Throwing Shade at Nursing Theory: a Millennial’s Perspective

Welcome to Shannon Constantinides,
who is joining the Nursology.net blogging team!
Shannon also contributed the content on
Jane Georges’ Theory of Emancipatory Compassion

Dear Colleagues,

Shannon Constantinides

As a current PhD candidate (Yay! I’m making progress) and experienced NP of about a decade (Yikes! Time flies!), I have a few thoughts on Dr. Foli’s well articulated post and associated call for action/ questions regarding nursing theory in academics. It is with a great reverence for the bright minds of this community that I share these ideas with you all. Please consider my comments simply for no more than what they are: some thoughts from a novice scholar (who happens to be a millennial).

First, the humor and humility with which Dr. Foli broached the topic of “nursing students throwing shade at nursing theory” made her post fun to read and so relatable!

Second, and not entirely related to the topic at hand (which I’ll get to), as an NP who often precepts students, I loved the question posed to students, “Are you running from something in your current job, or running toward a goal of being a nurse practitioner?” I think probably too often nurses go to NP (Nurse Practitioner) school without a clear idea of what the role and day-to-day of the job entails. On a number of occasions, I’ve gently refused to write letters of recommendation to NP school for newly graduated BSN students, because I truly believe that the knowledge and experience gained by working as a nurse is beyond measure. First and foremost, NPs are nurses. I can’t underscore enough the importance of building a strong professional foundation. Equally as important is taking the time and opportunities to explore the endless possibilities that come with nursing practice (finding what sets one’s soul on fire, so to speak). I think this goes for new-grad RNs who are fixated on any one speciality, as well. I would not be on the path that has lead me down my professional and academic journey without first practicing in a number of areas (being in the military made this an easy possibility). Having experience in a number of areas has been invaluable to my career as an APN – clinically and in broadening my understanding healthcare systems and the lived experience of health, itself.

Third, I think the struggle to connect theory to practice comes from a few places. Overall, however, I think it may be time we re-envision and modernize how we approach teaching theory, in the first place. We did this for clinical practice, right? How many of our colleagues ever trained in a sim lab, for example? Updating the what, how, and environment in which we teach doesn’t have to be limited to the parameters of the clinical side of practice. I think the sample principles apply to teaching theory, especially if we want students to learn how to integrate the two. So a few thoughts…

Why is there SO MUCH reading!?

I’ve deduced that what has seemed like an ungodly amount of reading over the course of my education has served the following purposes: 1) taught me the practical knowledge needed not kill my patients (literally), 2) exposed me to new ideas, and 3) exercised my brain and made it grow in its ability to comprehend complex and abstract ideas – just like exercising a muscle.

In regard to the amount of reading that goes along with nursing education: I had NO idea! And I say that as a naturally voracious reader who grew up in a home that purposely had no tv! Honestly, I think 99.99% of students have no idea what they’re getting into when they sign up for nursing education – at any place on the educational spectrum. Students need to be reassured, probably on repeat, that the reading has a purpose. As much as the discourse in nursing espouses that we ascribe to the anti-handholding/ law-of-equal-suffering/ eat-our-young narrative, reassuring your students is more than being nice or helpful. On a deeper level, reassuring your students demonstrates the ethics of compassion and caring that is preached in the pedagogy of the discipline.

To that point, your millennial students will also to be curious as to why you’ve selected specific reading material. I’m not saying you need to, or should, justify each reading assignment. However, giving students a general idea of why certain material is important, especially for theory and philosophy, will help create a connection to the content. I say this with love for my generation, but millennials (and post-millennials) are a different animal. We’re a “special” breed, if you will. We have been raised to question everything. Every. Thing. It’s in our DNA. And you’re just in luck, because there’s A LOT of us! By many accounts, we’re the largest generation in history! (That is, millennials – people born between 1981 and 1996, and post-millennials – people born between 1997 and the present day).

Now, to that point, let’s not also forget that the frontal lobe doesn’t fully develop until late adolescence/ early adulthood. So, some of your students who are innately left-brained, “linear” thinkers (who, inherently, may have a harder time wrapping their heads around some of the non-linear concepts in theory and philosophy), will also be young, concrete thinkers. Their brains literally have just only developed to a point of abstract thinking understanding the basic concepts related to the more esoteric ideas we talk about in theory. And this issue is compounded by unique educational, professional, and personal backgrounds and upbringings of each student.

