Never a Guardian: Remembering Breonna Taylor

Want to learn more about Nursing and Racism? Read the following Nursology blogs: Nursing and Racism and Decolonizing Nursing.

Artwork used with permission of the artist Ariel Sinha

The Guardians of the Discipline is a series featured on Nursology.net as a way to commemorate the giants whose shoulders we stand on as we forge our nursing paths. Today, we – the Nursology Theory Collective – would like to memorialize someone who never had the chance to join the discipline, though we understand that she intended to be a nurse (Oppel & Taylor, 2020). Her name is Breonna Taylor. Murdered by the police executing a “no-knock” warrant, Breonna Taylor, a Black woman, was murdered as she slept in her home. Startled by the unannounced and forced entry of Louisville law enforcement, Breonna Taylor’s boyfriend – a licensed gun owner – began firing his gun, assuming their home was being invaded. The police returned fire, striking Breonna who died six excruciating minutes later, no aid ever rendered (Simko-Bednarski et al., 2020). Final analyses showed the police had invaded the wrong home and that she remained alive for minutes without critical aid being offered. Lack of further investigations suggests that  Breonna Taylor’s life has seemingly been brushed aside. To date, no one has been held accountable for her murder. The no-knock policy remains uninterrogated (Oppel & Taylor, 2020).

We wish to honor Breonna Taylor, recognizing the structural missingness her death signifies in our profession (Hopkins Walsh & Dillard-Wright, 2020). NTC members Jane Hopkins Walsh and Jessica Dillard-Wright (2020) “synthesized the concept of structural missingness to capture the state of exclusion from healthcare due to inequalities within a system, a country or globally” (p.1). The concept was imagined to capture the injustices and inadequacies of talking about healthcare as a structurally-sound starting place for any kind of analysis, recognizing the people and groups who are all too often missing in colonized and capitalism driven spaces. In this blog post, we wish to extend this concept, recognizing the implications that the murder of Breonna Taylor has for nursing, acknowledging that nursing will never have the opportunity to learn from her knowledge and experience. 

Breonna Taylor’s murder is a structural missingness double-jeopardy. Her murder points to violent systemic racism, inequities and injustice. As a discipline, nursing is part of the racist system, and carries this internalized and systematized racial prejudice (Barbee, 1993; Barbee & Gibson, 2001). Nursing bears the hallmarks of normative whiteness, part of the hidden curriculum of nursing enacted through practices rooted in the received values around respectability; what are accepted dress codes, hairstyles, body art, leading to gatekeeping, professionalism codes, and civility policing that narrowly define what a nurse looks like (Allen, 2006; Puzan, 2003).  Scholar Ibraham Kendi refers to this implicit racist system as the “White judge” (Kendi, 2017 p. 4). Nursing professor @UMassWalker recently spoke to this idea in their critique of the vague and subjectively worded term “good moral character” bound within their university’s prelicensure nursing syllabus (see Twitter post from July 22, 2020). Dr. Walker’s blog post the next day further expanded upon the issues of institutional racism in the system of nursing education. These enshrined messages and images of how nurses ought to look, speak and act connect back to our received historical narratives- the stories that tell stories (Haraway, 2016). 

The Nightingale chronicles are an example of how this image of normative whiteness in nursing continues to be the dominant legend for all who enter the profession. The reified Nightingale history embeds systemic values that intersect race narratives alongside received norms for behavior, gender, sexuality, and class. Mary Seacole who self identified in her writings as a Creole person, was a Jamaican nurse and peer of Nightingale’s who was awarded international medals for her service in the Crimean war. She was a published author, commented on political issues of slavery and racism, made scientific observations around cholera and diarrhea, but historical letters suggest she was deemed unsuitable for service by Nightingale and other British authorities. Her contributions to nursing are underreported, diminished and debated to this day (McDonald, 2014; Staring‐Derks et al., 2015).

Breonna Taylor will never graduate from nursing school. Murdered in her sleep, she has been rendered structurally missing by virtue of her death by brutal aggressive police actions, a victim of the very institution that purports to serve and protect. Breonna is forever erased from our discipline. We recognize this injustice and by honoring her memory, we refuse to ignore the political ideologies that fail to interrogate aggressive policing systems that neglect to bring her killers, who are still free, before the court. Her death speaks to the complex and structurally violent structures that silently continue to collude, reifying nursing’s hegemony through systematic exclusions and injustices surrounding Black people who are systematically oppressed and erased. We, the discipline of nursing, are not immune from the effects of police brutality, and as a result a future nurse and colleague is missing. Furthermore, nursing is not immune from perpetuating racist systems. We must actively work towards a more just, equitable, and inclusive discipline, recognizing that the minimum bar of humanness demands actively protesting and opposing police brutality and the unacceptable murders of Black people, including Breonna Taylor.

What can you do to support Breonna Taylor, who never got to be a guardian of our discipline?

