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Running head: A PHILOSOPHY OF NURSING

A Philosophy of Nursing

Bon Secours Memorial College of Nursing

Makenzie Ludwig

Dr. Marcella Williams DNP, RN, CNE, CMSRN

&

Faith Miller, MSN, WHNP, RN

NUR 4140: Synthesis of Nursing Practice

October 31, 2020

“I, pledge”
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Definition of Nursing

Nursing is sometimes defined, simply, as bringing one back to their original state of

health or well-being. I feel that nursing will be one of the most impactful experiences of my life,

therefore encompassing far more than “just” nursing someone back to health. Nursing is running

into battlefields to assist in rescuing a soldier while also assessing/triaging them. Nursing is

stepping into an operating room to monitor the patient while a physician places a new heart into

them, when their heart could not beat any longer. A nurse is someone who says good morning

and good night to an elderly patient that can’t remember their name. A nurse is someone who can

walk into a hospital during a pandemic and not think twice, because taking care of the patient’s

inside is where they are called to serve.

The basis of nursing begins with a person simply reading a book, listening to someone

speak, and sitting at a desk, whether, in a classroom or virtually. While attending Virginia

Commonwealth University (VCU) with a major of Biology and a pre-medicine focus, I had a

sudden realization, I wanted to be a nurse not a Doctor. I wanted to be the Doctor’s eyes and

ears; working the front lines and caring for these patients holistically. This led me to Bon

Secours and their continual service to the poor and underserved. The basis that I’ve received in

the three years of nursing school is the first set of building blocks that I will continually build

upon for the rest of my nursing career.

To be caring is to be kind, understanding, helpful, sincere, supporting and encouraging.

As a nursing student, I’ve learned that it is important to remind yourself each day that you are

there to help heal people. People that come to the hospital don’t typically want to come, most of

the time they are there because they have to be. They are sick and need a nurse that is not “burnt
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out, tired, ready to go home”, they need a nurse that is kind and present in the moment. Nursing

is a service to people in need.

Personal Philosophy

Throughout nursing school and life, I have been lucky enough to meet many different

types of people. I’ve worked in different areas inside and outside of healthcare. I’ve developed

so many relationships and have molded to various working environments. As a patient care tech

(PCT) I’ve served as a waitress, hairdresser, advocate, sitter, engineer, cleaner, cheer leader, and

a person to lean on. I try to listen completely to each patient that I care for, putting in the effort to

acknowledge their needs/wants of the day. This effort develops trust in patients that otherwise

may not have had that trust. Having open communication between the nurse and the patient and

the nurse and the interdisciplinary team can also strengthen the trust on the unit. If everyone is on

the same page, then there shouldn’t be any surprises, therefore creating confident relationships.

These relationships have helped me develop my own standards of ethics. Integrity,

dignity, nonmaleficence, and autonomy are what I want to continue to implement going forward

into my nursing career. Integrity or having the honesty to own up to what you are doing and what

you have done is crucial in the nursing environment. Being able to admit that you are wrong and

that you may have messed up, can go as far as saving a patient’s life. Autonomy or treating each

patient as their own person is legally required by every nurse. A person has the right to refuse

and make their own decisions as long as they are of sound mind. Efforts to keep each patient’s

dignity need to be continuously implemented as it can be often ignored. I always try my best to

close doors, shut curtains, and keep my patients covered as I take care of them. Being in the

hospital can sometimes strip Patients of their dignity, by trying to maintain it, I feel that it

increases their confidence and sense of security. Another huge ethical principal that I will go by
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is nonmaleficence, or to do no harm. This can be implemented in my practice by simply triple

checking each medication that is administered. I believe that five years down the road if I were to

rewrite this paper, my ethical principles could be even more extensive, because as I gain

experience, I hope to gain wisdom.

Values and Beliefs

I feel that my values and beliefs have not changed very much since my original

philosophy of nursing paper. I believe that they have been strengthened, gained more detail and

are backed by evidenced based practice and experiences that I have endured. Again, maintaining

human dignity, encouraging autonomy, practicing nonmaleficence and always expressing

compassion in everything I do. These ethical values are what can create a positive work

environment and patient-nurse relationship. I also value trust and humility in the nursing

environment, as I feel that they go hand in hand. Being able to express that you have done

something wrong can create a sense of trust with the managers, nurses and patients on the unit. I

feel that I will continue to add on to my list of values and beliefs as I begin my nursing practice.