For example, it wasn’t until my masters-level (and more so, PhD) studies, that I really started understanding some of the more abstruse, Delphic concepts in nursing theory. As a BSN and MSN grad of the CU system, I naturally gravitated to Watson’s work – but generally – the more experienced I became professionally, academically, and in life, the more I came to understand the “other” theories I was learning about in school. As an 18-year-old, direct-entry BSN student I could understand (because I saw a way to concretely apply) Orem’s self care theory, Leininger’s cultural care theory, or Carper’s Pattens of Knowing (and, yes, I now know and understand why Carper said in a 2015 interview with Eisenhauer that her work was never meant to be a theory – but try telling that to a young, brand-new, nursing student! There’s no denying a certain level of concreteness to aspects of Carper’s work. This is something I love about Carper’s model – she wanted it to be readily tangible to the user, and it is!)

In reality, it’s taken me nearly two decades to “get the hang of nursing theory” and be able to digest and truly understand the works of such thinkers as Rogers, Patterson and Zderad, or Newman. Or actually appreciate the depth, intricacy, salience, and beauty of Watson’s work. In fact, as a BSN student, I remember sitting in a guest-lecture with Dr. Newman, and being the left-brainer that I am, raised my hand said, “Um, Dr. Newman, I don’t get it…” Looking back, I’m still mortified by this encounter! I was THAT student (insert #facepalm here!).

#facepalm

So, really, it’s taken the better part of my adult life to develop the intellectual ability and emotional maturity needed to sit with and understand complex ideas. There are articles, book chapters, and entire texts I now consider the Holy Grail, which when I first read them specifically remember thinking, “WT_?? Is this even in English???” And to that point: don’t forget that your students are literally learning new languages! They’re not only learning the technical language of healthcare, but also the language the informs the epistemology of nursing. So, again, I think showing your students a little patience, forgiving, and compassionate grace is key.

Likewise, it’s my opinion that once we get to a certain point in our careers (as a clinicians, scholars, educators, administrators, etc.) we take for granted knowledge that has become second-nature. I can say, with complete certainty, that I fall prey to this with my own clinical NP students. What do you mean you don’t have a clear, concise, and evidence-based plan for managing your older adult patient who has insanely complicated medial, psycho-emotional, and social needs?? We have to remember that knowledge for students – whether clinical or related to theory and philosophy – is often entirely new or being presented at a depth they weren’t expected to go to in the past. In addition, with APN students where we’re building off the knowledge and experience that comes from working as an RN and RN education. As far as theory and philosophy are concerned – that knowledge is really complicated, is often brand-new, and often isn’t intuitively grounded in day-to-day nursing work and education. Your students are learning new stuff, a new language, and and learning to think in an entirely different way. Patience is key. Finding a way to foster connection to the content is key. My suggestion would be to keep Benner’s Novice-to-Expert model in the forefront of your minds when you’re working with students – especially when it comes to teaching theory and philosophy.

Middle range theory & the ladder of abstraction.

I think a lot of students aren’t exposed to middle-range theories. This statement is, of course, purely based off anecdote consisting of my own academic and professional experiences, and what sound to be similar experiences shared by my colleagues. It’s my opinion that middle-range theory may an optimal place to bridge the theory-practice gap. Certainly, this bridge will be influenced by the paradigm framing the theory or the paradigm to that which the nurse knowingly or unknowingly ascribes. However, as Smith and Liehr (2014) stated, middle range theories are more straightforward and lie in-between that which is all-inclusive and that which is highly situation-specific. In this regard, a few exemplars that made sense to me and my peers included Story Theory, the Theory of Unpleasant Symptoms, and the Theory of Caregiving Dynamics.

I also think teaching the levels of theory abstraction as described by Smith and Liehr, even at the BSN level, could help make a little more sense of nursing theory in terms of applicability. Do I apply this theory at the bedside? In a specific situation? Does it guide a certain aspect of my practice? Or, is it something that will guide the entirety of how I approach practice, patients, and the general experience of health?

I think it’s so tempting to start off with the classics: the grand nursing theories. But honestly, some (ok, basically all) of those theories are super complicated! For your newer, less experienced learners, maybe initially include something a little more concrete, like a micro theory? Help your students dip their toes in the water, so to speak, rather than throwing them directly into the deep end. I think a lot of harm can be done when faculty knowingly or unknowingly teach at a level that is over the students’ heads. Your students will get there, trust me, but keep it simple in the beginning. Help your students build a strong foundation. You’d do the same with patient care knowledge and skills, right? So, same idea for nursing theory.

