Caregiver—Caring, Compassion, and Empathy

If the act of caregiving drives the health care delivery role, compassion is an essential identity characteristic that guides the actions of assessment, planning, intervention, and evaluation. When asked about the most important role of a nurse, most nurses respond with one word: caregiving. The nursing profession is grounded in the phenomenon of caring (Leininger, 1988). Leininger discovered that patients from diverse cultures valued care differently than nurses did. Gradually, Leininger became convinced of the need for a theoretical framework to discover, explain, and predict dimensions of care and developed culture care theory, the only nursing theory that focuses on culture, (Leininger & McFarland, 1997). This theory defines caring behaviors on the part of a caregiver as those that are congruent with the beliefs, values, and expressions of the care recipient. Similarly, Jean Watson’s theory of caring describes the scientific basis of nursing as extending beyond human interaction, to a moral concern for preserving human dignity and respect for the wholeness of the care recipient (Childs, 2006). Both of these theories demonstrate the link between the caregiver role and the identity characteristics of compassion and empathy.

Caring is an essential feature of the profession, one that is central to a nurse’s identity and that serves to facilitate health and healing: “The culture of caring, as a fundamental part of the nursing profession, characterizes both concern and consideration for the whole person, a commitment to the common good and health of all, and outreach to those who are vulnerable.” (National League for Nursing, 2009, para 1).

Because of this fundamental maxim, preparing the nurse for the caregiving role is an established practice in nursing education. What is more difficult to engender, however, but nonetheless as fundamental, is fostering caring through compassion. Although “teaching” identity is a complex process, nurses need to be awakened to and evaluated on the emotions prompted by the pain and suffering of others. Grounded in the development of empathy, caring is the vigorous attempt not only to feel another’s pain but to take steps to alleviate suffering and to seek the wellness within that person. Covington (2005) states, “Caring presence is mutual trust and sharing, transcending connectedness, and experience. This special way of being, a caring presence, involves devotion to a client’s well-being while bringing scientific knowledge and expertise to the relationship” (p. 169). Kathy Robinson (2003), former president of the Emergency Nurses Association, writes, “No technology in health care replaces the critical thinking of a human mind, the caring of a human soul, the proficiency and skill of a human hand, and the warmth of a human heart in healing the sick and injured. That is nursing, esteemed colleagues; that is you” (p. 200).

Colleague—Collaborating and Connecting

The role of nurse as colleague is not only essential to collaborative clinical and research practices, but integral to the team process in dynamic health care. Working together toward common purposes, improving health, respecting shared strengths, caring and compassion—these are fundamental to the profession. For example, in 2009, 90% of American Association of Critical-Care Nurses (AACN) members responding to a survey reported that they were colleagues with physicians and administrators and that they believed this was among the most important elements in creating a healthy work environment (Morton & Fontaine, 2009). At the heart of being a colleague is the ability not only to cooperate, but to actively collaborate. Collaboration is a multifaceted process of working together to accomplish a common goal; it involves a mix of differing viewpoints to better comprehend a challenging issue. Arising between true colleagues, collaboration is the ability to be innovative in achieving consensus to achieve shared goals.

According to Gardner, there are 10 lessons in collaborations: (1) know thyself; (2) learn to value and manage diversity; (3) develop constructive conflict resolution skills; (4) use personal power to create win-win situations; (5) master interpersonal and process skills; (6) recognize that collaboration is a journey; (7) leverage all multidisciplinary forums; (8) appreciate that collaboration can occur spontaneously; (9) balance autonomy and unity in collaborative relationships; and (10) remember that collaboration is not required for all decisions (Gardner, 2005, Section 3).

Interprofessional collaboration is a vital aspect of plans designed to increase the effectiveness of delivery of health care (Morton & Fontaine, 2009). According to Dorrie Fontaine, RN, PhD, FAAN, former president of the AACN, “Escalating financial pressures and alarming workforce shortages make it imperative that physicians and nurses actively work together to establish new patient-focused practice models. The combined efforts of the AACN and the American College of Chest Physicians (ACCP) will establish a strong leadership force in effecting meaningful change in our hospitals and health systems on behalf of the critically ill patients we serve” (Robinson, 2003, para 6). From initiatives to promote interdisciplinary education in health care to institutes focusing on fostering dynamic international collaboration involving nursing, medical and allied health researchers, clinicians, academics, and quality managers, collaboration among colleagues has emerged as vital to professional nursing.