  1. Learn more about Breonna Taylor and her murder.
  2. Sign a petition demanding justice for Breonna Taylor’s murder.
  3. Read the Nursology Theory Collective anti-racism statement and commit to be actively anti-racist. 
  4. Use the platforms you have to name, address, and dismantle racism and white supremacy in the systems in which you work and live.
  5. Contact your local, state and federal elected officials weekly to inquire about legislation they are enacting to combat violent police practices against Black people and other Non Black People of Color.
  6. Consider running for elected office to embody the change we want to see.
  7. Constructively critique existing nursing theories and philosophies to deconstruct the effects of colonization of our formal knowledge base and to understand the ways that racialized systems and structures influence the development of our discipline.
  8. Use these insights to develop anti-racist research, theory, education, practice and policy that is aimed to decolonize nursing.

References

Allen, D. G. (2006). Whiteness and difference in nursing. Nursing Philosophy, 7(2), 65–78. https://doi.org/10.1111/j.1466-769X.2006.00255.x

Barbee, E. L. (1993). Racism in US nursing. Medical Anthropology Quarterly, 7(4), 346-362. https://doi.org/10.1525/maq.1993.7.4.02a00040

Barbee, E. L., & Gibson, S. E. (2001). Our dismal progress: The recruitment of non-whites into nursing. Journal of Nursing Education, 40(6), 243-244. https://doi.org/10.3928/0148-4834-20010901-03

Haraway, D. J. (2016). Staying with the Trouble: Making Kin in the Chthulucene. Duke University Press.

Hopkins Walsh, J., & Dillard-Wright, J. (2020). The case for “structural missingness:” A critical discourse of missed care. Nursing Philosophy, 21(1), 1–12. https://doi.org/10.1111/nup.12279

Kendi, I. X. (2019). How to be an antiracist. One world.

McDonald, L. (2014). Florence Nightingale and Mary Seacole on nursing and health care. Journal of Advanced Nursing, 70(6), 1436–1444. https://doi.org/10.1111/jan.12291

Oppel, R. A., & Taylor, D. B. (2020, July 9). Here’s What You Need to Know About Breonna Taylor’s Death. The New York Times. https://www.nytimes.com/article/breonna-taylor-police.html

Puzan, E. (2003). The unbearable whiteness of being (in nursing). Nursing Inquiry, 10(3), 193–200. https://doi.org/10.1046/j.1440-1800.2003.00180.x

Simko-Bednarski, E., Snyder, A., & Ly, L. (2020, July 18). Lawsuit claims Breonna Taylor lived for “5 to 6 minutes” after being shot. CNN. https://www.cnn.com/2020/07/18/us/breonna-taylor-lawsuit/index.html

Staring‐Derks, C., Staring, J., & Anionwu, E. N. (2015). Mary Seacole: Global nurse extraordinaire. Journal of Advanced Nursing, 71(3), 514–525. https://doi.org/10.1111/jan.12559

Diversity, Equity, Inclusion, Justice, and the Future of Nursing Theory: A Webinar of Disciplinary Reflection

To learn more about the Nursology Theory Collective,
or join us in future work, please click here.
See video and full report here

On Friday, June 12th, the Nursology Theory Collective hosted a live webinar titled, “Diversity, Equity, Inclusion, Justice, and the Future of Nursing Theory.” In this webinar, Dr. Lucinda Canty and Patrick McMurray addressed the interrelated concepts of diversity, equity, inclusion, and justice in nursing. They discussed nursing’s homogeneity and how the absence of diversity in our discipline contributes to and reinforces inequity, injustice, and exclusion, even as our professional organizations purportedly value social justice and strive to reduce health inequities.

It is long past time for nurses and nursologists alike to take a stand and actively work towards an antiracist future for nursing. This is nonnegotiable and the time for action is now. We challenge you as readers of Nursology to watch this insightful webinar, reflect on your role in advancing equity and justice, and comment how YOU are going to contribute to transforming nursing into a more diverse, equitable, inclusive, and just discipline.

We understand that this topic may be uncomfortable – and if so, we encourage you to reflect and unpack that discomfort. Maybe you feel defensive as if you have done nothing personally to warrant interrogating your own positionality. Maybe this resonates with you because you see and know this truth as congruent with your own experience.In the words of Monica McLemore, “this can all be different,” if we choose to make it so. The starting place for this is critical self-reflection which paves the way for antiracist growth which creates the possibility for community-building and envisioning new futures for nursing. Embracing the discomfort we can become a more diverse, equitable, inclusive, and just discipline. As Patrick McMurray stated, “nursing is an act of justice,” and it can be if we do the work.

In Solidarity,
The Nursology Theory Collective

For more background on this webinar as well as the presenters, please click here.

Black Lives Matter: Building an Antiracist Nursing Future

Register for June 12th Webinar

“Our lives begin to end the day we become silent about things that matter.” Martin Luther King, Jr.

We, the Nursology Theory Collective, in light of the current events surrounding the murders of George Floyd, Breonna Taylor, and Tony McDade, cannot be silent.