Aging-out and aging-into the current sociopolitical & cultural context

I can’t stress this enough: nursing faculty have a critical place not only as clinical and scholarly role models, but in modeling the language and behavior of advocates and voice-givers. When I started my BSN in 2000, and even by the time I graduated with my NP in 2011,  I didn’t really know what social justice was. I couldn’t really answer the question, “What are you doing to be an advocate?” Over the course of my PhD program, however (and thankfully so), I’ve had the amazing fortune to work with and be mentored by some exceptionally stellar minds in my quest to figure out my place as an advocate and voice-giver (especially Dr’s Peggy Chinn, Patricia Liehr, Jane Georges, Debra Hain and Deb D’Avolio… to name a few). And, boy, do I wish I’d had a social justice/ emancipatory focused curriculum as a BSN or MSN student, like our students do at FAU!

So how does this relate to teaching theory? As feminist Holly Whitaker (2019) wrote in her book, “Quit Like a Woman,” we are now, likely more so than ever, aware of our own oppression, the oppression of others, and aware of how our actions or inactions have abetted the oppression and marginalization of others. Whitaker states, and I whole-heartedly agree, that thanks to movements started by the LGBTQIA community, radical feminists, and women of color, our common vernacular now includes words like privilege, misogyny, and patriarchy. (I would also add terms like toxic masculinity and inclusivity). Likewise, I contend that our language reflects a paradigmatic shift that is occurring in society: we are moving toward a more humanistic way in how we view and interact with others. For example, we’re moving away from socially constructed and derogatory descriptors. Rather than calling someone “disabled” we acknowledge that the individual is of other-ability. Rather than being called “elderly” or “geriatric” we honor the experience that comes with older adulthood. We recognize that someone is involved in “sex work” is a “sex worker,” not a “prostitute.” We now see that the term “violence against women” is problematic in that it is passive and alleviates the blame of the perpetrator.

Students, especially millennials, are probably hip to these issues and this type of language, but this is not an assumption to make. It is your responsibility as a faculty member to stay informed and engaged in this regard. Just like you would teach from a place of best evidence regarding clinical practice and patient care, stay up to date on what’s going on in the world, the language being used, and the issues that matter to your students.

The good news is that we now have theories and books that are grounded in a social-justice paradigm! Take, for example, Georges’ (2013) Emancipatory Theory of Compassion (or really, any of Dr. Georges’ work dealing with the nature of human suffering). I adore Georges’ work (and work she’s done collaboratively with Dr. Susan Benedict) for a number of reasons, especially how she takes the concept of suffering head-on, and calls out nursing in regard to the profession’s historical (and generally unspoken) complicit involvement in oppression. Intentionally moving away from the traditional, Western narrative that has a propensity for the patriarchy, Georges’ work focuses instead on alleviating suffering through compassion, empowerment, and deconstruction of power relations. Falk-Rafael’s Critical Caring model, for example, also goes in this direction as it looks at role power relations have in public health outcomes. Likewise, I consider Kagan, Smith, and Chinn’s (2016) Philosophies and Practices of Emancipatory Nursing, and the works there within, a critical must-read for anyone wanting to study or practice nursing theory in context of today’s sociopolitical climate. To that point, a quick search on Amazon revealed a number of nursing textbooks centered around contemporary theory-based approaches for caring for vulnerable populations, approaches to healthcare policy, and approaches for healthcare advocacy.

And, to very briefly touch on the topic of technology in nursing theory: if your students are my age (I’m 37) or younger, we never knew what it was like to live without technology (let alone practice nursing without computers, smart phones, apps, EHRs, or the internet!). My husband, a physician (I know, I married the enemy), is 10 years older than me. We work in the same primary care practice. Even though he is fairly tech savvy, it’s astonishing how much longer it takes him to adapt clinical technology compared to those of us in the clinic who are a decade younger. I’m not saying this is true across the spectrum: I absolutely interact with younger clinicians who have less tech know-how than our colleagues a few decades our senior. What I’m saying is that those of us who were born into and grew up practicing nursing in the information age have a different relationship and understanding of healthcare (and view of the world, in general) than those even a decade ahead of us.

Several years ago, at the suggestion of my fairly tech savvy entrepreneur dad, I read “The World is Flat” by Thomas Friedman. My dad thought this work was incredibly forward-thinking. The concept and manifestation of a globalized humanity secondary to advances in technology was mind-blowing to him. However, I remember thinking, “yeah… so this is not a new thing to me, Dad…” Keep in mind that the world has always looked so different to those of us in the millennial and post-millennial generations. In terms of nursing theory, Watson’s work – I think especially Caring Science as Sacred Science and Unitary Caring Science – both hit the nail on the head in terms of addressing globalization and caring for a global humanity.