An example of an important new arena for collaborative practice for nursing is the rapid advance of telehealth as a critical vehicle for health care delivery, especially in rural underserved communities. Telehealth is the exchange of medical and other health information via electronic communications from one site to another with the intent of addressing patient needs. Through telehealth, colleagues provide medical, nursing, or other health care to a remote location. The remote site almost always requires a nurse to be present with the patient to present the history and physical, provide clinical interventions, offer health education, and ensure follow-up. This is collaborative practice in its highest form, because the role of the nurse in this setting is to leverage technology and nursing expertise to provide quality health care (Cattell-Gordon, 2009).

Manager—Leading, Inspiring, Thinking Critically

Fundamental to nursing practice—whether it is an individual nurse directing patient care, an administrator of a nursing unit, or a chief nursing officer for a health system—is the role of nurse leader as manager. In this role, the nurse recognizes the identity of manager as the caregiver of the caregivers. In short, nurse manager is the role of pulling together people with the common goal of caregiving.

Although the role of manager or administrator of a nursing unit is not one that every nurse will assume, understanding managing as a primary nursing function is essential. All nurses essentially assume the role of manger every day in their work when they care for their patients. The role of manager requires a systematic way of providing care, a precise tending to details, and working from a comprehensive assessment and plan, as well as engaging colleagues in compassionate, collaborative, interdisciplinary practice.

A nurse, for example, in caring for a dying patient, needs to know the critical point when the family should be called, how to manage the medications, when to touch and not to touch, when to be silent, and when not to do anything but be present. This role calls for the nurse to manage care and demonstrate leadership, seeing the whole and the part—the individual patient and the whole of the process of dying.

A leader is someone grounded in the core value of compassion with the capacity to inspire mentorship, collaboration, creativity, and critical thinking. To communicate this leadership, the leader must provide the framework from which complex problem solving evolves. A core element of managing and leading is understanding the nature of servant leadership and possessing emotional intelligence (Triola, 2007). Nurse leaders demonstrate these identity characteristics when they set priorities based on the needs of those they are leading and are committed to the professional growth of others. Effective leadership is vital to creating healthy work environments that are conducive to promoting quality patient outcomes and health for staff. Authentic leadership, according to Kathleen McCauley, former president of the AACN, is the “glue” needed to hold together a healthy work environment.

In some settings, a nursing culture with a focus on task orientation, rigid hierarchical structures, and the possible disempowerment of staff is an impediment to delivery of compassionate patient-centered care. As a nurse leader, if one sets the tone of joining with the patient in a process of compassionate collaboration, outcomes in health will be more optimally achieved (Jonsdottir, Litchfield, & Dexheiner, 2004).

Educator—Learning and Guiding

The role of the educator is essential to the overall function and identity of the nurse. In the complex world of contemporary health care, as patients seek to manage their disease and cope with illness, the nurse assumes the primary role of educator. At every level, the patient educator role exists within the scope of practice because it significantly affects a patient’s health and quality of life. The process of providing education parallels the nursing process, with the first step being an assessment of the learner’s needs, readiness to learn, and learning style, followed by an individually designed intervention, and completed only when the outcome has been evaluated (Bastable, 2007). The ability of nurses to effectively provide health education is essential in addressing local and global health problems.

To be effective as a teacher requires a commitment to be a learner; to see teaching and learning as the act of guiding; and to understand the essence of the phrase “to educate.” As John Dewey posits, learners grow in concert with others: “Every experience lives on in further experiences. Hence, the central problem of … education … is to select the kind of present experiences that develop fruitfully and creatively in subsequent experiences” (Dewey, Kilpatrick, Hartmann, & Melby, 1937, p. 45). The role of educator in the profession of nursing is based on the desire to help individuals and communities grow. The nurse educator is in essence nurturing a relationship, sharing knowledge, and empowering individuals, families, and communities. The nurse in this role can actively teach and guide patients, families, and communities about health/wellness and illness—about living and dying.

This role of the nurse as educator is further optimized by fostering personal knowing. It is the ability to be empathetic, to see an event from the perspective of another, and to recognize the other as a subject rather as an object. Personal knowing is the discovery of self and others, which is arrived at through reflection, synthesis of perceptions, and connecting with that which is known (Kaminski, 2006, p. 14).

In addition to empathy, nurse educators strive to foster critical thinking skills in their students. Lemire (2002, p. 69) notes that in educating nurses for leadership, the educator must emphasize the cognitive and disposition aspects of critical thinking in order to promote active and sequential learning. Critical thinking and problem-solving skills are acquired over time through lifelong learning and experience.

