the ability to consistently function safely and effectively as a registered nurse
Motivations for becoming a nurse
As you embark on your career, you will probably be asked, ‘Why did you choose nursing?’ There is no right or wrong answer, as each individual will answer on the basis of their own perspective. Nursing may be something you chose out of genuine interest, for practical reasons or as a default option (Jirwe & Rudman, 2012). However, the reasons for your decision to pursue nursing studies and your level of motivation can have a significant effect on educational and professional outcomes because one day you may ask yourself, ‘Why did I choose nursing?’ Having a strong awareness of why you chose nursing – or why nursing chose you – is vital to your early and ongoing career development. You may wish to work in a tertiary referral hospital as part of a metropolitan trauma centre. Alternatively, you may be intrigued by the rigours and demands of rural and remote healthcare. Some students enter nursing with a view to caring for people in developing countries under the sponsorship of aid agencies or the military. However, not all students will enter nursing with such clear goals or ambitions beyond a simple desire to care for people in need.
By understanding your motivations for pursuing a career in nursing, you will begin to develop self-awareness. For instance, a 2008 study of pre-registration student nurses found that those with stronger self-efficacy (the strength of one’s own awareness and ability to complete tasks and realise goals) were less likely to withdraw from their studies in nursing and more likely to perform at higher levels in their studies (McLaughlin, Moutray & Muldoon, 2008). Furthermore, emotional intelligence – inclusive of self-awareness and motivation – was identified as having a potential impact on student learning, ethical decision-making, critical thinking, and the synthesis and integration of evidence in nursing practice (Bulmer Smith, Profetto-McGrath & Cummings, 2009). It is therefore very important to identify:
- the factors that resulted in your current enrolment in a program of nursing education
- the personal characteristics that will inform your progression in scholarly and clinical environments, and
- your awareness of how the context that characterises your present circumstances will impact on your development as a safe and competent nurse.
- emotional intelligence:
the emotional and social characteristics, skills and enablers that determine how we perceive and express ourselves, understand and relate to others, and cope with daily living
You are your own case study for this exercise. Reflect honestly on what motivated you to become a nursing student, identifying at least three reasons.
Communicating your self-awareness
Not all students are enrolled in nursing because it is their ambition to become a registered nurse. Some students view nursing as a stepping-stone to a different profession. Some see it as a secondary choice: ‘I had to do something so I chose nursing.’ For some, nursing is something they will do for a while before they move on to ‘something else’.
Not everyone will enter nursing because it ‘called them’. Not everyone will have a story of a sick relative or friend whose illness ignited a caring flame in them that cannot be doused. Not everyone will see the opportunities that a career in nursing can offer individuals. However, everyone – at some point in their lives – will need a nurse.
Stop and think
Does this describe you? Historically, nursing was seen as a calling, which arguably implied that those who became nurses were automatically predisposed with qualities that would elicit consummate professionalism and profound compassion.
As you develop an awareness of yourself through carefully answering these questions, reflect on how your personal attributes will frame your learning experience, colour your nursing practice and shape the progression of your career in healthcare.
Becoming aware of your ‘self’
Each individual possesses unique characteristics that impact positively – and sometimes negatively – on how they can contribute to nursing. For instance, you may have entered nursing with a deep desire to care for people, yet struggle with blood or needle phobias. You may be attracted to the high-pressure environments of the intensive care unit, the operating theatre or the emergency room, or you may be drawn to areas where you can build a unique rapport over time with patients and their families in aged care, rehabilitation or respite settings. Your motivation to work in these environments speaks as much about your individual characteristics as it does about the unique nature of care environments across the healthcare sector.
Having a strong sense of self-awareness is integral to developing ideas about your inherent strengths and weaknesses as a professional, as well as where and how you can best contribute as a registered nurse in the healthcare sector. A growing body of research around emotional intelligence in nursing has highlighted the need for nurses to possess emotional intelligence. As mentioned above, emotional intelligence is defined as the emotional and social characteristics, skills and enablers that determine how we perceive and express ourselves, understand others, relate to them and cope with daily living (Bar-On, 2005). Emotional intelligence is recognised as having an impact on the quality of student learning, ethical decision-making, critical thinking, evidence and knowledge use in practice, and patient outcomes (Bulmer Smith, Profetto-McGrath & Cummings, 2009). Furthermore, emotional intelligence can affect individuals’ work outputs, general well-being and communication strategies (Salovey & Grewal, 2005). It impacts on a person’s effectiveness in teams, their ability to recognise and respond appropriately to the feelings of self and others and their ability to encourage themselves and others (Cadman & Brewer, 2001).