Additionally, the exciting thing about nursing theory in the information age is that new theories are emerging to deal with contemporary, tech-related issues! Dr. Rosario Locsin’s Theory of Technological Competency as Caring, for example, is pertinent and relatable for today’s students. A few years ago, I had the opportunity to listen to Dr. Locsin speak about his theory. I was, again, THAT student. I asked Dr. Locsin, “Are your theory and views on artificial intelligence and humanoids questioning how we define existence?” “No. Not necessarily,” he said, “But what if A.I. develops to the point where it can’t be differentiated from naturally living beings? What if a humanoid develops feelings? Can they develop feelings?” These may sound far-fetched, but the future is not that far away and technology is developing at a screaming pace! The philosophic questions, ethical dilemmas, and reality your students will face in the future will undoubtedly look like something out of a sci-fi novel – and for that I applaud Dr. Locsin for boldly going where no nursing theorist has gone before!

This next statement might be considered heresy, but for the sake of discussion, hear me out: I believe some theories are aging-out, or at least need to update their language. This is absolutely not a dig on older theories: let me be very clear about that! Some of the older theories were the embryonic origins of what, over time, have evolved into modern nursing theory and practice. Due to the social and political culture of the time, and in order to be taken seriously, the structure and verbiage of early nursing theories were informed by a patriarchal/ paternalistic, medical narrative that was dictated by an aristocracy of upper class, white, male physicians, scientists, politicians, and power-elite. People were either ill or well. Self-agency was not a thing if you were not a straight, white, cis-male. Social justice was not a thing. Human rights were not a thing. The right to health was not a thing (and arguably is still not a thing). Hearing the critical voices of underserved, under-represented, vulnerable, or marginalized populations was not a thing. Talking about energy (let alone shared energy) was definitely not a thing – or at least not a thing that was spoken of publicly or in circles of “hard science.” The male doctor gave the female nurse orders, and the female nurse would then perform prescribed actions.

I conducted a review of caring theories as a part of my comprehensive exam last summer. Again, let me be very clear: these theories were crafted by minds much more brilliant than I could ever hope mine to be, and there is indescribable wealth, depth, knowledge, and wisdom imbedded in these works. Truly, many will remain as enduring masterpieces of the discipline, and their authors have become beacons of progressive, forward-though. However. …. However, in conducting this review, I found that a few theories that by their nature of being framed by a context that no longer matches the current sociopolitical and cultural climate, have perpetuated the aforementioned narrative informed by the patriarchy and the notion of power imbalance. I believe this is antithetical to the emancipatory movement we are experiencing in nursing – and society, as a whole – where, for example, the out-dated adage of “enabling” the other should be updated to a focus on empowerment.

So, some closing thoughts:

Your students live and will work in a world that that changing at an unfathomable pace. While I believe that a great many works and ideas in nursing theory and philosophy are truly timeless and relevant, some are not. Stay up to date on what is pertinent and what is being published. Teach the classics, but also teach new, relevant theories. Try new articles. Try new textbooks. Talk to your students about what they think is timely and relevant.

And more importantly …. talk to your students. Connect with them. Millennials, in particular, like to be engaged and involved! Finding innovative and creative ways to connect with your students is especially important with the proliferation of online programs, where many students will never set foot campus. Trust me: your effort in this regard will be well worth it! Whether in the classroom or the online environment, I got the most from faculty who taught from a place of compassion and connection – where they openly and earnestly worked to understand the student perspective and got us involved and invested in what we were learning. In fact, I’m still in touch with a few faculty from both my BSN and MSN programs! (Dr’s Lea Gaydos, Lynne Bryant, Amy Silva-Smith…). Dr. Gaydos and Dr. Bryant were my BSN and MSN theory and philosophy professors, respectively, and were two of the first people I called when I had my first theory-related article published in 2019 in NSQ. It’s been nearly 20 years since I took Dr. Gaydos’ class, and I still have my term paper from that course. All I can say is: what an abomination! I was in tears, laughing, when I reread that “gem” last year!

My point is, these professors planted the seed of interest in nursing scholarship at the doctoral level. You will have THAT student. I was THAT student. Who am I kidding… I’m still THAT student! The student who wants to know “why” about everything. The student who will question everything. The student who will argue every last point on an assignment. Trust me when I say this: no matter how much shade your students throw at theory, you ARE making a difference. Because THAT one student … the one who pushed you and nearly drove you crazy … that student may be the one who grows up and wants to continue this dialogue.

Finally, and most importantly: I truly admire and respect Dr. Foli for putting herself out there. The issue she raises (students throwing shade at nursing theory) is very real and very much alive and well in the world of nursing academics. As Dr. Jane Georges once said to me, “violence can be done to students’ ideas,” and I applaud Dr. Foli in her quest to improve the academic experience for her learners.

