Running head: PHILOSOPHY OF NURSING 1

Philosophy of Nursing

Madison Caudill

Bon Secours Memorial College of Nursing

Dr. Turner

NUR 4140 Synthesis for Nursing Practice

March 25, 2019

“I pledge”
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Philosophy of Nursing

The purpose of this paper is to reflect upon my growth over the past three years while in

nursing school and assess any changes to my nursing philosophy as the result of my experiences

during my nursing curriculum. I will be assessing my personal value system and will include

examples of patient encounters that have influenced me to mold my current set of values or

integrate new values into my belief system. Additionally, I will incorporate Patricia Brenner’s

theory: From Novice to Expert to assess my level of skill acquisition as well as develop an action

plan for future long-term professional development.

Definition of Nursing

When I first started nursing school, I truly believed that nursing was dispensing

medication and taking vital signs. I was under the impression that nurses provided physical care

to the sick and dying. Over my time in school and through my clinical experience both as a

student and as a tech, I have learned that nursing is so much more than the physical. Nurses do

dispense medication, we do take vitals, we perform CPR, and we start IVs. However, to me,

nursing is the art of providing holistic care to patients. Nursing is listening when an angry patient

is venting about his new heart failure diagnosis. Nursing is placing a beautiful, healthy boy into

the arms of a couple who have been trying to get pregnant and have finally been successful.

Nursing is sitting in silence with a family member who is saying goodbye to their husband of

50+ years after making the decision to withdraw care. Nursing is celebrating with our patients at

their highs and supporting our patients through the lows. Many of us, including myself, go into

nursing with the goal of helping others. It isn’t until you are at the bedside that you realize what

“helping others” really means. It is hard to define nursing simply because it is such a complex art
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of caring and your definition is continuously being shaped by the experiences of your practice. I

expect my definition to continue evolving as I begin as a new graduate nurse.

Personal Philosophy

My personal philosophy of nursing is centered around maintaining an open-mind,

commitment to safe practice, providing patient-centered care, and lifelong learning. Nursing

requires critical thinking, courage and should always revolve around patient-centered care. It

requires you to recognize that your patient is deteriorating at 3:00 in the morning and make the

call to the physician despite getting an earful for waking him up and despite the fact that you

might be wrong in your assessment of the situation. When I first started immersion, I was really

intimidated to call physicians and make recommendations, but I have learned that it’s not about

me. When you put the patient first, you do what you have to do to provide the care they need.

Nursing requires you to keep an open-mind, to provide the same quality of care for patients

despite how similar or different their culture, religion, values or beliefs are from your own.

Throughout my clinical experiences, I have cared for patients very different from myself and I

have challenged myself to always provide the best quality of care for my patients despite these

differences.

Nursing requires commitment to safe practice and endurance. When you are on day 4/4

of back-to-back 12-hour shifts and no amount of coffee can touch your exhaustion, nursing

requires you to stay focused and maintain safe practice because a mistake could cost a life.

During my immersion, I recognized a mistake my preceptor made in calculating a dose for a

medication. While I was nervous to speak up and vocalize that she had made a mistake, she was

appreciative that I did because we were able to protect the health of the patient. Nursing requires

for you to always look for ways to improve. At this point in my career, after finishing three long
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years of staying up late to study for exams and showing up for clinicals at 6:30 in the morning, it

would be very easy for me to become complacent and put off further education. However, I

know the importance of continued education in nursing practice and, therefore, will continue to

seek out ways to grow and develop as a nursing professional.

Values and Beliefs

When I read through my personal philosophy from NUR 1100, I’m surprised by how

much my current values and philosophy align. As written in that paper, a belief “represents the

intellectual acceptance of something as true or correct” (Black, 2014, p. 256). Beliefs are stable

and resistant to change and, therefore, I expected my beliefs to remain similar. In NUR 1100,

part of my personal philosophy was providing patient-centered compassionate care. I believed,

and still believe, that in order to provide this form of care, I must maintain a non-judgmental

attitude towards other’s beliefs. I accept that it is not my duty as a nurse to change another’s

person’s beliefs because they differ from my own. Further, from my experience in global

outreach, I have learned the art of listening to others to understand without necessarily accepting.

