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Running head: COURAGE IN NURSING PRACTICE 1

Courage in Nursing Practice

Ashlyn Witt

University of Saint Mary


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Abstract

Courage in nursing must be taught as an important value to college nurses. This skill must then

be fostered and grown in the hospital and care facility setting. Nurses who feel empowered to

take personal risk and act courageous in the profession are happier and feel a broader sense of

well-being over nurses that feel morally tired from the inability to act on courage. Ultimately,

nurses who were taught the importance of courage in their profession are happier, more

competent in their practice, and make enhanced patient connections. They better felt that they

could be leaders in their field and were able to express a confidence that came with the

courage to act on what is right.


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Courage in Nursing Practice

Nursing is a multifaceted discipline that requires many key abilities and traits for

those in its practice. Among those traits include kindness, caring, competency, and compassion.

One of the most important qualities is courage with courage being essential to the nursing

profession. Oftentimes, according to Edmonson, staff that are higher ranked inside the hospital

are expected to use courage and advocacy in their profession more often than other staff (2015).

This shows that nursing must include courage and patient advocacy. Nurses should be seen as

health care leaders for others that may not have the same training that nurses have. Courage

should be valued as equally as other nursing qualities, it can and should be taught in nursing

school and nursing continued education classes. This education lays the foundation for

leadership in nursing and can empower nurses to teach courage to the others around them.

Ultimately, a nursing practice without courage is unsatisfactory and often leaves nurses with the

feelings of moral fatigue.

First of all, courage must be seen as a vital part of nursing practice. Hawkins and Morse

state that while courage in nursing has been historically viewed as valuable and necessary for the

profession, the concept of courage in nursing has now been eliminated from nursing theory

completely (2014). Literature sounding courage in the nursing practice is slim and oftentimes

this literature tends to be vague and not very well defined. This vagueness does not allow for the

concept of courage to be easily teachable and easily accessible as a theory in nursing practice.

This can cause less schools to teach about nursing courage and can lead to nurses being scared to

act on morality inside their practice. Part of the vagueness surrounding the literature on courage

in nursing is due to courage taking on multiple roles inside the working profession. Some

examples of courage in nursing includes constant education, constant application of safer


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techniques, the ability to do difficult things, and staying within the scope of one’s nursing

practice. The courage to continue one’s education refers to the constant research health

professionals must do and the application of this learning that is required of the professional.

This could mean staying up to date on new peer reviewed research that comes out in nursing

books. This may also mean learning new techniques from newly graduated nurses. This could

also mean the admission of being incorrect and learning how to adjust and apply new knowledge

gained from other resources. Nursing also requires the courage to do difficult things. This

includes taking responsibility, to step up when a wrong is being committed, and sometimes to

step back when something is out of the scope of one’s practice as a nurse. This could also mean

stepping up to tell bad news to a patient or taking a difficult case from a fellow nurse that just

cannot handle it. Knowledge is critical in nursing and in the practice of courage. Knowledge lays

the foundations of confidence and in turn that confidence incites the act of courage. Ultimately,

according to UK Essays, courage is rooted in caring and the nursing profession is fundamentally

caring in practice (2013). A nurse cannot do his or her job well without caring, and therefore

cannot do his or her job well without courage; caring and courage will always be critically

intertwined. This illustrates that a multifaceted definition of courage must be created in order to

teach this skill in life and in work. Courage has many forms and it takes constant continued

practice to maintain and master. Courage also must be fostered in hospitals settings to support

good nursing practice. This allows for nurses to identify patients who are at higher risk and act to

protect these vulnerable populations. If the hospital does not allow an environment that

encourages good nursing practice that includes confidence and courage, then good nursing

practice becomes almost impossible to do. This can lead to frustration and turnover. Nurses must

feel able to confidently practice safe, quality, and skillful care.


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Courage, to continue, may seem like a characteristic that some people may or may not

have. It has often been viewed as a core quality or trait the a person either is born with or as

developed over one’s lifespan. However, research has been shown that courage can be taught and

fostered in nurses by environments and teachers that encourage moral behaviors. Studies have

proven that courage does need to be taught to nursing students. According to Bickhoff, L.,

Sinclair, M.P., & Levett-Jones, T., nursing students do not feel comfortable intervening with

poor medical practice even if they feel a deep moral obligation to do so, and oftentimes remain

spectators that are passive in the medical community and rely on others to speak up (2017). This

can be changed by simple exercises over the course of a few hours throughout one week. With

studies showing significant improvement of one’s courage in the nursing profession (Edmonson,

2015). Courage can be drawn from people fairly easily just from education on what courage is

and how it can be used. Sometimes, just showing examples of when courage is necessary can

allow nurses the confidence to practice courage in their work environment. This can help

encourage nurses to be more active in the healing process and strong leaders in the healthcare

community. Nurses are patient advocates and must have strong morals and ethics to perform

their jobs well. Edmonson explains that education in morals and ethics can help encourage

nurses to perform courage and advocacy in situations that require the ability to assess moral

ambiguous situations and require interventions (2015). This shows how powerful education can

be in situations where one may feel uncertain with how or when intervention is appropriate.