Sources

Benedict, S. & Georges, JM. Nurses in the Nazi “euthanasia” program. Advances in Nursing Science: 2009; 32(1): 63-74.

Chinn, PL. & Falk-Rafael, A. Embracing the focus of the discipline of nursing: critical caring pedagogy. Journal of Nursing Scholarship: 2018; 50(6): 687-984.

Eisenhauer, ER. An interview with Dr. Barbara Caper. Advances in Nursing Science: 2015; 38(2): 73-81.

Falk-Rafael, A. Nursology: Critical Caring. https://nursology.net/nurse-theorists-and-their-work/critical-caring/. Accessed June 2, 2019.

Falk-Rafael, A. Advancing nursing theory through theory-guided practice: the emergence of a critical caring theory. Advances in Nursing Science: 2005; 28(1): 38-49.

Georges, HM. Biopower, compassion, and nursing. In: Philosophies and practices of emancipatory nursing: social justice as praxis. Kagan, PL., Smith, MC., & Chinn, PL. (eds). New York: Routledge; 2014: 51-63.

Georges, JM. An emancipatory theory of compassion for nursing. Advances in Nursing Science: 2013; 36(1): 2-9.

Georges, JM. Evidence of the unspeakable: biopower, compassion, and nursing. Advances in Nursing Science: 2011; 34(2): 130-135.

Georges, JM. Bio-power, Agamben, and emerging nursing knowledge. Advances in Nursing Science: 2008(A); 31(1): 4-12.

Georges, JM. The politics of suffering: implications for nursing science. Advances in Nursing Science: 2004; 27(4): 250-256.

Kagan, P.N., Smith, M.C. & Chinn, P. (eds.) (2014). Philosophies and practices of emancipatory nursing. Routledge.

Lenz, E.R. & Pugh, L.C. (2014). The theory of unpleasant symptoms. In: Middle range theory for nursing, 3rd ed. (Smith, M.J & Liehr, P.R, eds). Springer.

Locsin R. Technological competency as caring in nursing: co-creating moments in nursing occurring within the universal technological domain. The Journal of Theory Construction & Testing: 2016; 20(1): 5-11.

Smith, M.J. & Liehr, P.R. (eds). (2014). Middle range theory for nursing, 3rd ed. Springer.

Smith, M.J. & Liehr, P.R. (2014). Story theory. In: Middle range theory for nursing, 3rd ed. (Smith, M.J & Liehr, P.R, eds). Springer.

Watson, J. Unitary caring science: the philosophy and praxis of nursing. Louisville: The University Press of Colorado; 2018.

Watson, J. Caring science as sacred science. Philadelphia: F.A. Davis Company; 2005.

Whitaker, H. (2020). Quit like a woman: the radical choice not to drink in a culture obsessed with alcohol. Random House.

Williams, L. (2014). Theory of caregiving dynamics. In: Middle range theory for nursing, 3rd ed. (Smith, M.J & Liehr, P.R, eds). Springer.

A Dozen and One Ways to Love Our Discipline!

Later this week February 14th, is Valentine’s Day – the internationally recognized holiday that variously inspires young children to try their hand at making an original card expressing at least admiration for other children, and compels adults to exchange gifts symbolizing their adoration of one another.  Putting aside the commercialization of a day with deep roots in Roman religious festival traditions, I would like to consider ways in which we as nursologists can express, in our actions and deeds, our fundamental respect – and yes, our love, for the discipline to which we have committed our professional lives, and for many, our personal lives as well.

So in the spirit of the best traditions of Valentine’s day – here are a dozen and one ways to love our discipline!

  1. Express appreciation every day to a nurse who has made, or makes a difference in your life.
  2. Form a small support or interest group with a few nurse colleagues to work on a persistent challenge you are facing; include early-career nurses who are so vulnerable to these challenges.
  3. Recognize ways in which racism and other forms of discrimination are expressed in everyday ways in your work environment, acknowledge your part, and explore ways to resist and transform these situations.
  4. Practice the fine art of “active listening” whenever you encounter a nurse colleague whose point of view differs from your own, explore common ground and build bridges of understanding.
  5. Reach out to a nurse who is hurting, discouraged, or fearful for any reason;  listen to their story, and pledge to continue to listen.
  6. Settle on your own clear and succinct explanation of what nursing is all about; express this to at least two other people every day, and notice their responses to refine your message.
  7. Read one article every month, or two books a year, to learn about nursing history and the nurses who made significant contributions to our discipline.
  8. Practice one or more self-nurturing activity every day, such as physical activity (walking, yoga, tai chi), meditation, play and laughter, saying “no” as a complete sentence!
  9. Resolve to speak the truth of nursology to power at every possible opportunity.
  10. Use every avenue possible to communicate with the public – with your local community leaders, the media, and politicians.
  11. Love and care for the earth and its animal creatures as you would your most cherished patient; take at least 3 opportunities each day to teach others to love and care for the earth and for animals.
  12. Join at least one nursing organization and work to create needed changes in our discipline and in healthcare.  AND
  13. Follow Nursology.net, share the site far and wide, and participate in sharing ideas to shape the future of nursing/nursology.
Thank you to the following nursologists who have contributed to this list!
Chloe Olivia Rose Littzen
Jane Hopkins Walsh
Jess Dillard-Wright
Brandon Blaine Brown
Savina Schoenofer
Marlaine Smith
Vanessa Shields-Haas
Christina Nyirati

