Wednesday, December 15, 2010

The True Identity of a Nurse

The True Identity of a Nurse
Natalie M. Starr
University of Kentucky

The True Identity of a Nurse
Caring is the essence of nursing. (Jean Watson, 1985, Nursing: Human Science and Human Care)  If you asked a room full of people to give one characteristic of a nurse, caring would most likely be the number one answer.  When most people think of a nurse, they think of someone who is kind, dependable, and always wanting to help.  Yes, these are the most obvious qualities of a nurse.  When I think of a nurse, I think of someone who provides around the clock care to critically ill patients.  To me, nurses are strong individuals who have many great characteristics that are not always recognized.  Nurses don’t have one identity; they have multiple.  Many people only see the outermost qualities, but the truth is the identity of a nurse is a wide range of characteristics and is constantly changing.  The individual perception the nurse has, the nursing staff perception on each other, and the perception they have on the community is never set in stone.
Individual perception
            A nurse has their own perception of themselves.  They may see themselves as reliable, confident, and smart.  They go about their day learning more about who they are and what their role is in their community.  They learn from their mistakes and grow as an individual while always evaluating who they really are. 
Who am I?
What I Know
            My family has had generations of people working in the hospital.  My grandfather was a surgeon in Louisville, my uncle is an ER doctor in Cincinnati, and now my brother Matt is ICU nurse in Lexington.  I look at these three important people in my life and they all have many similar qualities.  They are protective, intelligent, dedicated, and hardworking.  My uncle is very protective in a way that he is always keeping an eye on his two young daughters when they play outside.  My brother shows his intelligence in conversations with doctors throughout his shifts.  My grandfather loved the hospital and he performed to the best of his ability everyday he was there.  I always admired these three family members and they inspired me to want to join the nursing community.  Starting my research for this project I felt that I was knowledgeable on some of the characteristics a nurse has may have.  However, I soon realized that there is way more to a nurse than just the four qualities I described above.
Why Choose Nursing           
Nursing is very demanding and at times a high stress profession.  Many outsiders do not understand the reason behind wanting to become a nurse.  The shifts can be crazy hours and you could be on your feet for hours!  For Matt Starr, a nurse in the Immediate Care Unit (ICU) at Baptist Hospital, he chose this career so that he could “make a difference in improving the quality of life in others.” (Personal Communication, Matt Starr, 2010) From an interview with Matt Starr, I found that nursing allows people to give help to those in need and in return they receive a satisfaction of knowing they make a difference in someone’s life.  When asked in an interview about why he chose nursing, Starr stated, “It is very rewarding to apply my knowledge and skills to a critically ill patient.” (Personal Communication, Starr, 2010) I believe that this profession is very difficult at times, but knowing that all the hard work in school potentially saved or bettered a person’s life is worth it to the nurses.  They remember the long nights of having to cram for exams in order to get a passing grade.  In the end, it paid off for them because now they get to enjoy making an ill patient feel better. 
Starr also stated in his interview, “Nursing offers a high degree of versatility and upward mobility in career advancement.” (Personal Communication, Starr, 2010)  For example, Starr is now an ICU nurse and is planning to go back to school to become a Certified Registered Nurse Anesthetist.  In the nursing community, I have learned that anyone can go back to school to attain a higher paying job within the hospital.  Promotions are always available for the nursing community as long as you put in the hard work and time.  Research has showed me that nursing is not an easy career, and the outside community may never understand why someone would want to become a nurse.  However, those who have succeeded in the nursing community would not have it any other way.
Nurses Daily Routine
            For the most part, a nurse has a daily routine.  They can either have a day shift or a night shift. In an interview, Starr shared what his shift was like on a regular basis.  “I work the night shift on my unit, and the shifts are 12 hours long.  I come in at 7pm and the night shift nurses get together and self-assign two patients to each nurse.  Once I have my patients for the shift I go and get report from the day shift nurse who had my patients.  From there, I get organized and settled in for the night.  In the ICU we do a full patient assessment every 4 hours, which includes 7 systems: neuro, respiratory, cardiovascular, gastric, urinary, skin, and pain.  I also give lots of medications, ordered by doctors.  My night really depends upon the acuity of my patients.  Some nights I will be running around the unit nonstop trying to manage unstable vitals, or identifying changes in patient’s health status and having to wake up doctors at 3am for new orders.”  Starr explained that not every day has the same amount of stress.  There are some days where the nurse has an easy shift and their role is to watch over the patient.  Other days the nurse is constantly on the move making sure their patients receive the medical attention needed.  For Starr, “Many of the patients on the unit are unconscious and hooked up on ventilators, so we need to play the role of patient advocates and identify their needs.”  For nurses, their roles can change throughout the day as illustrated above.  However, they have the same duty every time they come to work; do the best work you can.
Nurses Emotions on the Job
            Emotions are a significant factor in a nurse’s life.  It takes a high degree of emotional intelligence to learn how to control what you feel in a stressful situation and place it aside so the task at hand can be accomplished.  When Starr was interviewed about his emotions on the job, he said, I have found that a nurse needs to know what situations to show emotion and empathy, and when to strictly think from an objective point of view so the best possible care can be provided to the patient.” (Personal Communication, Starr, 2010)  Nurses can be put in situations where it is life or death for a patient. 
A strong, confident nurse needs to give the patient and family the most useful information about which plan of action to take.  They need to put their feelings aside and give facts.  Starr stated in the interview, “It is hard to walk away from an emotional shift, knowing I gave everything I had but did not achieve the desired outcome.  But with every experience like that I learn how to be a better nurse, and provide the best care possible in emotionally intense situations.” (Personal Communication, Starr, 2010) Emotions are powerful and a nurse needs to learn when to show them and put them aside.  Only experience in the hospital will teach a nurse how to deal with their emotions.
            A nurse will form relationships with their patients.   Starr stated in his interview about relationships, “It is expected that we as nurses maintain a professional relationship with our patients.  In most cases these professional boundaries are kept, but the reality is that sometimes a nurse can’t help but have some attachment to a like-able patient they have provided care to for several shifts in a row.” (Personal Communication, Starr, 2010) Nurses want to do anything and everything possible to get the patient feeling better and out of the hospital.  Nurses become invested in the relationship with patient, and begin to see them as a person. 
Nursing Staff’s Own Perception
            The nursing staff is a family at the hospital.  They look out for each other and always want to be of help to the other nurses.  They expect the best of each nurse every day and anything less is unacceptable.  They see themselves as providers, caregivers, and people working toward the same goal.  They form relationships with each other, while having to deal with new roles.  This section will explain how nurses form close relationships with other nurses and the roles they partake as a group.