Image created by NTC member Jessica Dillard-Wright

In partial answer to this, we have included our anti-racism position statement below, and invite you, as nurses and nursologists, to join us this Friday, June 12th from 4:00 – 5:00 PM EST to discuss the future of nursing theory and its interrelationship with diversity, equity, inclusion, and justice. We understand that many of us don’t know where to start, but it is in times like these that as the most trusted profession in the United States we must use our privilege to create a more equitable and just world and do something. It’s time we actively listen, learn, unlearn, discuss, and take a stand for those who have been oppressed for hundreds of years, raise their voices, and be better together.

To join this event, please register here in advance to save your seat. 

  • We support the protests in the names of George Floyd, Breonna Taylor, and Tony McDeade, recognizing that their murders are some of the innumerable instances of anti-Black violence that corrode our collective consciousness 
  • We condemn police brutality, a state-sanctioned violence, and recognize its deleterious and disproportionate impact on the lives of Black people
  • We recognize the collusion of white supremacy, capitalism, and patriarchy as the root cause of the ongoing violence that is experienced by Black people
  • Structural racism and white supremacy are public health crises, socially-constructed, legally-entrenched systems of power that benefit and privilege white people
  • We will act to dismantle the structural racism that has characterized the status quo in the United States for over 400 years as a critical, urgent, and essential nursing intervention
  • We recognize our disciplinary complicity with white supremacy, capitalism, and patriarchy, which has shaped modern nursing from its beginnings
  • We collectively commit to do the work: to continue reading and promoting anti-racist work, donate to funds and support initiatives that advance antiracist work, divest from groups that promote hate, promote Black leadership and cite Black scholars, speak out against racism in all its forms, hold space to support and center this essential work while acknowledging this as a forever initiative
  • We commit to uphold anti-racism and anti-oppression, and acknowledge that this commitment must be an ongoing and eternal process

The statement above is a collaborative project, commenced on June 1, 2020. We invite you to join us in this initiative, continue the dialogue, create a better world, amplify Black voices, and show that #BlackLivesMatter.

To join us and sign your name to acknowledge support for the NTC formal position statement, please follow this link: https://forms.gle/NpYWRHtsKe7WZmrD9

In solidarity,
The Nursology Theory Collective

The Nursology Theory Collective is a group of scholars and students that formed after the landmark conference, “Nursing Theory: A 50 Year Perspective Past and Future”, on March 21-22, 2019 at Case Western Reserve University. The mission of the Nursology Theory Collective is to advance the discipline of nursing/nursology through equitable and rigorous knowledge development using innovative nursing theory in all settings of practice, education, research, and policy.

To join the Nursology Theory Collective, and be added to our email list, please send us an email at nursingtheorycollective@gmail.com.

Part 1 – Access to Nursing Knowledge: A Privilege or a Right?

In the practice environment, nurses are guided by evidence-based practice, policy, and procedures specific to their institutions. Comparably, nurses in academia refer to recent and relevant academic literature based upon institutional licenses. In preparation for the Nursing Theory Annual Conference, a gap was revealed among members of the Nursology Theory Collective dependent upon their work environment as it related to access to nursing knowledge. As described by a member of the Nursology Theory Collective who has worked in the practice environment, I attempted to access a nursing research article from fifty years ago and found that I would have to pay $49, when the same article was freely available to my academic colleagues through their organizational access.” This member’s experience was not in isolation, and ended up being more of a norm than a rarity. At the publishers permission the article was able to be shared by academics to those without appropriate access in practice, but this is not a permanent solution and nor should it be a norm.

The question then arose: should access to nursing knowledge be a privilege or a right? Dependent upon our organizational affiliation (or lack thereof) nurses are blocked from relevant and essential nursing knowledge. Practicing nurses then have to consider purchasing academic literature, whether per article or journal subscription, at prices that may be unaffordable for their salary. Nurses in academics face similar issues when they are limited by what specific journal licenses their organizations may have. Ultimately, this may lead to nurses reaching out to colleagues located in other institutions in order to gain access to literature that is needed for their work.

The lack of equity in access to nursing and other disciplinary knowledge further perpetuates issues in nursing, such as the theory-practice gap also, referred to as the academic-practice gap. How can nurses in practice be expected to consider recent and relevant knowledge if they do not have access to it? Some nurses may never realize what they are, and are not able, to access. For example, when nurses’ are on-boarded or oriented into their healthcare institutions, if they are not educated on their resources (such as journal subscriptions or medical libraries – also, why aren’t there nursing or nursology libraries?), how can they be expected to use it for practice, education, or research? Similarly, how can nurses in academia educate or complete research on relevant nursing issues if they are blocked by paywalls (or should we say, selective paywalls – something to consider)? Reaching out to colleagues can result in loss of time/productivity, and coincidentally can place a colleague in an awkward situation. Moreover, this lack of equity in access to knowledge perpetuates a delay in translational research. Remember the old saying that it takes 17 years for research to become practical knowledge? In this day in age where knowledge is produced at such exponential rates, this shouldn’t be the norm.