Transitions in Leadership Positions: Is There a Best Time?

As we know, leaders transition to and from their positions within educational and clinical institutions. Meleis’ transitions theory, which focuses on “the human experiences, the responses, [and] the consequences of transitions on the well-being of people” (Meleis, as cited in Fawcett, 2017, p. 347) tells us that transitions may be anticipated, experienced in the here and now, or have been completed. Transitions may be development, situational, organizational, cultural, or well-illness; each type may occur singularly or with one or more others. (See https://nursology.net/nurse-theorists-and-their-work/transitions-framework-transitions-theory/)

Transitioning to or from a leadership position is a situational transition, which could be combined with a cultural transition as the nursologist moves to or from a new academic or clinical institution or even another country. The situational transition could be combined with a developmental transition as the nursologist enters another lifespan developmental phase. Furthermore, the situational transition could be combined with an organizational transition as an academic institution undergoes a major shift in priorities or a clinical agency merges with another clinical agency.

Alternatively, the transition of a nursologist to or from a leadership position could create an organizational transition as all affected people and structures adjust to the change. Finally, the situational transition, especially transitions from a leadership position, could be combined with a wellness-illness transition if the nursologist experiences a sudden acute illness or can no longer effectively manage a chronic disease.

One question about leadership transitions is: How does a nursologist transition to becoming an effective leader? Another question is: Is there an optimal time for a nursologist to transition to or from a leadership position?

© 2020 Jacqueline Fawcett

HOW DOES A NURSOLOGIST TRANSITION TO BECOMING AN EFFECTIVE LEADER?

Transitioning to becoming an effective leader obviously first requires a desire to be a leader, although at times, a nursologist may find self gently (or not so gently!) pushed into a leadership position by colleagues or senior administrators or by a vacuum left by someone who transitioned from the position suddenly.

Transitioning to becoming an effective leader also requires certain competencies. The American Organization of Nurse Executives (now the American Organization for Nursing Leadership) identified five competencies for effective leadership in practice and education (Waxman, Roussel, Herrin-Griffith, & D’Alfonso, 2017).  Although the competencies focus on those for executive level leadership positions, they are relevant for all levels of leadership. The five competencies are listed here. The specifics of the competencies are available in the Waxman et al. (2017) journal article or at https://www.aonl.org/resources/nurse-leader-competencies:

  1. Communication and relationship-building
  2. Knowledge of the healthcare or academic environment
  3. Leadership
  4. Professionalism
  5. Business skills and principles

The nursologist may already have acquired these competencies or has to acquire them by enrolling in a formal program and/or finding a mentor or leadership coach. Formal programs for nursologists are offered by Sigma Theta Tau International, the American Association of Colleges of Nursing, the American Organization for Nursing Leadership, and the Robert Wood Johnson Foundation. The programs are:

Sigma Theta Tau International
American Association of Colleges of Nursing
American Organization for Nursing Leadership (formerly, American Organization of Nurse Executives)
Robert Wood Johnson Foundation

Mentors and leadership coaches may be included within formal programs or the nursologist may have to approach recognized leaders and ask that they share their wisdom about leadership.

IS THERE AN OPTIMAL TIME FOR A NURSOLOGIST TO TRANSITION TO OR FROM A LEADERSHIP POSITION?

Aspiring or actual leaders may ask: Am I too young or too old to transition to or from a leadership position? Inasmuch as many institutions do not have mandatory age requirements for employees, wisdom is an important element of the transition decision. Although, as Larson (2019) pointed out, wisdom may come with older age, my experience indicates that younger persons also may be wise. Wisdom at any age requires nursologists to use “mindfulness, empathy, and self-reflection to learn from their mistakes, failures, and successes over the years” (Larson, 2019, pp. 789-790). Thus, those people who aspire to be leaders or already are leaders may want to heed Larson’s words and engage in serious self-assessment to determine whether they are ready to transition to or from a leadership position. In addition, aspiring or actual leaders may want to assess their leadership competencies, which can be done using a self-assessment instrument that is available at https://www.aonl.org/resources/online-assessments.

