NURS 1511 Profession hood and Knowledge of Nursing Is Nursing a Discipline and/or Profession? The foundation of nursing is that nurses bring their humanness to a caring practice in which each nurse intentionally chooses how to be a nurse and how to be in interaction with others. At its essence, nursing is about connections and relationships. It is essential to consider what it means for nursing to be a discipline and/or profession. In order to maintain what nursing is and should be, we must remember the disciplinary foundation of nursing. It is about “being with” people who need the help of a nurse. I believe that nursing is both a discipline and a profession. However, I think that in our current health care contexts, nurses are at risk for forgetting their disciplinary foundation – they risk losing the essence of what nursing is or should be. The main driving force for this risk are factors within the nurse and environment or within the interaction between nurses and their environments that shift the focus away from the basics of nursing toward a technical view of the human experience in health and illness. Prioritizing the technical aspects of care, tasks, and the technology used in care to the exclusion of what it means to be human and human connections do not reflect the essence of what “nursing is”. Rather, such focus reflects in part what nurses frequently do. Nursing as a Discipline Nursing is distinct from other disciplines. Yet, even nurses are not always able to articulate answers to the question of “What is nursing?” This was evident to me in a mental health organization when nurses were asked, “what is mental health nursing?” Their responses often focused on nursing tasks and duties in an effort to show how nursing was distinct from other disciplines. However, many of the tasks mentioned could potentially be done by other staff. Interestingly, patients’ responses when asked about nursing, were more reflective of the essence of nurses. They spoke about ways that nurses were with them and listened that made a difference to their care and recovery. If nurses are challenged in articulating nursing, how can nurses demonstrate to society that nursing is important or even essential. Therefore, nurses must understand and article what nursing is?
Nursing is a complex discipline that requires much more than being competent at technical skills. Despite the need for and importance of technical competency, such competency is not sufficient. Below are some ideas about how nursing meets the requirements of a discipline. As you progress through this course and the nursing program, I hope you will re-visit these ideas to enhance your understanding of what nursing is.
- Academically, nursing is a discipline because it has its own branch of education and departments of learning; and nurses are educated about nursing’s domain of knowledge.
- Nursing has specific approaches to knowledge and knowing that are distinct from other disciplines.
- Nursing has discipline-specific language to convey its role in society.
- Nursing has theories and philosophies of science which serve as the foundation for discipline-specific knowledge.
- The discipline reflects what nursing, not other disciplines such as medicine, holds as important: nursing’s values, its heritage and traditions, and knowledge development toward sustaining caring, humanity, and health for all.
- The discipline reflects nursing’s ontology (how nurses think about ‘being’), not that of other disciplines such as medicine: the whole person and a relational unitary worldview.
- The discipline reflects nursing’s, not other disciplines such as medicine’s, philosophical orientation toward humanity and ethical global covenant with humanity.
- The discipline reflects nursing’s theories, orientation toward knowledge development, and what counts as knowledge, rather than the views of other disciplines, and goes beyond conventional Western science and medical epistemologies.
- The discipline reflects nursing’s, not other disciplines such as medicine’s, research traditions and diverse, evolving approaches to knowledge development, the disciplines specific orientation to knowledge, and approaches and critiques re “what counts as knowledge”.
- The discipline reflects nursing’s, not other disciplines such as medicine’s, expanded, diverse, creative, and innovative methodologies and methods consistent with human caring-healing, as well as health-illness experiences and phenomena.
A clear disciplinary foundation is required to guide development of the nursing profession. Without this disciplinary foundation for knowledge and practice to guide the profession, nursing can easily be pressured to conform to a technical view of human experiences. This technical view contrasts with nursing’s disciplinary worldview that includes unity of mind, spirit and body.
Nursing as a Profession
The nursing profession needs the disciplinary foundation for knowledge and practice in order to flourish and succeed, and at the same time nursing deserves the recognition that is attributed by people in society to a profession. The ways in which a profession is defined are different from those of a discipline and a profession is more than simply a job. In general, professional nursing (e.g., RN) is differentiated from practical nursing (e.g., Registered
Practical Nurse [RPN] in Ontario) through advanced educational requirements and a more complex scope of practice.
Though there are various categories that could be used when considering if a job or a discipline is also a profession, the following five categories are a useful fit for nursing.
Institutions of Higher Education
A profession must have a clear educational pathway into the practice and a constantly growing body of knowledge within institutions of higher learning; it also has the pedagogical goal of providing students with the practical knowledge and theoretical basis to deliver safe and effective health care as integral members of the inter-professional healthcare team.
- Not all countries have a single pathway to becoming an RN; some countries, and also the Canadian province of Quebec, do not require a baccalaureate degree as entry to practice; a diploma is considered sufficient.
- In Ontario though a baccalaureate has been required for entry to practice since 2005.
- In Canada, all nursing graduates (for RN) write the NCLEX-RN examination before they can register as an RN, except Quebec that has its own exam.
Nursing as a profession is constantly expanding its scope of practice and challenging its workforce to continue its education, e.g.,
- RN prescribing in Ontario.
- College of Nurses of Ontario (CNO) Quality Assurance Program.
Autonomy of Practice One specific quality of a profession is that, under legislative approval, a profession operates independently in creating policy and it supervises its own professional standards and the practices of its practitioners. Autonomy is evident in nursing, e.g., in Ontario:
- CNO’s main purpose fits with this category.
- CNO develops and enforces regulations and standards.
- There is individual autonomy for nurses themselves under CNO and within workplaces (though can vary depending on workplace rules).
Adherence to an Established Code of Ethics
- Codes of ethics exist both provincially/territorially and nationally in Canada, and nursing organizations in other countries have their own codes of ethics.
- The CNO and the Canadian Nurses Association (CNA) both have ethics documents that codify the fundamental values of nursing in Ontario/Canada, establish the boundaries of nursing duty, and articulate the ethical responsibilities of the nurse.
- The CNO and CNA documents outline the guiding principles, obligations, and commitments of the nursing profession so that the public (society) understand nursing’s contract with society and can expect that all nurse with whom they interact will meet the ethical standards.
Expansion of the Level of Knowledge
- The existence of a well-defined and organized body of knowledge that can be applied within the complex healthcare environment is part of being viewed as a profession. Such knowledge exists in nursing, though the breadth and depth of knowledge is still being expanded and the knowledge is more established in some areas than in others.
- Nursing is a constantly changing profession and all nurses have an obligation to remain current and knowledgeable regarding advancing health care practices.
- Nurses are required to possess a strong knowledge base developed through evidence-informed practice.
- Nurses are required to be involved with research in some way, ranging from being a consumer of research as an RN (e.g., using others’ study results to enhance one’s own practice) all the way through to being a PhD-prepared researcher who conducts and leads research.
- In Ontario, all nurses registered by CNO must participate in the CNO’s Quality Assurance Program.
Common Culture and Values Present Among Members
A common culture and values is evident within a profession. One way to develop and maintain a nursing culture and to strive to ensure similar values across members of a profession is to develop and enforce professional standards, e.g.,
- In Ontario, the CNO standards and guidelines set out what is expected of nurses in Ontario.
- Nationally, the CNA code of ethics and the framework for the practice of RNs set out what is expected of nurses in Canada.
A culture of caring that encompasses the set of norms including altruism, excellence, caring, ethics, respect, communication, and accountability is important within the nursing profession.
- This culture begins within the confines of nursing education.
- Undergraduate nursing curricula emphasize caring as a basic tenet of nursing education.
- Student nurses learn that the art and science of nursing involves all dimensions of patient care.
- A focus on the patient’s needs is paramount for nursing students as they develop a connection with the patient. A connection to the patient is part of the initiation of compassionate appropriate care.
- The establishment of core values in the education of a student nurse is part of the advancement of a strong caring culture in the nursing profession* The discipline of nursing is what holds nursing’s timeless values, its heritage and traditions, and knowledge development toward sustaining caring, humanity and health for all. The discipline is what holds and honors ontology of whole person – the unity of mind body spirit and a relational unitary worldview.