omissions and assumptions obscure the epistemological and ontological foundations of nursing knowledge. For example, there is a fleeting mention of “science-based disciplinary knowledge,” but it is vague and underdeveloped. There is no explicit recognition of the philosophical and theoretical frameworks that have emerged from within to explain phenomena specific to nursing (e.g., the centrality of caring, holism, embodiment, praxis, relationality, critical reflective practice). This omission is not without consequence: it reflects and perpetuates the historical tendency globally to undervalue nursing’s scholarly contributions. Nursing generates knowledge through lived experience, reflective practice, community, and Indigenous wisdom (among others)—forms of understanding often devalued in biomedical paradigms but essential for holistic, integral care in nursing.
Terms like “the highest attainable standard of health, “equitable access,” and “compassion” are presented as self-evident and universally agreed upon, obscuring the culturally and contextually specific meanings they may hold. Whose standard of health is being upheld? Whose definitions of compassion or social justice guide nursing practice? How does nursing equitably ‘promote health’ in systems that are set up to maintain structural inequities? The universalizing, generic language used to define ‘nursing’—unsupported by any nursology framework— risks flattening the diverse epistemologies and lived experiences that shape nursing across contexts, countries, and organizations.
While the ICN’s definitions of ‘nurse’ and ‘nursing’ are rhetorically inclusive, they are intellectually underdeveloped. The omission of nursing theory from consensus-based definitions reduces nursing to a professional function within dysfunctional health systems rather than asserting it as a discipline with its own ontological and epistemological grounding. A nurse is not merely a doer — a nurse is a knower, whose practice is inseparable from theory. I encourage those reading this blog to examine the ICN’s definitions of ‘nurse’ and ‘nursing’ through the lens of a nursing theory that guides your practice. The definitions may have elements that resonate with some rather than others. You may also discover, however, that until the elephant-in-the-room is acknowledged and engaged, consensus-based definitions for our discipline will remain incomplete, depoliticized, oversimplified, and vulnerable to external—and in this case, global— appropriation.
About Robin R. Walter PhD, RN, CNE
Dr. Walter’s research developed the theory of Emancipatory Nursing Praxis, a mid-range learning theory explaining how nurses come to know and engage in social justice. She conducts state, national, and international policy analyses on issues adversely impacting vulnerable and marginalized populations. Her policy advocacy also includes nursing practice, education, and research issues. In this blog, she argues that the ICN’s newly released, consensus-based definitions of ‘nurse’ and ‘nursing’ dismiss the very knowledge base and critical consciousness that make nursing a discipline and a force for transformative change in the human condition. She encourages other nursologists to reclaim and reassert the centrality of nursing knowledge as the cornerstone of our professional identity and action.
Es.
Considero que el lenguaje no solo nombra la realidad, sino que la configura, delimitando lo que puede ser pensado, dicho y practicado en el campo de la enfermería. Las definiciones institucionales, como la emitida por el Consejo Internacional de Enfermeras, operan como tecnologías discursivas que producen subjetividades reguladas, alineadas con marcos tecnocráticos y racionalidades neoliberales. En este contexto, se vuelve imprescindible recuperar una enfermería capaz de disputar estos discursos, afirmando su autonomía epistémica y su compromiso con una praxis situada, ética y política. Solo desde ahí será posible avanzar hacia una enfermería verdaderamente emancipadora y transformadora.
En.
I believe that language does not merely name reality—it actively shapes it, defining what can be thought, said, and practiced within the field of nursing. Institutional definitions, such as the one issued by the International Council of Nurses, function as discursive technologies that produce regulated subjectivities aligned with technocratic frameworks and neoliberal rationalities. In this context, it is imperative to reclaim a form of nursing capable of challenging these discourses by asserting its epistemic autonomy and its commitment to an ethical, political, and situated praxis. Only then will it be possible to move toward a truly emancipatory and transformative nursing.
Thank you, Ramiro. Your reflection is powerful and deeply resonant. I appreciate your point that language is not neutral—it constructs realities, sets boundaries on thought, and governs what is seen as legitimate knowledge and practice in nursing. The idea that institutional definitions operate as “discursive technologies” is a compelling critique, especially in health care systems increasingly shaped by technocratic and neoliberal imperatives that can sideline care, context, and critical reflection. Reclaiming nursing as an epistemologically autonomous discipline is not only urgent—it’s revolutionary. Nursology.net is a consistent space (and invitation) for these conversations—they are essential for a future of care that honors complexity, humanity, and liberation.
Thank you for your blog! When I read the ICN definition of nursing I was appalled & at a loss for words. Your words form a platform on which many of us stand!
Thank you, Wyona! Theory defines our practice, not tasks!
Robin, Thank you VERY much for this very important blog. Of course, basing the definition of nursing (nursology) and nurse (nursologist) on theory rather than supposedly atheoretical consensus (how can any thinking really be atheoretical, though?) is what ICN and all other nursology organizations should be doing. I have to wonder whether conceptual and theoretical perspectives would be more valued and acknowledged by ICN if our discipline were known as nursology and our members as nursologists.
Thank you, Jackie. I agree we should challenge the notion of “atheoretical” thinking — theory is always present, whether acknowledged or not. Adopting the language of “nursology” and “nursologist” more broadly could help to elevate the value of conceptual and theoretical foundations within organizations like the ICN.
Thanks for this thoughtful comment, Dr. Walter.
Indeed, the elephant once again remains in the room. It’s a pity that the biggest nursing council wasn’t able to address and clearly name the body of knowledge of nursing as a science and profession.
More nursologist’s inputs are needed in active roles in the ICN to support it, but they also need to be listened to by the administrative and management nursing personnel. If both sides reach out and collaborate more, a more grounded and holistic definition will result which also clearly describes nurses’ accountability, critical thinking and nursologysts contributions to patients, their families and communities.