Solutions for Change: Making Nursing Knowledge a Right

Instead of perseverating on the identified gap at hand, perhaps it’s time to discuss potential solutions and make nursing knowledge a right and not a privilege. Our hope is with this blog you can begin to educate yourself on what is equitable access to nursing knowledge, including potential solutions for change. With this, perhaps you can take some of these solutions back to your institution and colleagues, and keep some in mind for your future work. The following list contains potential identified solutions to creating equity in access to nursing knowledge.

1. Blogs on Nursing and Nursology

Blogging, as well as reading nursing blogs, is a great way to engage with the global nursing community without borders. Through these interactions, you have the capability to learn more about the work of others (whether in-process or complete) be exposed to new ways of thinking, have discussions around important topics, receive feedback on your work, and be referred to relevant and available resources. For example, on Nursology.net you can find blogs on resources for teaching, sociopolitical issues, student perspectives, and exemplars for theories, philosophies, and more. Other notable nursing blogs (such as at the American Journal of Nursing or Advances in Nursing Science) offer an opportunity for nurses to read about and discuss scholarly issues without a fee. Interestingly though, many academic journals do not have an adjacent blog. Perhaps it’s time for editors to consider integrating a blog for their journal, and maybe it is time for you to consider writing a blog about something you are passionate about?

2. Journal Clubs

While journal clubs get a bad reputation for disorganization and/or low participation, they are an effective way to develop community for equitable knowledge access. Whether internal to your institution, or external with colleagues (what about a journal club for practicing nurses AND nurses in academia?!), a journal club can be a great way to help disseminate relevant nursing knowledge to colleagues who otherwise wouldn’t be exposed. Additionally, journal clubs help stimulate discussion on potentially overlooked issues and knowledge gaps, driving our discipline into the future.

3. Nurses On Boards

Often when we think about boards, we picture a dry and unproductive boardroom meeting that could have been summed up in an email (also referred to as CHBAE). This is not to say that this doesn’t occur… but, nurses are hugely underrepresented on boards across the U.S. (and probably the world). The Nurses on Boards Coalition “represents national nursing and other organizations working to build healthier communities in America by increasing nurses’ presence on corporate, health-related, and other boards, panels, and commissions.” How does this relate to knowledge equity in nursing you ask? Well, if nurses are underrepresented on boards, ultimately, what is approved as valid knowledge within an institution (think about hospitals here) will lack a nursing voice. Conversely, if nurses have a voice on boards, they can bring their unique disciplinary perspective to the institution and help drive what IS considered as valid knowledge. Think back to the medical library versus nursing library comment above, or maybe you have another example in mind? That being said, think how your voice could impact your institution on a board, and how that voice could help shape the future of knowledge equity in nursing.

4. Development of Anthology’s on Nursing Knowledge

In 1986, the book titled “Perspectives on Nursing Theory” was published by Dr. Leslie Nicoll which “is an anthology of classic and contemporary peer-reviewed articles that address various theoretical and philosophical perspectives on knowledge development in research and practice” (Reed & Shearer, 2012, p. vii). Since the original publication, there have been six editions of this book, most recently by Dr. Pamela Reed and Dr. Nelma Shearer. This book is an exemplar of what nurses in academia can do to promote access to knowledge for those in the practice environment. Dependent upon the area of expertise (whether theory or perhaps another topic) similar books can be developed that are a collection of the classic and contemporary peer-reviewed articles that address the area of interest. Moreover, as new editions are developed (hopefully faster than 17 years), practicing nurses have an ability to access essential knowledge which helps bridge the theory-practice gap, and simultaneously, translate research into practice. In addition, in light of environmental concerns related to book production, authors, editors, and publishers should consider decreased prices on electronic book versions to decrease their carbon footprint, and also to increase access to nursing knowledge.

5. Open Access Nursing Repositories and Journals

Open access journals and repositories make original research freely available via the internet. While there are concerns around the quality of articles contained within open access repositories and journals, there are acceptable options provided by notable nursing organizations. For example, Sigma Theta Tau International hosts the Virginia Henderson Global Nursing e-Repository (otherwise referred to as the Henderson Repository). The Henderson Repository “is the only repository solely dedicated to sharing works created by nurses around the world. It is an open digital academic and clinical focused service that freely collects, preserves, and disseminates full-text nursing research, educational, and evidence-based practice materials in a variety of formats and item types.” You can even find posters that have been presented at conferences, such as the Nursology Theory Collective’s poster at the King Conference in 2019. Lastly, there is also an underlying community collection that contains theses and dissertations that have been completed and defended, making it easier to access unpublished works (which is also important!). That being said, have you shared your important work with a nursing repository?

6-?. You decide!

