Running head: PHILOSOPHY OF NURSING 1

Philosophy of Nursing

Courtney Browning

Christine Turner, PhD

NUR 4142: Synthesis

October 14, 2018

“I pledge…”
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Definition of Nursing

Nursing is not a career to enter into lightly. It is a position that puts you front and

center during pivotal moments in patients’ lives and many times their families as well.

As a nurse, you are an integral part of their journey, which may be one of great sorrow,

great joy, profound loss, or important milestones in their health. Often times, a nurse is

what makes or breaks the experience a patient has during their stay. A nurse wears

many hats. They are a shoulder to cry on, a confidante, a companion, an advocate, a

listener, a “fixer”, a “doer”, a healer, a lifeline, a facilitator, a gatekeeper, and so many

other things. You must be a lifelong learner in this profession in order to provide the

best care possible for your patients. Keeping your knowledge up to date is important in

order to advocate, facilitate, and heal. A nurse treats all people, those in their care and

otherwise, with dignity and respect. A nurse must be able think both objectively and

subjectively, logically and intuitively, analytically and compassionately. You must be

able to flip a switch - from seeing a diagnosis to seeing a person, who may be

vulnerable and in need. To be able to think of what interventions they need for their

physical condition, and simultaneously consider what needs to be done for them

emotionally. Seeing a patient in a holistic manner is necessary.

The tenets of our program mirror my definition of what nursing is, and how we

should act within our profession. Caring, health, and service are three tenets that ring

especially true. As previously mentioned, a nurse must be able to think in ways that may

seem to oppose each other (such as analytically and compassionately), they must see a

patient as a whole, and facilitate healing by offering themselves in whichever way they

are needed most at that time. All of these things represent the tenet of caring. Believing
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in and demonstrating specific values and beliefs in your practice, such as those our

organization has put forth allow us to be of great service to those who need it most. This

is the tenet of service. The last tenet that closely reflects my idea of what nursing is, is

health. I believe it should be widely accepted that your job as a nurse is to be “good

help to those in need” (Bon secours). This motto should not be unique to the Bon

Secours system, I think that all nurses should feel this way about their profession and

their purpose. Once again, seeing a patient holistically is key to the tenet of health. As a

nurse, you must be able to see that a patient is made up of so much more than a

diagnosis. Each patient has a unique background, whether they’re from a rural area or a

city, if they’re Buddhist or Christian, or perhaps they’re Gypsies or homeless. A nurse

must be able to consider these factors, implement individualized interventions as

needed, and treat each patient with dignity and respect.

Personal Philosophy

My personal philosophy of nursing is fairly concrete. I do not think that it will

change much in theory over the course of my career. I hope that I will become even

more adept at acting in accordance with my philosophy over time and with practice. In

most scenarios it is easy to apply values into my practice, such as respect, compassion,

integrity, justice, and quality. In difficult situations though I’ve found myself needing to

take a step back, remind myself why I’m there, or why a patient may be acting a certain

way, and adjust my attitude or approach.

With my patients I’m very open and honest, I treat them respectfully and with

dignity, and approach patients and their families with compassion. I try to treat all my

patients as if they were my family member. This is one of the reasons that I wanted to
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become a nurse, because of the difference I saw that nurses made in my grandparents’

care. It’s important to me that the patient has someone who is there to treat them and

care about them like a family member would. I strive to provide both safe and quality

care, I research things I do not understand, and ask questions to improve my practice

and enhance my knowledge.

Nurse Patient Encounter

Most recently I’ve been in the Neonatal Intensive Care Unit for my clinical

immersion. I had a patient assignment that was very challenging for me, as there is a

delicate balance with this patient population between patient advocacy and the role of

the infant’s family during their stay. This particular instance involved a set of twins that

had just been born. The band-holders for the infant had come to the bedside to visit for

the first time since they were transferred over from the delivery room. We had stabilized

both infants, both were doing fairly well, but twin A more so than twin B. Both babies

had on devices for respiratory support. We had a different setup of equipment on twin B,

but for all intents and purposes it was the same machine. The grandmother was very

concerned about twin B because the twin sounded more distressed, was creating more

oral secretions, and was paler in color than twin A. She insisted that we change out the

equipment because it was hurting twin B, and that twin A was doing better because of

her particular respiratory device. Despite education that was provided and

conversations with myself, my preceptor, and the unit manager, the grandmother

continued to insist that we change the device.

In this situation I had to remind myself that this conversation we were having was

not totally about the device, or maybe not about the device at all. The root of this issue
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was related to the grandmother being afraid. Seeing her grandchildren in a

compromised state, laying on a warming table with only a diaper and respiratory

equipment covering their faces, and alarms going off – she was scared. She had no

control in the situation and that was the only way she could think to make twin B more

comfortable. It was her way of trying to find her footing in a difficult situation. I had to be

patient, compassionate, understanding, and try and imagine the position that she was in

at that time. In this moment I had to remember why I chose nursing, what my beliefs

were about how I should practice in my profession and remain professional and level-

headed. I did not go off and gossip about the “crazy grandma”, rather I supported her

and met her where she was at emotionally in that moment. I continued to offer

explanations as appropriate and reassured her that the very best care was being

provided to her grandchildren.