In order to be a culturally-competent nurse and provide the highest quality of care, you have to

be willing to listen to what others believe, even if you know you won’t accept those beliefs into

your own personal belief system.

Values are defined as “the freely chosen principles, ideals or standards held by an

individual…that give meaning and direction to life” (Black, 2014, p. 258). I expected that my

experiences throughout nursing school would alter my values, but, in reality, they have

strengthened and added context to the principles by which I live my life and conduct my nursing

practice. In my original paper, values that were important were personal responsibility and

accountability, patient advocacy and lifelong learning. Through my time in nursing school, I
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have learned the importance of personal responsibility and accountability. I have observed nurses

go before the Virginia Board of Nursing and own up to mistakes they made in their practice and

accept the Board’s rulings with dignity and respect. I have watched as nurses advocate for their

patient’s wishes, despite having to go against the wishes of the family or a physician. Through

my evidence-based research class, I have learned the importance of assessing our practice for

ways to improve and that it is okay to ask “why?”.

Nurse-Patient Encounter

The four domains of practice that make up the nursing professional practice model of

Bon Secours are community-focus, person-centered care, professional excellence and ministry

leadership. A recent immersion experience on CCU at St. Mary’s embodies the domain of

person-centered care. Given the patient population, I’ve had a lot of experience developing my

nursing skill set by doing things such as putting in Foleys, starting IV’s, caring for patients on

vents, giving medications through many different routes, monitoring cardiac output utilizing

pulmonary artery catheters and more. However, during a recent immersion experience, my

patient expressed to me at the beginning of my shift that his clinical issues were not a priority for

him. He was extremely upset with care he had received at another Bon Secours facility and felt

that his healthcare providers had not been up front with him about his condition. He felt that

people were coming into his room and talking around him rather than to him and that his

healthcare providers were having conversations about him that were not being discussed with

him directly. I told him at the beginning of my shift that my goal for the day was to assist him in

working through some of his frustrations, facilitate him in becoming an active member of his

care and be in a better state of mind by the time night shift arrived.
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I ensured I was present at every interaction he had with his physicians that day. I voiced

his concerns to the physicians and facilitated any questions he had to the correct physician so

they could be answered. I went over every medication he was receiving and why. I placed a

consult for patient advocacy to come and speak to him and to help him in changing practice so

future patients would not have similar experiences during their care at Bon Secours facilities. By

the end of my shift, the patient was visibly in a much better state of mind and thanked me for

helping him work through his emotions throughout the day. This embodies person-centered care

because we should always strive as nurses to put the patient at the forefront of their care plan.

This patient was upset because he felt he wasn’t an active member of his care and I worked to

reorient him to the center of his care. In order to provide holistic care, it’s important to assess all

of our patients needs at the beginning of our shift and I was able to meet the patient’s spiritual

and emotional needs because I didn’t dismiss them and choose to focus on the patient’s physical

condition or clinical issues.

Change Agent

To me, a change agent is someone who is initiating and leading change in their

environment. During the NUR 4140 practicum, we are all acting as change agents as we take on

an issue in our community and work together in creating an intervention that will improve

patient outcomes. With the members of my group, I am working to tackle uncontrolled high

blood pressure among patients who visit Care-A-Van. To me, this is an incredibly important

issue because Care-A-Van works to create sustainable health in the communities they serve. This

allows them to continue moving into other communities who are underserved and in need of

assistance. We have conducted a root cause analysis and a literature review of evidence-based

research to develop an intervention we believe could assist Care-A-Van in managing chronic

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conditions, specifically hypertension, in the patients they serve. We will present our findings and

intervention to the leaders of Care-A-Van in an effort to aid them in tackling their issue. This

experience has been a great learning opportunity because it has taught me the steps that go into

changing nursing practice. Lifelong learning is a part of my nursing philosophy because

healthcare is an ever-evolving field and we are constantly developing new interventions that can

improve patient outcomes. I believe this project will aid me in advocating for change in the

future and will serve as a good foundation for continued learning and improvement of practice.