Image copyright of Shannon Wheller

While this list is not exhaustive, this is just the beginning. If you have any further solutions to suggest on how to promote equity in access to nursing knowledge, please comment below. Remember, there are no wrong answers! We believe in the incorporation of nursing theory into practice, and practice into nursing theory, and we suggest that to support our discipline we need to close the gap in access to knowledge. Nurses in academia and practice need each other. We are interdependent and better together. We hope that in the process of closing this gap, we can foster collaboration across settings between nurses, ultimately bettering the health and well-being for all. 

Nursing knowledge should be a right and not a privilege, and we all need to work together to enable it to be that way.

Note: The Nursology Theory Collective would like to thank Mike Taylor for bringing up this important issue to discuss with the Nursology community.

References

Reed, P. G., & Shearer, N. B. C. (2012). Perspectives on nursing theory (6th ed.). Lippincott Williams & Wilkins.

Perspectives of Nurses on the Term Nursology: An Informal Twitter Poll

First described by Paterson in 1971, the term nursology was originally coined to capture the essence of “the study of nursing aimed towards the development of nursing theory” (p. 143). Since this definition, nursing scholars have continued discourse around the name of our discipline. In 1997, for example, Reed suggested a name change from a verb, nursing, to a noun, nursology, while still retaining nursing within the metaparadigm. In 2015, Fawcett and colleagues re-presented the idea of changing the name of the discipline of nursing to nursology. Again in 2019, the term emerged as a topic for discussion at the Case Western Nursing Theory Conference.

To understand the perspectives of nurses on the use of the term nursology, an informal Twitter* poll was conducted by the Nursology Theory Collective asking the question, “what do you think about using the term Nursology instead of nursing to describe our discipline?” Twitter polls enable individuals to voluntarily respond to questions posed by individuals or organizations on Twitter (Twitter, 2020), and are not meant to be scientific. The informal poll also included the ability for nurses to comment and share their thoughts on the topic. All participants, but one, gave permission for the use of their write-in responses to be included in this blog post. Only participants who gave permission were included in this post.

A total of 34 responses were received with six comments; not all of the participants were current followers of the Nursology Theory Collective. The responses revealed that 32% of participants thought that Nursology as the name of our discipline made sense, whereas 27% were unsure. 41% of participants responded that they were not supportive of Nursology as the name for the discipline.

For the write-in responses, participants shared various reasons they were in favor of or opposed to, the name change. The use of the suffix -ology seemed to represent a primary concern for participants. For example, one participant stated, “using the term -ology feels like it discounts the art of nursing. It is a science and an art. It’s more than biology, physiology and psychology. It’s about the whole not the sum of parts!” Comparably, another participant in favor of the change stated, “as disciplines have specialized areas within the “ology”. How about nursing practice, nursing education, nursing science as some examples for us within the ology?” Others suggested that utilizing the suffix of -ology “feels like an attempt to assimilate into an existing hierarchy of medical disciplines, instead of a staking out of nursing knowledge as more than another silo-ing of medical ology, but as an entirely different paradigm…” Lastly, while some commented that they liked the term nursology and looked forward to learning more from the group, others expressed concerns that Nursology as a term “suggests disciplinary insecurity,” conveying the idea that nurses somehow do not see ourselves as legitimate as we are, investing energy in an endeavor that ultimately changes little about the work we do.  

While more voters opposed adopting the term ”nursology” than were in favor of adopting it, 27% of voters were neutral to the change. This suggests that nurses may not have strong feelings about the name nursing for our discipline as it stands today, or perhaps the term was too new to them. One of the participants raised concerns of “disciplinary insecurity,” potentially supporting the idea that nurses may need to examine what it means to practice nursing versus study nursing as a body of knowledge, a stance that very well could reinscribe the theory-practice gap. Alternatively, this finding may support that nurses are open to change, but need more information in order to make an appropriate judgment. Nursing scholars should take this as an opportunity to open discussions with nurses outside of academia, especially in the practice environment, and publish relevant literature to stimulate future discourse on the name of our discipline. 

Finally, the write-in responses raise the concern related to the use of the suffix -ology. As expressed by one of the participants, this suffix is commonly used in the medical sciences, but this suffix does not originate in medicine (e.g., Geology and Mythology). The question is then raised why the suffix -ology is so controversial? One of the participants discussed how the use of -ology discounts the art of nursing, although they expressed nursing is still a science. Perhaps nurses today with their understanding of nursing and nursology, see nursing as the art, and nursology as the substantive study of nursing? Further discourse and individual reflection are needed on this topic as we navigate the perceived duality that exists among art and science, nursing and nursology, and nurse and nursologist. The question then becomes, is every nurse a nursologist?

For more information on the Nursology Theory Collective, please email us as nursingtheorycolletive@gmail.com, or follow us at @NursingTheoryCo on Twitter.