Some of these situations can civil and social courage that may be more difficult than professional

courage. Nurses have an obligation to ensure the best patient care possibly and this may require

the social courage that comes with human to human interactions. Edmonson’s evidence also

shows that moral courage can be taught and that when nurses have training in morality and the
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courage to act on this morality there is an increase in how often a nurse will intervene. This is

incredibly important in a practice that revolves around patient advocacy and care. The nursing

profession has been slowly moving towards viewing the nurse as the last line of defense for

patients. This means intervention and the courage to intervene becomes a matter of life and death

for a patient. The last line of defense is completely dependent on courage. Edmonson also

theorizes that this environment that emboldens a nurse to act on their courage and education

gives nurses a greater sense of well-being, happiness, and job satisfaction. In a job where stress,

lack of sleep, and lack of time is abundant, there must be autonomy to act on one’s morality.

However, what happens if nurses do not feel empowered to act on their feelings?

Oftentimes, ethical dilemmas can cause distress and disagreement between health care

professionals and the clients they are caring for (Potter, Perry, Stockert, and Hall, 2017). This

distress leaves nurses with a sense of powerlessness and a decrease in job satisfaction. Moral

distress is an important issue that comes along with the nursing profession. If a nurse feels

powerless in a situation where he or she may have helped the condition with intervention, then

resentment can build towards the profession, one’s coworkers, or the patients. Some nurses may

feel angry, lonely, depressed, and guilty due to situations that they were unable to act upon their

morality. This can cause a higher turnover of nurses in care facilities and sometimes emotional

withdrawal from a previously caring and involved nurse. Edmonson explains that this means

there needs to be recognition that courage should be taught and nurses should feel empowered to

act on their morality to help provide safe workplaces. One way to allow nurses to express their

morality is by teaching them what personal risk taking is. Risk taking is placing oneself on the

line for the greater good. Risk is the prospect of losing something of importance and nurses

know that there could be so much to lose. Knowing this, some nurses shy away and disengage
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with the hope that the risk to them is lowered by not speaking up. They weigh the consequences

to themselves in hop that nothing bad will happen if they do not say anything. This is when

courage, honesty, and integrity all intertwine together and need to be used as stepping blocks for

morality.

Ultimately, courage is a necessary trait in nursing practice. While nursing involves many

numerous qualities and involves following various codes and principles to be successful, nursing

must intertwine all other traits with courage. It is a virtue that, when fostered and encouraged,

can be a tremendous asset in the profession. It can be taught and nurtured through continuing

education programs and should be taught in all nursing schools and all health care professionals.

It truly allows for “First, do no harm” to come to fruition. Nurses that feel empowered to step up

and act on courage have increased happiness, better job satisfaction, and have less job turnover.

They will also face less moral distress and feel like critical members and leaders of the health

care community. Nurses also have better patient outcomes, patient connections, and patient

centered care when they are encouraged to act on their morality. Courage is critical in all aspects

of the nurse profession and cannot be taken lightly. Without courage in the nursing profession,

nurses would have no influence in society: amongst patients or amongst other health care

professionals. Fundamentally, nursing courage is acting on morals to ensure good patient

outcomes even with fear for self or others (Hawkins and Morse, 2014). Nursing cannot be what it

is without certain values, responsibilities, and competencies. Moral courage is a nursing value,

nursing responsibility, and nursing competency; therefore it should be treated as such and taught

as such in the health care community.


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Reference Page

Bickhoff, L., Sinclair, M.P., & Levett-Jones, T. (2017). Moral courage in undergraduate

students: A literature review. The Australian Journal of Nursing Practice, Scholarship

and Reasearch, 24(1), 71-83. doi: https://doi.org/10.1016/j.colegn.2015.08.002

Edmonson, C. (2015). Strengthening moral courage among nurse leaders. Online Journal of

Issues in Nursing, 20(2), 9. doi:10.3912/OJIN.Vol20No02PPT01

Essays, UK. (2013). A concept analysis of courage in nursing, nursing essay. Retrieved from

https://www.ukessays.com/essays/nursing/a-concept-analysis-of-courage-in-nursing-

nursing-essay.php?vref=1

Hawkins, S. F., & Morse, J. (2014). The praxis of courage as a foundation for care. Journal Of

Nursing Scholarship, 46(4), 263-270. doi:10.1111/jnu.12077

Potter, P.A., Perry, A.G., Stockert, P.A., & Hall, A. M. (2017). Fundamentals of nursing (9th

ed.). St. Louis: Mosby Elsevier.

Price-Dowd, Clare. (2017). The three stages of courage of nursing. British Journal of Nursing,

26(17). Retrieved from CINAHL


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Appendix

I. Introduction and Thesis

a. Nursing as a multifaceted discipline

b. Courage in Nursing Practice

II. Courage as a vital part of nursing practice

a. Courage as an important nursing tool

III. Courage as a teaching tool

a. Courage can be taught and learned

IV. Lack of courage as a cause of problems

a. Lack of courage causes distress

b. Lack of courage causes turnover

V. Conclusion

a. Courage in nursing practice conclusion