Values and Beliefs

My values and beliefs have not changed since I wrote my paper on my nursing

philosophy at the start of my schooling, but they have grown and become more

expansive and meaningful. I spoke about kindness, thoroughness, the “Golden Rule”,

empathy, and advocacy in my first paper. I mentioned some values then that I did not

specifically address this time, but they all stem from the same premise, that nurses are

meant to be “good help to those in need” (Bon secours). I think that I’ve had the same

idea of what nursing is, how to be a good nurse, and how to behave within my

profession from the beginning of my time in nursing school. I understood what it looked

like to respect my patients, to treat them like family, and how to apply the values that the

organization I’m associated with sets out for us. I am still applying these values in my
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practice, those of my organization and the ones that I wrote about in my first philosophy

of nursing paper. I’m glad to see that I haven’t changed all that much from the

beginning, but that I’ve grown over the course of my schooling and will be a better nurse

because of it.

Benner’s Theory

Hubert and Stuart Dreyfus created the skill acquisition model, which serves to

plot an individual’s professional skill progression through five levels. The five levels

include: novice, advanced beginner, competent, proficient, and expert (Benner, 1984, p.

v). Dr. Patricia Benner collected information and observations by practicing nurses,

analyzed the information, and subsequently applied it to the Dreyfus’ skill acquisition

model (Benner, 1984, p. v).

The novice level of Benner’s Stages of Clinical Competence is where we start in

nursing school. The novice has no previous experience in the clinical setting. A novice

lacks confidence, clinical judgement, and needs assistance to practice safely in a

clinical setting (Benner, 1984, p. 20-22). The advanced beginner is slightly more

comfortable and self-assured because they have some experience in real-life situations,

are more skillful, and have accrued more knowledge (Benner, 1984, 22-25). A nurse is

not considered competent until they have been in the same job or clinical setting for two

to three years. The competent nurse is efficient, skilled, competent, and can complete

their job well without assistance (Benner, 1984, 25-27). The proficient nurse is able to

see the bigger picture, can anticipate needs, and has a more holistic understanding.

These skills allow for the proficient nurse to use nursing judgement and reasoning and

make the best decisions for their patients (Benner, 1984, 27-31). The expert nurse is
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able to narrow down a problem quickly because she knows what information is not

relevant. This nurse can be the most flexible and proficient in their position and are able

to make smart decisions even in situations in which they have no prior experience

(Benner, 1984, 31-35).

Skill Acquisition

At this point in my nursing experience I feel that I am an advanced beginner.

While I was on adult units for two years, it was limited because we were only there one

or two days a week. This did not allow me to develop the skill set or proficiency of a

competent nurse. At this point in time I do not feel that I can perform every task on my

own, without having any questions or needing guidance of some kind. I fit more in the

advanced beginner category because I have some prior experience to pull from, but I

still lack confidence in my practice and sometimes require cues from my preceptor or

instructor to perform tasks. I ask a lot of questions, and sometimes skills and tasks take

longer than necessary because I’m reviewing the steps in my head, reading

instructions, or asking questions while trying to complete them. I am still developing my

nursing knowledge, especially now that I’m spending more time in the NICU for

immersion and will be starting my job there in January.

Action Plan for Moving Forward

In order for me to progress from an advanced beginner to a competent nurse I

need to have more experiences. I need to spend more time in the clinical setting and

see more patient situations and scenarios in order to build the experience, which will

help me to become more confident in my actions and coordinated in my skills. Seeing

more also helps to build my knowledge and competency in the clinical area I will be in
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and will help me to begin to build my clinical judgement and reasoning. In order to build

more experience I should orient to my new unit with an experienced nurse, one that has

at least reached the level of being competent. I will seek out learning opportunities and

advocate for my education. I will also work on honing my prioritization skills. I’d begun to

learn in adult medical-surgical patients how to prioritize, but just as I got comfortable

with that we moved on to the maternal and infant health clinical rotations. I’ve now spent

a fair amount of time in the NICU as a nurse extern and student nurse in my immersion,

but I will still need far more experience to be able to become more comfortable and to

learn how to best prioritize care for this population. The last thing that I will need to work

on in order to be able to advance to be a competent nurse is the ability to think

analytically and critically about interventions, patient diagnoses, and use this knowledge

in my plan of care for the day. Knowing the reasoning behind interventions and

understanding the connections between diagnoses and care help to guide your priorities

and plan for the shift.

I feel positive about where I am now, being so close to my graduation. I feel that

I’ve progressed significantly from the time I started school up until this point. Immersion

has made me much more confident in my abilities and in my career choice. I believe

that I have all the skills and background necessary to move up the competency ladder,

to become a competent nurse within my first year or two of working in the NICU. I

believe my training and nursing philosophy are a solid foundation in which to start my

career.
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References

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing

practice. Menlo Park, CA: Addison-Wesley, p. v-xvii.

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing

practice. Menlo Park, CA: Addison-Wesley, p. 19-35.

Bon secours’ mission services. (n.d.). Retrieved October 10, 2018, from

https://bonsecours.com/richmond/community-commitment/mission-services