*Twitter is a microblogging and social media networking platform where individuals and organizations interact and message each other using “tweets,” 140-character messages designed for brevity and quick exchange of ideas. Please see the following link for more information: https://about.twitter.com/en_us.html


References

Fawcett, J., Aronowitz, T., AbuFannouneh, A., Al Usta, M., Fraley, H. E., Howlett, M. S. L., . . . Zhang, Y. (2015). Thoughts about the name of our discipline. Nursing Science Quarterly, 28, 330-333. doi: 10.1177/0894318415599224

Paterson, J. G. (1971). From a philosophy of clinical nursing to a method of nursology. Nursing Research, 20(2), 143-146. Retrieved from https://pubmed.ncbi.nlm.nih.gov/5205160-from-a-philosophy-of-clinical-nursing-to-a-method-of-nursology/

Reed, P. G. (1997). Nursing: The ontology of the discipline. Nursing Science Quarterly, 10, 76-79. doi: 10.1177/089431849701000207

Twitter. (2020). About twitter polls. Retrieved from https://help.twitter.com/en/using-twitter/twitter-polls

Unity in Our Diversity: the KING Collaborative Conference and Nursology

         Last month, on November 14th and 15th, nurses from all over the world gathered to discuss nursing theory and the future of nursing at a landmark conference at George Washington University in Washington D.C. Hosted by the King International Nursing Group, the theme of the conference was “Nursing theories: Moving forward through collaboration, application and innovation.” Present at the conference included members of various scholarly groups in nursing such as the International Consortium of Parse Scholars, Leininger Culture Care, the Neuman Systems Model Trustees Group, Orem International Society, Roy Adaptation Association, Society for the Advancement of Modeling and Role Modeling, Society of Rogerian Scholars, the Transcultural Nursing Society, the University of Connecticut School of Nursing, the Watson Caring Science Institute, and the Nursing Theory Collective.

The above collage depicts different moments during the panel presentation at the King Collaborative Conference. On the bottom from left to right is Jacqueline Fawcett, Callista Roy, and Marlaine Smith.

         On the first day of the conference, a representative member of each of these scholarly groups presented on the nursing theory central to their organization. Each oriented their discussion toward the future of nursing as a discipline. Awareness of our habitual silos slowly emerged as each of these scholars presented, revealing our tendencies as nurse theorists – nursologists – to work in isolation. These voices were put into dialogue in a panel, convened to discuss the future of nursing theory and the discipline as we know it. From this discussion, panelists and attendees alike unanimously agreed that the future of the discipline required that we identify common ground and work collaboratively from our shared values grounded in nursing while recognizing and honoring our differences. The panel discussion concluded with a call to find unity in our diversity and recognize the strengths inherent in divergent perspectives. 

The Nursology Theory Collective at their first in-person meeting on November 15th, 2019.

      The next day, the Nursing Theory Collective had their first in-person meeting. In light of the pivotal discussion that had occurred on the previous day, representatives from different scholarly groups were in attendance to participate. One of the main agenda items for the first in-person meeting was revisiting the adoption of the term “nursology” in the group’s name, mission, vision, and values, in place of the term nursing. Achieving consensus through lively discussion on the politics and peculiarities of the term, the Collective ultimately determined that “nursology” was best suited for navigating the future of the discipline. As such, the Nursing Theory Collective has now been renamed the Nursology Theory Collective. It is our hope with this adoption that we can become more inclusive for all scholars and practitioners alike, breaking down walls towards a unified future for the discipline.

         Inspired by our shared space and time at the King Conference, looking towards the future, the Nursology Theory Collective intends to continue to advocate for the future of our discipline through practice, research, education, and policy. We hope to foster an inclusive home for nursologists from all perspectives. We ask you, as important voices in our discipline, what issues are most important to you? Though you may not attend our meetings, we value diversity, discourse, and dissensus. We want to hear from you about the future you envision for nursing. What are the theory, practice, education, policy issues you see as critical to our future? We want to hear from you, and we invite you to our next meeting on Monday, December 16th from 1:00 – 2:30 PM MST. If you wish to participate, please contact us via email at nursingtheorycollective@gmail.com

Please continue the conversation from the King Conference below in the comments, we look forward to hearing from you!

With gratitude,
The Nursology Theory Collective 

The Nursology Theory Collective at their first in-person meeting on November 15th, 2019.

Shaping the Future of Nursing Education and Practice: AACN Essentials Revision and the Next Generation NCLEX

In support of our mission “to advance the discipline of nursing/nursology through equitable and rigorous knowledge development using innovative nursing theory in all settings of practice, education, research and policy,” the Nursing Theory Collective (NTC) emailed the workgroup chairs of the American Association of Colleges of Nursing (AACN) Essentials Task Forces on September 16th, 2019. In this email, we as the NTC advanced our support for a strong nursing perspective and theoretical orientation in the planned revisions to the Essentials documents that form the basis for nursing education at all levels of study. To date, we have received positive responses from the chairs of the baccalaureate, master’s, and DNP essentials revision workgroups. We understand that AACN has invited nursing faculty to have discussions regarding the Essentials, both at their universities and future conferences. We have provided our letter below to foster open dialogue regarding the importance of nursing theory in the future of nursing education. Please join these conversations as you are able and feel free to use the points we have developed as a starting point for your thoughts as well.