An important early work by Goleman (2001) articulates the attributes or elements of emotional intelligence as follows:
- self-awareness (emotional awareness, esteem, insight)
- self-management (integrity, impulse control, adaptability)
- social awareness (developing others, managing conflict, bonding)
- relationship management (leadership, followership, work).
Although these attributes are not acquired quickly or easily, Clarke (2006) suggests that professional engagement and exposure to the healthcare environment facilitates the learning of emotional intelligence. For example, when caring for acutely ill patients, emotional intelligence is necessary to develop a nurse’s self-awareness and to respond to the needs of the patient. This is done by the nurse acknowledging their own personal experience and perspective to discern an appropriate response, and identifying the strengths and weaknesses of the response to improve their practice. In the same context, self-management acknowledges the adaptability and capacity for control of nurses to deal with the changing pace and complex demands of the healthcare system. For instance, sudden alterations in a patient’s condition will require a response that is appropriate to the needs of the patient and to the changing contexts of care. Social awareness in the nurse will be demonstrated by an ability to understand the emotional and social stressors caused by these sudden changes, and to work with the patient and their loved ones to achieve the best possible outcome. Finally, relationship management relates to the nurse’s ability to work through the difficulties of the context – such as conflict, upheaval and change – and extract the best from people in order to instil confidence, trust and acceptance in others. These attributes will facilitate the development of your professional identity and stimulate your learning of emotional intelligence.
- professional identity:
how an individual perceives and employs the characteristics that define their professional self
Having addressed the individual elements of how you define yourself and your professional identity, it is now appropriate to explore the broader context in which you will work, as a means of developing professional awareness.
Developing professional awareness
Developing a strong sense of self-awareness is vitally important to understanding the nursing profession and how it ‘works’. Modern nursing is situated in a rapidly changing higher education and healthcare environment, with established systems designed to define and regulate the nursing profession. While the systematisation of nursing has existed in variety of forms for almost as long as the profession itself, in more recent times the roles, responsibilities and scopes of practice inherent to clinicians in the healthcare sector have been associated intrinsically with regulations, policies, practices and evidence. These elements within the system are designed to set forth the expected level of safe and effective practice that the system expects of nursing graduates.
You are a small yet significant cog in the wheel of this system; however, health professionals and health consumers share a very special interest in the safety and efficacy of graduating practitioners. This means your learning and professional progression are of great interest to the broader community – including the nursing profession. The progressive systematisation of nursing and healthcare is evidence of a concerted attempt to communicate to students, the profession and the public that you, as an individual, have a tremendous ability to make a difference in the system of which you are now a part. Identifying how you can make a difference – both in positive and negative terms – stems from a strong sense of professional identity and professional awareness. Comprehending the complexities of your professional role and responsibilities, both as a nursing student and registered nurse, will further enable you to understand not only what the system expects of you, but what you should expect of yourself. Exploring both these perspectives during your progression towards beginning nursing practice will help you to form an appropriate response to the requirements of registered nursing practice. In the next section, we explore the roles of the nursing student and the registered nurse.
The roles of the nursing student and the healthcare professional
Your level of motivation will also play a significant role in how you receive and respond to the communicated expectations articulated by the system. Whether private or public, metropolitan, or rural and remote, healthcare systems are fallible; however, the nursing profession has established frameworks to promote the safety and efficacy of nurses through the use of legislation, professional requirements, codes, accreditation and competency frameworks (Birks, Chapman & Ralph, 2014).
a process by which an assessing entity (for example, a professional body) evaluates the credibility, reliability and validity of a program (such as an educational program) presented by another party for the purposes of approving its fitness for purpose
The structural organisation of both the higher education and healthcare systems communicates clearly to nursing students and nurses alike that a high standard of professionalism is expected of them. Since the inception of the Australian Health Practitioners Regulation Agency (AHPRA), all students enrolled in an approved program of study in nursing or those who are undertaking clinical training in nursing have been mandatorily registered with the Nursing and Midwifery Board of Australia (NMBA) (NMBA, 2014). For the same reasons that health practitioners are registered, nursing students are also listed with the NMBA to protect public safety and allow for appropriate steps to be taken when a serious contravention of the conditions of a student’s registration (such as evidence of an impairment or serious misconduct) has occurred (AHPRA, 2014).