Nurses Relationships
            A nurse may form a close relationship with their patient, while also forming a closer connection with other nurses in the hospital.  The nursing staff on a specific unit usually has a family feel.  They work closely together and everyone is constantly looking out for each other.  The staff never lets an individual fall behind in their work.  If a nurse is ever in need of help, they go to the closest nurse and ask.  The family atmosphere doesn’t allow room for competition or tension between nurses.  Starr stated, “Everyone is working toward the same goal.  A good nurse is expected to help other team members without having to be asked.” (Personal Communication, Starr, 2010)  The hospital needs to provide a home for those living in it and the way the nurses act is a huge part in making this successful.  No matter what position a nurse holds, “everyone is considered an equal” (Personal Communication, Starr, 2010).
Nurses Roles
              Nurses’ roles in the hospital can change at any moment.  They always have to be ready to take on a challenge and learn how to adapt to a new task.  In the Community Palliative Carejournal it describes how the community matron (CM) is constantly going through changes of their roles at the hospital.  This journal stated “Much of their work involved close and continued support of patients and families in circumstances where such support really mattered and now it seems to be more task-oriented, and in relation to palliative care, to focus on providing nursing support at the very end of life.” (King, 2010, pg 93)  These nurses are constantly being asked to take on different tasks and do them to the best of their ability.  It starts to create their identity of being flexible within their job and being a dependable person. Exploring New Advanced Practice Roles journal states, “Community and primary care nurses are expected to take on increasing responsibilities for unscheduled care, transform the public health agenda and support people with long-term condition.” (Aranda, 2008, pg 6)  Nurses start to see themselves as responsible and accountable for others around them. 
As well as nurses’ receiving new roles, the community sector is also experiencing major organizational changes.  “The nursing community is being modernized daily trying to include attempts to deliver more accountable, efficient and responsive services, a greater focus on public health and ‘public involvement’ as well as improving value-for-money and workforce re-design.” (Aranda, 2008, pg 8) Nurses have to deal with the merging of hospitals and being transferred to other locations where their help is needed.  The merging of hospitals is an experience that brings upon stress to the nurses.  “Challenges and stresses arise from nurses making the transition from working in different settings, there is often a lack of clarity over purpose or remit, and the organizations in which they work are mostly ill prepared for new roles and the new ways of working that they are supposed to embody.” (Aranda, 2008, pg 5) Nurses have to be ready for change in an instance.  Nothing is normal or relaxing in a hospital setting.  Changes are being made daily and everyone needs to work together in order for the transition to be successful. “Successful organizational change always requires not just fundamental cultural shifts, but changes to an individual’s sense of self or identity (Traynor 1999; Crowe 2005; Leonard 2003).” (Aranda, 2008, pg 6) The merging of hospitals and new roles change how nurses see themselves.  They are being put into different scenarios and facing difficult challenges.  This is a part of being a nurse.
Nursing Staff’s Outlook on Community
Nurses are constantly dealing with the doctors and patients.  There is a certain way that they identify themselves when interacting with these groups.  They always need to be professional and at times sympathetic with the situation.  The following section will describe nurses’ different interactions with the community and how their identity is once again changed.
Interaction with Doctors
       The nursing staff is held to a standard at all times.  They are a community that is being judged and stereotyped with every interaction they have.  When interviewed Starr, “A nurse who is interacting with a doctor wants to appear confident, competent, and knowledgeable.” (Personal Communication, Starr, 2010) When nurses are speaking with doctors, they need to be professional.  Doctors have high expectations for nurses and rely on them to be a professional caregiver in the hospital.  The nurses have a say with what goes on in the hospital and how to solve the issues.  However, according to the journal Rethinking Ethnography, “Nurses who had senior positions in the unit were the most vocal in the group, while those with less experience or who worked in junior positions, were the least vocal.” (Manias, 2001, pg 239)  In the hospital, the nurses see themselves as the middleman.  They do not run the hospital, but at the same time are not looked down upon.  They are a very knowledgeable group and many people come to them for their help, such as patients. 
Interaction with Patients
       The interaction between nurses and patients is on a professional level.  The nurse needs to act mature, confident, and respectful.  Nurses go through training where they are taught how to deal with certain situations.  In a journal,Effective Interaction with Patients it stated that, “The training had taught the caregivers to reflect more, and with increased awareness, on the position of the patients and on themselves. The training had induced them to reflect on what moved the patients and why they exhibited specific behaviors.” (Van Meijel, 2009, 257)
Nurses sometimes need to take a step back and evaluate the situation.  They need to try and put themselves in the patient’s shoes and understand the emotions they are going through.  When a nurse does this it allows them to give advice that is honest and the most helpful.  “This growing awareness created a more nuanced perception of the patients and their possibilities and limitations. The caregivers experienced a broadening of their own attitudinal options.” (Van Meijel, 2009, 258)  This allowed nurses to become more flexible and they can easily let go of their discrimination.  The nurses were able to make a decision that best suited the patient’s needs and attitudes in a professional way.  
The nursing community is a changing environment where identities are constantly forming.  I believe that there is no set in stone identity.  Nurses may perceive themselves as personal caregivers who try to perform to the best of their ability every shift.  Through research, I have found that nurses need to come into work with a positive attitude and become more knowledgeable every day.  The nursing staff may identify themselves as people who need to be flexible and accept changes that may undergo.  They learn from each other and it creates a family environment in the hospital.  I have learned that everyone is an equal in the hospital and they are all working for the same goal.  Lastly, the nursing staff may see the community within the hospital as people that are in need of their help.  When they interact with doctors they need to be calm, competent, and dependable.  The doctors need them to carry out the tasks with a good attitude.  When a nurse interacts with a patient they need to understand that they are a professional caregiver.  Their emotions need to be put aside in certain situations and give the most beneficial information to the patient.  I think that being a nurse is an extraordinary job.  It is stressful at times, but in the end potentially saving or bettering someone’s life is worth it.


Aranda, K., & Jones, A. (2008). Exploring new advanced practice roles in community nursing: a critique. Nursing Inquiry, 15(1), 3-10. doi:10.1111/j.1440-1800.2008.00393.x.

Crawford, P., Brown, B., & Majomi, P. (2008). Professional identity in community mental health nursing: A thematic analysis. International Journal of Nursing Studies, 45(7), 1055-1063. doi:10.1016/j.ijnurstu.2007.05.005.

Dixon, E. (1999). Community Health Nursing Practice and the Roy Adaptation Model. Public Health Nursing, 16(4), 290-300. doi:10.1046/j.1525-1446.1999.00290.x.

Harmer, V. (2010). Are nurses blurring their identity by extending or delegating roles?. British Journal of Nursing (BJN)19(5), 295-299. Retrieved from Academic Search Premier database.

King, N., Melvin, J., Ashby, J., & Firth, J. (2010). Community palliative care: role perception. British Journal of Community Nursing, 15(2), 91-98. Retrieved from Academic Search Premier database.

Manias, E., & Street, A. (2001). Rethinking ethnography: reconstructing nursing relationships.Journal of Advanced Nursing33(2), 234-242. Retrieved from Academic Search Premier database.

Van Meijel, B., Megens, Y., Koekkoek, B., de Vogel, W., Kruitwagen, C., & Grypdonck, M. (2009). Effective Interaction With Patients With Schizophrenia: Qualitative Evaluation of the Interaction Skills Training Programme. Perspectives in Psychiatric Care45(4), 254-261. doi:10.1111/j.1744-6163.2009.00228.x.

Watson, J. (1985). Nursing: Human Science and Human Care. Connecticut, USA: Appleton-Century-Crofts.