Skill Acquisition

In Benner’s “From Novice to Expert”, she talks about the Dreyfus Model of Skill

Acquisition and how nursing students and nurses develop their nursing skills and competence

within their practice (2001). The Dreyfus model suggests that in the acquisition and development

of a skill, a person must pass through five levels of proficiency: novice, advanced beginner,

competent, proficient and expert. Upon starting nursing school, I was a novice. I had no real

experience in the situations in which nurses are expected to act and intervene and, therefore, I

needed objective measures and context-free rules to guide my actions (Benner, 2001). For

example, at the beginning of nursing school, we are taught how to check blood pressure

manually utilizing the two-step method. I had never checked any person’s blood pressure prior to

learning this skill and, therefore, I followed the process exactly as I was taught. Now that I have

checked many people’s blood pressures during my nursing school experience, I know that I can

generally pump up to about 160-180mmHg to get a BP reading and do not need to utilize the

two-step method.

I believe I am now at the advanced beginner level of proficiency in nursing practice.

Benner describes this level as individuals who can demonstrate “marginally acceptable
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performance”, but who still need support in the clinical setting (2001). They are individuals who

need assistance in setting priorities and need preceptors to point out important aspects of care

that may be missed due to a lack of experience in the field (Benner, 2001). While I have a lot

more experience working with patients than I did when I started nursing school, there are still

many situations I haven’t had to deal with and that I would feel nervous intervening given my

lack of experience. I believe this is the reason that all new graduates are placed with preceptors

out of nursing school because they need support at the beginning of their nursing practice to keep

themselves and the patients safe. I value this practice and the support as I continue to learn and

grow more competent in my nursing practice.

Action Plan for Moving Forward

In order to move into the “competent” level of skill acquisition, I will need more

experience at the bedside and will need to learn how to remain organized despite a plethora of

demands. My patients in the morning will need a great deal of things, from medications to

assessments, from baths to teaching, and new graduate nurses who are at the advanced beginner

stage of skill acquisition are very reactive to situations. We don’t have enough experience to

predict our patient’s needs and, therefore, feel we are always being put off schedule from what

we originally planned for the day. In an effort to move towards competence, I will attempt to be

proactive as a new graduate nurse. I will take every chance to learn and I will be humble enough

to admit when I don’t know how to do something and ask for help. I will work to improve my

time management and learn how to cope when I feel I am “drowning”. I don’t expect to reach

competence within a year, but I hope to be close to this level of skill acquisition by two years

into my practice.
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Furthermore, nursing school has taught me that it is nearly impossible to care for others

when you don’t take the time to care for yourself. Just as we do with patients, I want to

holistically care for myself. I plan to develop a workout routine that fits into my schedule and

exercise to maintain my mental and physical health. Additionally, I hope to pack healthy lunches

and snacks to keep my body fueled for whatever the day decides to give me. I plan to drink lots

of water and enjoy my days off so that I can come into work refreshed and prepared to handle the

stresses of the job. I plan to participate in the new graduate nurse residency program and climb

the clinical ladder in an effort to continue my professional development after I have completed

nursing school. I also will look into joining a professional nursing organization to gain additional

support from fellow healthcare members and to attempt to stay up-to-date with nursing advances

in technology and practice. Finally, I will nurture my spiritual self by getting back into church

and praying more often. This program and my experiences in clinicals have taught me that I have

so much to be thankful for. I am blessed to be surrounded by an amazing support system, I have

the opportunity to help others every day and I love the work I do. I am thankful to be in a career

that allows me to continuously grow and learn and I am grateful that I can drive home every day

knowing that I am making a difference in the lives of others. I hope to continue to develop my

personal philosophy with every patient encounter and I look forward to countless more

opportunities to strengthen my values and beliefs.

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References

Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing

practice (2nd ed.). Upper Saddle River, NJ: Prentice Hall Press.

Black, B.P. (2014). Professional nursing: concepts and challenges (7th ed.). Maryland Heights,

Missouri: Elsevier.