This should include what/how nurses diagnose patients problems, resp. care needs, specified as nursing diagnoses. Also NURSING interventions that reach high quality nursing-sensitive patient outcomes need to be clearly addressed.
Nursing is more than tasks and inter-professional collaboration. Caring, healing relationships and the core of nursing – applying the Advanced Nursing Process based on nursing classifications which are grounded in scientific, evidence-based nursing knowledge – are key to the profession and should be described in the ICN definition.
And as you wrote, the patients/families/communities which the nursing professions serves is important to be described. Nursology isn’t there for its own, but for the communities we serve. Therefore, I support to strengthen also this focus in the definition.
Müller-Staub, M., Abt, J., Brenner, A., & Hofer, B. (2015). Expert report on nurses’ responsibility. Bern: Swiss Nursing Science Association (ANS). https://www.researchgate.net/publication/283091709_Expert_Report_on_the_Responsibility_of_Nursing
https://www.vfp-apsi.ch/fileadmin/user_upload/Dokumente/Expertenbericht_Englisch.pdf
Müller-Staub, M., Abt, J., Brenner, A., & Hofer, B. (2015). Rapport d’expertes concernant le domaine de responsabilité des soins infirmiers. Bern: Swiss Nursing Science Association (ANS). https://www.vfp-apsi.ch/fileadmin/user_upload/Dokumente/Expertenbericht_Franzoesisch.pdf
Müller Staub, M. (2019). Accountability: A Proposed Policy for Federal Recognition of Nurses’ Responsibility in Switzerland. A peer-reviewed Policy/Theory Exemplar published June 16, https://nursology.net/policy-theory/nurses-accountabil-ity/https://www.researchgate.net/publication/351971693_Accountability_A_Proposed_Policy_for_Federal_Recognition_of_Nurses'_Responsibility_in_Switzerland_A_peer-reviewed_PolicyTheory_Exemplar
Müller Staub, M. (2022). Accountability: Update to A Proposed Policy for Federal Recognition of Nurses’ Responsibility in Switzerland. A peer-reviewed Policy/Theory Exemplar published at https://nursology.net/policy-theory/accountability-update-to-a-proposed-policy-for-federal-recognition-of-nurses-responsibility-in-switzerland/
https://www.researchgate.net/publication/375993026_Accountability_Update_to_A_Proposed_Policy_for_Federal_Recognition_of_Nurses'_Responsibility_in_Switzerland_Nursology
Thanks for this thoughtful comment, Dr. Walter.
Indeed, the elephant once again remains in the room. It’s a pity that the biggest nursing council wasn’t able to address and clearly name the body of knowledge of nursing as a science and profession.
More nursologist’s inputs are needed in active roles in the ICN to support it, but they also need to be listened to by the administrative and management nursing personnel. If both sides reach out and collaborate more, a more grounded and holistic definition will result which also clearly describes nurses’ accountability, critical thinking and nursologysts contributions to patients, their families and communities. Nursing is more than tasks and inter professional collaborations. Caring, healing relationships and a professional nursing language which are grounded in scientific, evidence-based nursing knowledge are key to the profession.
https://nursology.net/exemplars/policy-theory/accountability-update-to-a-proposed-policy-for-federal-recognition-of-nurses-responsibility-in-switzerland/?amp=1
Thank you for this article inviting critical reflection on the knowledge basis for nursing. I’ve been unable to “unthink” the thought I had a few years ago: nurses are (generally) allowed to do, but are not (generally) allowed to know. This affects us and our practice, deeply. This dynamic is enacted across all the levels of social domains and institutions, and historically. There is much to think through and consider in the way forward for nursing.
Thank you, Dr. Muller Staub, for extending the discourse to include nurses in management and administrative positions as part of discussions about how we define ‘nurse’ and ‘nursing’ in the global context. It made me think about the relationship of nursing leadership and leadership theories. Specifically, how western nursing leadership theories might be inadequate to guide nursing leadership in non-western countries. For example, many Western leadership models assume nurses have a level of autonomy in the clinical setting, work in decentralized, flexible systems, and/or emphasize individual transparency and directness. These theories might be popular, but inappropriate in non-Western societies due to cultural misalignment. The disconnect may also impact non-Western nurses’ experiences of Western leadership styles (and vice-versa). It’s exciting to see what bubbles-up in conversations like this! Thank you!
Your articulation—“nurses are (generally) allowed to do, but are not (generally) allowed to know”—succinctly captures the epistemological tension that has long shaped our sociocultural and professional positioning as a ‘practice’ discipline. The dynamic you describe is emblematic of broader structural forces that continue to constrain nursology, subordinating it to biomedical- and other, external- paradigms that privilege action over theorizing. This “epistemic disqualification,” to borrow a Foucauldian term, has led to definitions of nursing that focus on functions and tasks rather than on ways of knowing, caring, and becoming. As nursologists, we must amplify nursing’s theoretical foundations—not as abstract ideals, but as vital tools for resistance, praxis, and transformation. The work of rethinking definitions of ‘nurse’ and ‘nursing’ must be a collective act of epistemic allegiance. Thank you for introducing a phrase that I, too, am happily unable to ‘unthink’!
Hello Robin! I can’t believe that I am reading this blog for the first time right now! I’m going to find you! I am also working on revealing the elephant in the room!
Hi Marcia! Reach out any time! My email is robinwalterphd@gmail.com. There’s already a webinar planned on how to embed the definitions into global regulations: https://us02web.zoom.us/webinar/register/WN_sQxW5VWsQMKMjJDMWxug8g#/registration