From this place of learning and knowing comes the ability to be a caring person who seeks to collaborate to achieve a common purpose for health and wellness. This same posture applies to the role of nurse educator—whether it is within a school of nursing, a community college, or with fellow nurses on a unit or in a clinic. The critical pedagogy of nursing requires a fundamental understanding of the dyads, an ability to guide and teach others a whole understanding of the profession, and an evaluation of the sociopolitical context of learning and care. In short, professional nurse educators teach role and nurture identity.

Mentor—Sharing and Role Modeling

Mentoring refers to a formal or informal process in which a mentor and a mentee establish a relationship with the mutual goal of meeting the career goals of the mentee (Bally, 2007). One role of the mentor—to be true to oneself and guide another to greater personal awareness and skill—is crucial to retaining and encouraging nurses in the workplace. According to the literature, the initial 3 months of a newly graduated nurse’s transition is vital to long-term success in the profession (Winfield, Melo, & Myrick, 2009). This initial transition involves an all-encompassing transformation of roles and responsibilities, an acceptance of the differences between the theoretical orientation of the nurse’s education and the practical focus of professional work, and an integration into an environment that emphasizes teamwork as opposed to individually based care provision. The role of the professional nurse as caregiver, leader, teacher, colleague, and mentor is a critical one in helping newly graduated nurses or any nurses who change roles to feel successful in their new environment (Schumacher & Meleis, 1994).

Because nursing excellence is embodied in the combined competency of skills and practice, the experienced mentor, grounded in the spirit of nurturing, is crucial to the development of careers, collaborative networks, and a contagious enthusiasm within the profession. For this enthusiasm to take hold, the mentor must be a person whom the mentee can trust. The mentor acts as a “role model and advocate to pass on life experiences and knowledge in order to motivate, support and enhance their mentee’s personal and career development” (Kuhl, 2005, p. 9). Building on this, the key qualities in an effective nurse mentor reflect the identity characteristics of the role modeling and sharing.

The National League for Nursing (NLN), one of the membership organizations for nurse faculty and leaders in nursing education, states, “Experienced nurses everywhere have the opportunity to become mentors for other nurses. Mentoring another nurse is a professional means of passing along knowledge, skills, behaviors and values to a less experienced individual” (NLN, 2006, p. 10). The NLN further asserts that in a positive sense, the act of mentoring gives nurses an opportunity to create a legacy. By sharing information and insights with members of their own profession, experienced nurses can enable others to maximize their potential, thereby improving patient care and ultimately strengthening the profession of nursing (Henk, 2005).

Researcher—Inquiring and Discovering

The role of researcher in the nursing profession is vital for generating new knowledge to underpin nursing practice, clinical care, and public health. As both a caring art and scientific enterprise, nursing has an obligation to provide care that is continually examined through research (International Council of Nurses, 2009). Nurses working as independent investigators or in multidisciplinary research teams offer new insights and unique perspectives to the process. According to Patricia Munhall from the NLN, nurses change in “how” they believe in something rather than “what” they believe and states, “The sands of science itself are shifting, as more and more scientists, including nurse scientists, realize that science cannot be a field of absolute and final truth but is an endeavor focused on illuminating an ever-changing body of ideas” (Munhall, 2007, p. 12). Nursing research, in fact, is critical to the emergence of community-based participatory research, an approach in which the scientific process is applied to a collaborative process with the community of interest.

One way to illustrate the importance of the researcher role is to describe a misalignment between the role and identity of a nurse who works on an oncology unit who is not aware of research or curious about the discovery of new treatments for cancer. This dissonance in an area where so many die from the disease is likely to cause frustration and burnout. Thus at the most basic level, the role of the nurse requires a comfort with research and a curiosity with clinical investigation. At the next level, the nurse applies research at the bedside by providing interventions that are based on current evidence. At an advanced level, the role of nurse as a researcher is fundamental to improving patient care and public health by defining research questions and designing scientific studies to answer them. This process includes writing grants, analyzing data, and sharing findings with the larger health care community.

To be successful in the role of nurse researcher, the identity of the researcher must be grounded in curiosity and the desire for discovery driven by compassion for human suffering. This identity, in turn, empowers patients because it is not proprietary knowledge but rather is about sharing and inspiring new knowledge. Further, curiosity creates an interest in learning and guiding that helps break down barriers between cultures. The curious nurse researcher asks important “how” and “why” questions and builds essential stepping stones toward awareness, appreciation, and understanding of other cultures. Through curiosity, people can gain new perspectives, unparalleled learning and growth, and a chance for interesting conversation and reflection at every interaction (Kaminski, 2006).