Fang and Mainous (2019) examined factors related to short term deanship, which they regarded as problematic. (A short tenure leadership position is one that ends sooner than the specific term of the position, such as 3 years or 5 or 6 years.) Their study of data from the 2016 American Association of Colleges of Nursing Annual Survey revealed that certain personal and organizational characteristics are associated with short tenure chief nursing academic administrator positions, including the titles of dean, chair, director, or department head. The characteristics are: age (60 or older) at beginning of the leadership position, having a title other than dean, being a dean who subsequently takes another deanship, being a first time dean, being a dean in a school without a tenure system, and being a dean of an associate degree program or a baccalaureate degree program.

As I read Fang and Mainous’s (2019) article, I wondered whether short tenure leadership positions are always problematic. Could it be that the position is not consistent with what the person hopes and dreams it will be? Could it be that the person’s leadership style is not conducive to inspiring a faculty or clinical staff to attain personal, professional, and/or organizational goals? Perhaps, then, transitioning from a short tenure leadership position may be a positive event for the nursologist leader and for the faculty or clinical staff. Perhaps everyone breathes “a sigh of relief” that the leader has transitioned from the position (Larson, 2019, p. 789).

Another situational transition, which may be combined with a developmental transition and which affects almost everyone, is retirement. Those nursologists who are contemplating retirement most likely were or still are leaders in the institutions where they work, even if they are not “official” leaders, such as deans, directors, or chairs. Larson (2019) discussed her decision to retire from her faculty position. She regards retirement as “the next transition in my career development” (p. 789). At age 76, Larson (2019) noted, she “made the scary and difficult decision to retire in less than a year . . . [and] not wait until people breathed a sigh of relief that I was finally gone” (p. 789).

Meleis (2016) wrote about her situational transition of anticipating, experiencing, and completing stepping up from a deanship. She explained that stepping up “connotes climbing to a higher place in our lives, taking with us what we learned in the previous [step]” (p. 187). Meleis identified and described five phases in the transition to and from a deanship. I will presume to be so bold as to generalize Meleis’ (2016) description of the deanship transition to all leaders, add a sixth phase (expressing an initial professional voice), and adapt the phases to both transitioning to and from a leadership position. The six phases are:

  1. Expressing an initial professional voice
  2. Deciding to transition to or from a leadership position
  3. Searching for the leadership position
  4. Being named to the position
  5. Exiting from the position by stepping up
  6. Reclaiming a professional voice

© 2020 Jacqueline Fawcett

I applaud those nursologists who are willing to transition to a leadership position and congratulate those who have transitioned from a leadership position. I send best wishes to all for much happiness, wellbecoming, and exciting and stimulating next ventures in stepping up.

References

Fang, D., & Mainous, R. (2019). Individual and institutional characteristics associated with short tenures of deanships in academic nursing. Nursing Outlook, 67, 578–585. https://doi.org/10.1016/j.outlook.2019.03.002

Fawcett, J. (2017). Applying conceptual models of nursing: Quality improvement, research, and practice. New York, NY: Springer.

Larson E. L. (2019). Musings on retirement. Nursing Outlook, 67, 789-790. https://doi.org/10.1016/j.outlook.2019.04.008

Meleis, A. I. (2016). The undeaning transition: Toward becoming a former dean. Nursing Outlook, 64(2), 186–196. https://doi.org/10.1016/j.outlook.2015.11.013

Waxman, K., Roussel, L., Herrin-Griffith, D., & D’Alfonso, J. (2017). The AONE nurse executive competencies: 12 years later. Nurse Leader, 15, 120–126. https://doi.org/10.1016/j.mnl.2016.11.012

Visions for 2020 – the Year of the Nurse

To all Nursology.net visitors – welcome to the Year 2020!  As we enter this year, we members of the site management and blogging teams join in celebrating the “Year of the Nurse and Midwife” and offer our visions for the coming year and beyond!

The year 2020 was designated In January 2019 by the World Health Organization (WHO) as the “Year of the Nurse and Midwife”  in honor of the 200th birth anniversary of Florence Nightingale.  Far from being a mere sentimental expression recognizing the importance of nursing and midwifery worldwide, this designation is part of a worldwide effort to improve health globally by raising the status of nursing and midwifery.  Here is the statement issued in establishing this designation:

The year 2020 is significant for WHO in the context of nursing and midwifery strengthening for Universal Health Coverage. WHO is leading the development of the first-ever State of the World’s Nursing report which will be launched in 2020, prior to the 73rd World Health Assembly. The report will describe the nursing workforce in WHO Member States, providing an assessment of “fitness for purpose” relative to GPW13 targets. WHO is also a partner on The State of the World’s Midwifery 2020 report, which will also be launched around the same time. The NursingNow! Campaign, a three-year effort (2018-2020) to improve health globally by raising the status of nursing will culminate in 2020 by supporting country-level dissemination and policy dialogue around the State of the World’s Nursing report.