Nurse to Patient Encounter

A nurse to patient encounter that I experienced that stuck with me would be a time when

a patient was beginning to be discharged. This patient had been experiencing uncontrolled eight

out of ten pain throughout the day, with no relief from high dose pain medication. This patient

was upset when their Doctor came into their room and told them about their plans to discharge

them in just a few hours. The patient called their nurse and I into the room and was expressing

their pain, when it started and that it had become uncontrolled. The patient would be sent home

on a high dose Tylenol prescription that wasn’t touching the pain when administered earlier that

day. I expressed my concerns to my preceptor, and we expressed those concerns to Doctor. The
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Doctor seemed to be stuck on the fact that this pain was chronic pain and not acute pain.

However, upon assessing the patient and specifically the onset of their pain we concluded that

this pain was a new pain. We then progressed the situation to the charge nurse who said that we

should again reach out to the discharging Doctor. The Doctor then came up to the unit and

consulted the patient again, regarding the pain. My preceptor and I stood at the bedside while the

Doctor consulted them. The patient expressed their pain to the Doctor as she did us, which did

cause the Doctor to reconsider the discharge orders. They added on a slightly stronger pain

medication and told the patient that they needed to consult with a specialist that wasn’t supplied

at St. Francis Hospital. The patient seemed relieved that they were listened to and were ready to

be discharged so that they could set up an appointment with the recommended specialist, to help

treat their underlying condition that was causing the pain.

When I realized that the Doctor had misunderstood the patient’s cause of pain, it caused

me distress. I was desperately trying to get the point across to the doctor that this was an acute

pain rather than a chronic pain. I actually mainly spoke to the doctor regarding the patient, which

allowed me to think about the Bon Secours Professional Practice Model. Feeling compassion for

that patient and I felt that I put that patient in the center of their care (patient centered care). I feel

that I displayed professional excellence in the way that I approached the situation as well as

collaborated with the charge nurse and the Doctor.

Role as a Change Agent

Creating a project based to improve Sepsis treatment in St. Mary’s hospital has felt very

impactful over the last few months. Communicating with the Clinical Care Lead (CCL) of the

Emergency department and suggesting our idea, and the fact that the CCL said that it was great.

Another way that I have felt that I can be a change agent is by my experience at two different
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hospitals. The way that each hospital operates is different and allowing me to visualize what

works on each unit I work on. I can take those experiences and transfer them to new units that I

work on.

Hospitals are ever changing and every one that works at a hospital has the opportunity to

change their workplace for the better. I’ve seen the beginnings of bringing Licensed Practical

Nurses (LPN) back into the hospitals to help with the nurse to patient ratios. I’ve seen Patient

Care Technicians (PCT) increase their scopes of practice. I’ve seen changes in nursing practice

over the three years that I’ve worked as a PCT. All of these changes are mostly positives and I

expect to see more changes as I switch into a nursing role. Furthermore, I hope to be able to

create and follow evidenced based practice to improve and impact every unit that I work on as a

nurse.

Benner’s Theory and Plan of Action when Moving Forward

While reviewing Dr. Benner’s theory “from novice – expert”, I feel that I am at the stage

“advanced beginner”. I don’t feel that I am in the “novice” stage because I have almost

completed the immersion experience. This experience has me following a preceptor and

performing tasks. These tasks aren’t independent, but my preceptor allows me to act on my best

judgement and will only step in if I am wrong. I feel that the “novice” stage really reflects me in

the first semester of nursing school. I was being taught how to be a nurse, but I wasn’t actually

practicing on real people. I was mainly studying the textbook and had not had any experience in

a nursing role. I believe and based on Dr. Benner’s theory, that once I graduate, I will still be in

the “advanced beginner” stage for one to two years.

However, I hope to move on to the “competent” stage of nursing following the first two

years of being a new nurse. I plan to do this by really pushing myself to find my place in the
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world of nursing. This could be as simple as gaining experience on the floor and familiarizing

myself with common ailments that are seen day to day. I would further study and research

(evidenced based practice) cardiac related ailments as I will be working on a cardiac step-down

unit. I will join the American Nursing Association as well as the Association of Critical Care

Nurses and utilize those organizations to take classes and obtain certificates. This will also help

me to see if I want to move to more critical nursing role: the emergency department or the

intensive care unit.

Selfcare is often pushed to the side. Throughout my life I have always loved being active.

This hasn’t changed much during nursing school, other than decreasing the amount of activity I

do weekly. Running, biking and hiking are great at reducing stress in my life, and I also find

enjoyment in each one. During nursing school, if I had a test that I was worried about I would

usually clear my head by going on a run. This helped relax me and allowed me to actually focus

on studying once I started. I feel that as I advance into my career as a nurse, the new grad role

and furthering my education I can confidently say that I will be able to continue my selfcare

throughout. I definitely plan time out of each week to go on long walks with my dog, bike, or

occasionally road trip to a great hiking location. I know that this will reduce my stress from the

week and allow me to feel rejuvenated going back into work.