Such stringent requirements may come as a surprise to nursing students. However, the intent of this chapter is to highlight the system-wide communications that are geared towards the high standards established for nursing students and nurses who operate within the higher education and healthcare sectors.
The systems of higher education and healthcare are multifaceted and extraordinarily complex. It is important to remember that the intent of these highly structured systems is to facilitate approaches to education and healthcare delivery that primarily benefit the individual in need of care. Such an approach translates to the concept of patient or person-centredness as a guiding ethos in both the preparation of nursing students for professional practice and the practice of registered nurses working in the clinical setting.
Person-centredness was initially articulated as an approach and a standard of care that prioritise the patient/client at the centre of care delivery (McCormack, Manley & Titchen, 2013). In order to explain the concept more clearly, we will examine the principle of person-centredness and its influence on healthcare and education.
As a current or future healthcare professional, you will communicate almost constantly in ways unique to the contexts of healthcare. For instance, communication between health professionals often occurs in an extremely structured way, using pre-determined and agreed-upon frameworks. In one moment, you may communicate through structured handovers using mnemonics such as ISOBAR (Identify, Situation, Observations, Background, Agreed Plan, Read Back), or perhaps frameworks of documented communication such as SOAP (Subjective, Objective, Assessment, Plan). Whatever the case, such a structure reflects the expectation that clarity, accuracy and detail are the hallmarks of communication between health professionals.
Often occurring simultaneously with structured communication is the unstructured communication that occurs between the patient or their loved ones and the practitioner. Strong and effective communication between the patient and the practitioner is the cornerstone of safe and effective therapeutic relationships. The need for trust, respect and rapport – often in times of great difficulty and distress in a person’s life – is vital to mitigating the discomfort that periods of illness can impose on people’s lives. In many senses, healthcare is unique in the almost instantaneous changes it demands of those who are responsible for the delivery of care. In one sense, communicating through the extreme structure of clinical handover and documentation is often simultaneously juxtaposed with the unpredictable and complex contexts brought to bear by persons requiring a nursing presence.
It is arguably the concept of the nursing presence that distinguishes nurses from all other healthcare professionals. Nurses are far more present than other healthcare practitioners, and consequently are placed in a privileged position to be able to constantly assess, observe and act on changes to the needs of the patient. Therefore, in terms of the nursing profession, the concept of person-centredness comes from the fact that nursing has always valued the privilege of presence in that it enables nurses to provide a person-centred experience throughout care. Nurses will adapt to the needs of the person using communication – whether that need is to communicate the patient’s condition to colleagues through clear and accurate documentation or handover, or to reassure the patient with whom the nurse has built a strong therapeutic relationship by using their expert communication skills.
In the higher education sector, much is made of the student experience. The importance of providing each student with a rich experience at university is often recognised by the extensive support systems, social clubs, facilities and events that characterise university life. These initiatives are intended to provide a supportive environment to students, which facilitates a rich and relevant learning experience for each individual.
In nursing education, the most appropriate way to provide a valuable student experience is to diffuse person-centred approaches through the strategies used to facilitate learning and teaching. As addressed throughout this chapter, the purpose of each system – whether healthcare or higher education – is to ensure that each graduate who completes a program of formal education is safe, competent and relevant to the needs of the Australian healthcare consumer.
In this respect, your ability to articulate an awareness of yourself and the factors that motivated you towards a career in health is very important if you are to interpret how you can use what you bring to the profession in ways that benefit the person in need of healthcare.
Throughout both systems, using person-centredness to guide the delivery of healthcare and to facilitate learning in nursing education is common. In higher education, the focus on curriculum is indisputably professed to be person-centred. The preparation of health practitioners is almost exclusively focused on educating students of nursing and other health disciplines towards optimising their capacity to provide safe and competent care to those in need.
Across the healthcare system, one fact is clearly communicated: that the position of the patient or person is at the epicentre of all activities. These two systems work in tandem to articulate to the profession, the public and the person that the needs of the individual requiring care must be prioritised. The importance of the partnership between practitioner and person is therefore paramount, and a strong, therapeutic, person-centred relationship between the caregiver and care receiver is fundamental to realising the very existential purpose of each of these systems (see Figure 1.1).
Figure 1.1 Communication between people, contexts, systems and agendas