Blogs on Nursing- What it is and what it should be: Know your role

Healthcare is comprised of numerous professionals and ancillary staff that are all essential to the care of a patient within a system, no matter how grand or seemingly insignificant the scale. Nursing makes up only one of these roles.... Or does it? If you have read Notes on Nursing: what it is and what it is not by Florence Nightengale, then you probably know that the practice of "modern" nursing actually consists of many different roles...all focused on the holistic care of the patient. Florence, a public health statistician, did not attempt to provide a manual for nurses of her time, nor did she profess that her book be the end-all reference for nursing practice. What she did do, however, was blend her "calling" to help others with her analytical thought process, and began to make keen observations on the health and welfare of "hospitalized" soldiers during the Crimean War. She noted that certain factors, or an absence thereof, seemed to play a part in the successful recovery of these soldiers, physically and emotionally. For instance, Nightingale offers her "tips" to would-be nurses as to what is important. Among these "canons" of nursing are proper ventilation, pure air and water, efficient drainage, cleanliness, light, noise, "variety", proper nutrition, and observation. This is not an all-inclusive list, only an example of common-sense practices that were not so "common" in her time. If you have not read Notes on Nursing, I strongly recommend it. Florence was a very intelligent and dedicated woman, who truly made a lasting impact on nursing and public health practice. We must learn all we can from our profession, both past and present. We must always seek knowledge through science and reasoning, always guided by ethical and moral principles, aimed to serve a those within our community and those we will never know.

What cruel mistakes are sometimes made by benevolent men and women in matters of business about which they can know nothing and think they know a great deal. ~Florence Nightengale

Florence recognized these varied factors to be very important to the wellbeing of patients and of the public. Take, for instance, the practice of handwashing. She recognized this simple practice to be extremely effective in the prevention of the spread of illness. Although she did not accept the "Germ Theory " as fact, she observed the basic principles of sanitation to be very effective in disease prevention. Today, ask any nurse about disease prevention, and they will tell you that handwashing is the number one way they can prevent the spread of disease from one patient to another. Nurses use to provide virtually all patient care duties: hygiene, meal preparation and assistance, cleaning floors, emptying trash, and even obtaining and evaluating laboratory specimens. Of course now there are many professional and ancillary service staff to provide these services...among numerous others. The point is, nursing has a very rich history, deeply seeded in the comprehensive care of patients. Nurses, and student nurses, truly use to "do it all". By today's standards, and with curent technological advances, it would be impossible-and unrealistic- to perform by the same standard as those before us. However, we should not soon forget what we are doing, and why we are doing it...for the patient. We can not know it all, we can not do it all, and we can not for one second think that we are capable of such a task. We are surrounded by a wealth of resources, there to assist in the care of the patient. We must know our resources, USE our resources, and coordinate all of these activities. After all, that is what professional nursing is all about: being the coordinator of care. Though we may not do it all, we should at least help ensure it gets done, all with the patient's best interest at the forefront of our minds. Florence was leading us in the right direction. It is up to us to maintain the course. So, was this about Florence and her contributions to patient care and organized medical and nursing care? Somewhat. The real reason I spoke so much of her is because in order to "know our role" we must understand what it is we do, and try and understand our beginnings. We must understand what we do and why we are doing it, otherwise we are not basing our professional practice in anything more than folklore and tradition. Evidence Based Practice (EBP) is what guides us today, and what we use to rationalize continuation or discontinuation of practice standards. We are a caring, intuitive profession guided by science and reasoning. If we lose this, we lose our identity as a profession. Observations guide research. Research provides evidence. Evidence support standards. Standards shape policy. Policy influences practice (among many other factors). In the end, we as nurses, are ultimately responsible for our own practice, and being knowledgeable of the various policies, standards, and legislational guidelines that both entitle an circumscribe our practice. Again, we must "know our role" or we may be not only endangering our patients, but our legal license to practice. I said this in a previous blog: "Nursing school is a floor, not a ceiling." We must not stop seeking knowledge simply because we are not in an academic setting. We must be current on recommended practices and what research is available. We must be able to find this information and make sense if it. We must not accept everything as being finite. We must own our practice and our profession, living up to our dedication to our patients. We cannot be afraid of asking questions, and furthermore, of seeking the answers. In her book Notes on Nursing, Nightingale even indicates that her work was not meant to tell nurses what to do; she wanted them to teach themselves, through the use of her "tips." We should continually teach ourselves about nursing, because after all, we have yet to attain all the answers when we do not even know all of the questions. I will leave you with another quote from Florence: