Are Nurses There for the Patients, the Organizations, or for Themselves?

What Keeps Nurses In Nursing?

Full disclosure here – I believe nurses are motivated by their intrinsic desires to help others, rarely by healthcare organizations’ missions.

I think nurse leaders get this, but I do not think CEO’s and others leaders in healthcare get it. And I wonder how often nurse leaders confess this to the CEOs?  I know that I didn’t often enough.

Nurses find science and technology interesting and challenging, but it’s their authentic connections with patients and caring that bring meaning and purpose.

OK What Does The Literature Say? Which Mission Should/Do Nurses Follow?  

There are different views in the literature and in organizations about which mission nurses should follow.

Here are 4 articles that show how missions play out in organizational cultures, spiced with my  interpretations ….  and biases, I’m sure.    

Part of My Mission with my website is to illustrate the slippery slope nurses live in as being a part of  organizations.

The Question –  Who’s Mission Is It That Nurses Are Striving To Meet?

Here are my quick thoughts about each article:

  1. I picked up paternalism in the first article, which stifles our autonomy and professionalism. Ouch!
  2. I believe that overemphasis in PCC pushes nurses in a corner and stifles nurses’ openness about what holds them back from delivering PCC.   These are the conversations needed.
  3. As much as I love caring science and Caritas practices, it’s too far reaching for mainstream healthcare and the majority of nurses.  We have to simplify this mission.
  4. The fourth article is a breath of fresh air.  Here is a story of how nurses healing practices came to define an organization.  WOW!
  • Article / Hospital #1 – Well-Being Program

This organization offers a Well-Being Program for all staff with the aim to enhance joy in their jobs — part of IHI’s Quadruple Aim.  They used a comprehensive systems approach in offering a plethora of wellness services that extended from the employee through the community.  The program was based on the premise that it is the job that gives people their sense of purpose.  Their conclusion was that the Well-Being Program resulted in improved engagement scores.

The resources offered in this Well-Being program would make any of us envious.  However, one of the conclusions of the article was spot stopping for me. They emphasized the importance of  employees feeling cared for by their employer.

Should that be the aim of organizations for nurses?  

It’s true that organizations are the employers, and have the obligation to ensure fair wages and safe working conditions.  These basic elements are needed for nurses to practice nursing.

For nurses, it’s not the job or organization that give a sense of purpose, is it?  It’s the unique specifics of nursing – their connection with the patient in the hub of healthcare’s complexities and vulnerabilities- that satisfy their sense of purpose.

Nurses don’t need to be protected or cared for by an organization. That’s what created paternalism in healthcare.  That comes from a time when nursing was perceived of as a job done selflessly, and out of nobility, self-sacrifice and virtue.  This notion ceased with the advent of nursing science and professionalism.  Despite our advancements, paternalism still exists, and muddies the waters of good intentions, as seen in this organization.

  • Article / Hospital #2 – Patient/Family Centered Care Initiatives

This article describes all that is necessary to truly integrate (PFCC) person and family-centered care into practice in organizations. They provide a great list of myths about PFCC, which cuts to the heart of the article, ‘PFCC is a philosophy that has been espoused for decades and yet is rarely embedded in healthcare organizations.’   This article is a great resource for any leader interested in PFCC.

I have one point that needs consideration where there is strong championing of PFCC.  I believe that PFCC has created a slippery slop for nurses and nurse leaders:

Our current emphasis on patient-centered care – without equal time with nurses on how they access and cultivate their authenticity and caring connections required for PFCC care leaves a gap…  A gap between nurse leaders with nurses.

Helping nurses identify what holds them back from accessing their authenticity and connection with patients is needed for all higher-level caring initiatives, not just PFCC. 

  • Article / Hospital #3 – Caring Science / Caritas Affiliates

This third article is one dear to my heart. It focuses on applying Watson’s Caring Science,  Caritas CoachingSM, and the authors’ use of Theory of Relational Caring Complexity.

The purpose of the article is to illustrate the challenges nurses and nurse leaders experience in their efforts to provide social caring ethic, and transformative practice as reflective values-in-action….. All the while balancing economics and technology with caring.  I do appreciate the rich wisdom and benefits outlined in this article.  My favorite line,

“Nurses have discovered that hospital administrators cannot control caring practices.” YEA!

My question is how can we simplify the basic tenets of caring science and start tapping into nurses at large on grass root levels, without an academic or organizational design?

Authentic caring certainly exists today, but not at the frequency or systemic level it could if it was talked about and became an active part of the work environment.

What if nurse leaders just started talking with nurses in episodic and momentary conversations—in between patients and meetings—tapping into and growing nurses’ existing caring practices by talking about what works and what doesn’t in caring….  Doors would open.  Nurses’ wisdom and what holds them back is there to be shared.   Nurses are hungry for their caring to be noticed and expanded.

These conversations between nurses and leaders could create a new narrative of mutual authenticity and caring consciousness that could keep it real everyday.

  • Article / Hospital #4 –     A pioneering organization where nurses’ healing became the center piece and Nurses are leading a therapeutic healing environment

What this hospital achieved is impressive! Awarded in 2015 Institutional Excellence in Holistic Nursing Practice by the American Holistic Nurses Assoc.(AHNA).

They integrated:

  1. The AHNA holistic practice standards
  2. The BirchTree Center for Healthcare Transformation Model
  3. The Integrative Healing Arts Academy (IHAA) curriculum
  4. Over 2300 of their nurses have completed courses
  5. The have 2 Integrative Healing Practitioner RNs and 125 integrative healing resource nurses.

They fund this through their savings in RN turnover reduction which is at 7.6% (unheard of by all standards!)

One of their main lessons learned – “… holistic and integrative practice is within the scope of nursing and we shouldn’t need to ask permission to initiate related practices.” 

What Are Nurses There For?

Nursing is a complex profession with an overarching impact across the world based on our covenant with humanity and our social covenant to society to preserve human caring.

Nursing leadership’s unique challenge is to embolden this covenant. And we can start wherever we are. 

image courtesy of
  1. Jacobs, McGovern, Heinmiller, Drenkard. 2018. Engaging Employees in Well-Being. Nurs Admin Q. 42.3. 231-245.
  2. Barnsteiner & Tisch. 2018. Role of the Chief Nurse Officer in Ensuring Person/Family- Centered Care. Nurs Admin Q. 42.3. 284-290.
  3. Ray & Turkel. 2014. Caring as Emancipatory Nursing Praxis. Advances in Nursing Science. 37.2.132-146.
  4. Shanahan, Andrus, Leichmam, Karas-Irwin. 2018. Mapping an innovative future: Pioneering the healing organization. Nursing Management. August. 25-31.

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