In addition to the effort regarding the Essentials revision, we also reached out to the National Council of State Boards of Nursing (NCSBN) regarding the Next Generation NCLEX Project (NCSBN, 2019). As you are likely aware, the NCLEX is currently under revision with an eye toward ensuring novice nurses possess the necessary skills to detect the subtle changes in patient status, preventing deterioration, as well as avoiding errors. In pursuit of this project, the NCSBN has underscored the importance of clinical judgment and decision making in the safe practice of newly registered nurses. It is our concern that due to the absence of a framework founded in nursing knowledge and theory, the disciplinary perspective is lost such that clinical reasoning and clinical judgment devolve from a nursing skill to a generic biomedical task orientation (Bender, 2018). Moreover, the absence of nursing theory in the foundation of the Next Generation NCLEX project begs questions about our core values, how we value nursing knowledge, and to what regulation we agree to adhere (Perron & Rudge, 2015). Email communication with NCSBN about theory content and a guiding theoretical framework belied a lack of interest on their part in engaging in discussion of this issue, at least at this time. Given the role that the Essentials play in nursing education, the NTC has decided to focus on our efforts with the Essentials. We hope that, in time, with revision to the Essentials NCSBN will be motivated to consider the role of nursing theory in NCLEX and more readily engage. 

Appended below you will find our Essentials letter to the DNP workgroup, which is similar to the other two Essentials letters. Please share our letter among your colleagues to assist in the facilitation of discourse on this important topic.

Dear members of the DNP Essentials workgroup,

            We are writing to you today because of your role in the workgroup for the Revisions of American Association of Colleges of Nursing (AACN) DNP Essentials. We represent the Nursing Theory Collective. Our collective membership, made up of experienced nurse clinicians, researchers, educators and scholars, as well as graduate students, emerged from the landmark nursing conference that was held at Case Western Reserve University called Nursing Theory: A 50 Year Perspective, Past and Future in March, 2019. 

As future educators and scholars, we represent the next generation of nurses who will implement the DNP Essentials in the process of educating nurses in the decades to come. We recognize that the DNP Essentials will have a substantive influence on the future of nursing education.

We appreciate your efforts as in the DNP Essentials workgroup and the challenges inherent in taking on the task of creating this powerful and empowering nursing document. We understand that this document, when finalized, will significantly influence the curriculum and the education of thousands of nurses in our country for many years.

It is the recognition of the lasting power and influence of the DNP Essentials recommendations that brings us to write to you today. We join with the American Holistic Nurses Credentialing Center and nursing leaders from institutions of nursing education across the country to respectfully ask that you consider the following points of concern:

1. Theory and Competencies
Nursing theory, representing the wide variety of theories, frameworks, and models used in nursing and including those that provide the historical foundations of nursing, are missing from competencies within the DNP Essentials recommendations. We request that nursing theory and nursing history be included in the Essentials at every level because it is anchors us to our past, present, and future knowledge of nursing. Nursing theory, including knowing the connections to its philosophical roots, shapes who we are as nurses and highlights the critical and distinct human service of nursing that is not met by other disciplines. Education in nursing theory, along with other essential educational content, ensures a solid foundation in disciplinary knowledge and perspective for future nurses, nurse scientists, and scholars. The ongoing development of nursing theory can also lead to the creation of knowledge that can be shared across disciplines. 

2.  Disciplinary Perspective
Competency-based education in nursing must reflect our unique disciplinary perspective with a focus on protecting, promoting and restoring health and well-being, the prevention of illness and injury, the alleviation of suffering (ANA, 2015, p.1) and perspectives on humanizing the health experience (Reed, 1997; Willis, Grace & Roy, 2008). The provision of nursing theory as a foundation for nursing education reinforces our discipline-specific perspective. Nurses need to be competent in articulating the history, voice, and vision of nursing. 

3. Nursing-Centered Frameworks 
Competencies derived from the biomedical models like the Interprofessional Domains of Practice (Englander, Cameron, Ballard, Dodge, Bull, & Aschenbrener, 2013) minimize 100 years of knowledge building that evolved within nursing to define the discipline specific contributions nursing brings to the patient care experience as a science and a discipline. This undermines the existence of the historical work that has been done in nursing theory development, and impedes the future progress of our discipline.

4. Nursing Identity
Interprofessional collaboration must be built upon a strong identity as nurses, so that each nurse can articulate what they bring to the healthcare team, highlighting the priorities that are different from but complementary to the interprofessional team. Without this perspective it will be all too easy for nurses to lose sight of their unique contributions to the interdisciplinary team.

5.  Healthcare Trends 
Healthcare trends and expectations will influence nursing’s roles and practice within healthcare delivery for the next decade, as AACN has articulated, making our strong nursing identity and unique perspective on patient care more important than ever. We are concerned that some current trends in healthcare may emphasize profit, technology and disease over the importance of nursing care, including an alarming shift away from the caring, holistic, scientific, and relationship-based nature of nursing and towards an often profit-driven, technical and biomedical model of interdisciplinary focus where nurses becoming identity-less “health care professionals.”

We envision harnessing the power of nursing through carefully constructed educational essentials to actively shape a just and equitable healthcare service model in the United States of America, and provide future nurses with a clear identity as nurses. However, our future nurses must be educated in the fundamental theoretical and philosophical foundations of nursing in order to preserve the character and ethos of our profession. 

In summary, nursing has always embraced interdisciplinary teamwork. However, we believe that our essential educational competencies must remain firmly grounded in nursing values, nursing theory, and nursing history. Educational essentials and nursing competencies must first reflect our nursing perspective, not those of other disciplines. 

We are nurses and our educational competencies should reflect nursing knowledge and nursing theory. We urge you to consider our recommendations, and how framing of the DNP Essentials within a biomedical, interdisciplinary model would minimize over 100 years of scholarly work by nurses to advance a unique disciplinary perspective and identity. We further recognize the impact that DNP-prepared nurses will have in the future of nursing and the future of healthcare, underscoring the urgency of our concerns.

We acknowledge and appreciate all of the hard work your committee has put forth on this important topic. We hope that you will consider our position in your future revisions of the DNP Essentials. If you wish to have further dialogue on this issue, we as future and present nurse leaders would appreciate the opportunity to engage further.

With gratitude,
The Nursing Theory Collective   

Cosigned by:
Brandon Brown, EdD Student, MSN, RN-BC, CNL 
Ellen Buckner PhD, RN, CNE, AE-C, FNAP
Clare Butt, RN, PhD 
Jill Byrne, MSN, RN, CNOR, PhD Student
Gayle L Casterline, PhD, RN, AHN-BC
Peggy L. Chinn, RN, PhD, DSc(Hon), FAAN
Da’Lynn Clayton, PhD, RN 
Catherine Cuchetti, RN, MSN
Jessica Dillard-Wright, PhD Candidate, MA, CNM, RN
Margaret Erickson, PhD, RN, CNS, APRN, APHN-BC
Rosemary W. Eustace, PhD, RN, PHNA-BC
Jacqueline Fawcett, RN; PhD; ScD (hon); FAAN, ANEF
Pamela Grace, RN, PhD, FAAN
Consuelo Grant, PhD Student, BSN, RN
Debra R. Hanna, PhD, RN, ACNS-BC
Jane Hopkins Walsh, PhD Candidate, PNP-BC, RN
Yuanyuan Jin, PhD Student, MSN, RN
Amy Kenefick Moore, PhD, RN, APRN, CNM, FNP-BC, APHN-BC, HWNC-BC
Kan Koffi, RN, AD, B.Sc., M.Sc.
Carrie Langley, PhD Student, MSN, MPH, RN 
Patricia Liehr, PhD, RN
Chloe Littzen, PhD Student, MSN, RN, AE-C
Colleen Maykut, RN, BScN, MN, DNP
Melissa McCoy, MSN, RN
Angela Norton, PhD Student, MSN/Ed, RN
Christina Nyirati, PhD, RN
Judith Pare, PhD, RN
Marilyn Ray, RN, PhD, CTN-A, FSfAA, FAAN, FESPCH (hon.), FNAP
Pamela Reed, PhD, RN, FAAN
M. Kay Sandor, PhD, RN, LPC, AHN-BC
Phyllis Shanley Hansell, DdD
Mike Taylor RN, MHA, CDE
Billie S. Vance, MSN, FNP-BC
Sylvia K. Wood, DNP, ANP-BC, AOCNP
Rorry Zahourek, PhD, RN, PMHCNS-BC (ret), AHN-BC, FAAN

References

American Nurses Association. (2015). Nursing scope and standards of practice (3rd ed.). Silver Spring, MD: American Nurses Association.

Bender, M. (2018). Re-conceptualizing the nursing metaparadigm: Articulating the philosophical ontology of the nursing discipline that orients inquiry and practice. Nursing Inquiry, 25(3), 1-9. doi: 10.1111/nin.12243

Englander, R., Cameron, T., Ballard, A. J., Dodge, J., Bull, J., & Aschenbrener, C. A. (2013). Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Academic Medicine, 88(8), 1088-1094. doi: 10.1097/ACM.0b013e31829a3b2b

NCSBN. (2019). Next generation NCLEX project. Retrieved from https://www.ncsbn.org/next-generation-nclex.htm 

Perron, A., & Rudge, T. (2015). On the Politics of Ignorance in Nursing and Health Care: Knowing Ignorance. New York, NY: Routledge.

Reed, P. G. (1997). Nursing: The ontology of the discipline. Nursing Science Quarterly, 10(2), 76-79. doi: 10.1177/089431849701000207

Willis, D. G., Grace, P. J., & Roy, C. (2008). A central unifying focus for the discipline: facilitating humanization, meaning, choice, quality of life, and healing in living and dying. Advances in Nursing Science, 31(1), E28-E40. doi: 10.1097/01.ANS.0000311534.04059.d9.