Nurses and midwives are essential to the achievement for universal heath coverage. The campaign and the two technical reports are particularly important given that nurses and midwives constitute more than 50% of the health workforce in many countries, and also more than 50% of the shortfall in the global health workforce to 2030. Strengthening nursing will have the additional benefits of promoting gender equity (SDG5), contributing to economic development (SDG8) and supporting other Sustainable Development Goals. (from https://www.who.int/hrh/news/2019/2020year-of-nurses/en/)

As members of the Nursology.net management team, we are welcoming the 2020 “Year of the Nurse and Midwife” with our visions for this coming year and beyond.  We hope our ideas will inspire you to join in making these values and visions a reality!

Maggie Dexheimer Pharris –

2020 vision. During an eye exam, there is a moment when just the right corrective lens falls into place and suddenly we appreciate 20/20 clarity of vision. Remarkable!  So too it is with theory. In this new decade may nurses around the world find just the right nursology theory to clearly see the path to creating a meaningful practice and equitable, accessible, and healing systems of care!

Karen Foli – 

Unity among nurses based on the care we offer and the universal experiences we share. kindness directed toward patients and fellow nurses, even when they may be unable to reciprocate in that moment. Wisdom to understand how nursing power can be harnessed to forward a sustainable, balanced work life and advocate for improvements in patient and family care. And for nurses’ truth to be spoken freely, a reality to be heard and honored.

Peggy Chinn – 

A renewal of deep respect and tireless dedication for the core values of our discipline – protection of the dignity of each individual, advocacy for the needs of those we serve, and belief in the healing potential of our caring relationships.

Marlaine Smith – 

An accelerating appreciation for the distinctive knowledge of the discipline and the unique contribution that this knowledge can make to the health, well-becoming and quality of life of those we serve. With this appreciation will come the growth of research that is focused on the theories of nursology and practice models that are theory-guided.  Our focus on human wholeness, health as well-being/becoming, the human-environment-health interrelationship and caring is what is missing and most needed in healthcare.

Jane K. Dickinson  –

My vision is that all nurses will know, value, and be guided by nursing knowledge and take caring to the next level in education, practice, and research.

Jessica Dillard-Wright – 

Because 2020 has been declared the Year of the Nurse by the World Health Organisation, my vision for the year is that nursing will embrace the emancipatory potential of our discipline, recognizing the interface between nursing knowledge, nursing praxis, and wellbeing on a global scale. In so doing, we can dismantle injustice and mobilize our profession to nurse the world.

Jacqueline Fawcett

 Now is the perfect time to accept NURSOLOGY as the proper name for our discipline and profession. Now is the perfect time to realize that all individuals licensed as Registered Nurses or equivalent designation worldwide are NURSOLOGISTS. Now is the perfect time for all nursologists to realize they are “knowledge workers” who engage in development, application, and dissemination of nursology discipline-specific knowledge so that we know and everyone else knows the what, why, how, where, and when of our work with those individuals and groups who  seek our services.

Chloe Littzen – 

My vision for nursing in 2020 is that we find unity among our diversity, despite settings, education levels, or beliefs, and work collaboratively to advance the discipline, enabling all nurses epistemic authority and well-being.

Rosemary Eustace – 

The year 2020 is a great reminder of the “200” unique contributions nurses and midwives make each day to improve health, health care, health policy and nursing across diverse settings.  As we celebrate this milestone, let us light our lamps in unity to advance nursing knowledge that is congruent with contemporary health care demands. Let us keep the Power of Nursology alive!

Marian Turkel – 

Vision for 2020: Nursing theory will guide nursing education, nursing practice and nursing research. RN-BSN, BSN and MSN programs will have at least one nursing theory course in the curriculum.  DNP and PhD curriculum will have 2 nursing theory courses.  Nursing faculty and Registered Nurses in the practice setting doing research will use a nursing theory to guide their practice and research.  The Nursology leaders will collaborate with the American Academy of Nursing to organize a conference similar to the Wingspread Conference. The American Nurses Credentialing Center will collaborate with the Magnet Recognition Program©® to require hospitals to have a nursing theory as the foundation for achieving Magnet©® Status Recognition.