How does one “become” a nurse, as opposed to learning nursing skills? What is “being” a nurse as opposed to “doing” nursing?
On our Facebook page last week, we posted this query: “Professional identity is more than what you do—it’s a part of who you are. What does being a nurse mean to you?” One of the responses we received was, “Caring providers that own it, do right, work together and solve problems with innovative methods to improve care methods and optimize outcomes.
The respondent’s use of “own it” resonated with me: from the thesaurus, to own something means “to possess, preserve, maintain, hold, profess, declare, accept, have possession of…” To me, it hints at holding onto something valuable, being mindful of it and not losing sight of it.
This original post came about because I had recently attended a meeting at the University of Kansas School of Nursing, where a group of about 50 invitees were asked to brainstorm how nursing students develop a professional identity—How does one “become” a nurse, as opposed to learning nursing skills? What is “being” a nurse as opposed to “doing” nursing? Most of us say, when asked what we do, “I’m a nurse,” not “I do nursing.” And some of us identify as nurses long after we’ve stopped working as nurses.
When did you ‘grok’ nursing?
In his 1961 novel, Stranger in a Strange Land, Robert Heinlein made up a Martian word, “grok,” to mean really and truly and deeply understanding something, really “getting it” to the fullest awareness so that it was a part of you. So, we’d love to hear from you—when did you “grok” nursing? And when did that happen—in nursing school, with your first job, or later on in your career? Was it a gradual awakening, or was there a watershed moment/situation where you realized you were unconsciously thinking, feeling, and acting like a nurse?
I found several interesting pieces related to the concept of a nursing identity in AJN’s archives—see the list below. (They’ll be free to read through October.)
“Nursing as Metaphor,” by Claire Fagin & Donna Diers (September 1983)
“Charged to Mentor,” by Lucille Joel (February 1997)
“Nursing and the Human Condition,” by Lucille Joel (May 1997)
“Am I a Nurse?” by Donna Diers (October 2005)
“The Best People I Know,” by Maureen Shawn Kennedy (May 2015)
I’ve told this story many times.
You just never know when the stars will align and you’ll hear, see, or do something that will determine the rest of your career. I had a moment like that on my very first first clinical day, the day a gifted teacher taught me to think like a nurse and I knew I could do it.
Who forgets the first day of clinical? Even if you’ve been a CNA or a candy-striper, getting up and putting on that spandy-new student nurse uniform and shoes, walking into the hospital, and meeting your new classmates on your first floor is … .
Oh, who are we kidding. Many of us don’t remember a lot about our first days, really. Some had genuinely horrible experiences they laughed about later — much later– and most of us, meh, maybe not so much. But I did actually have a career-changing experience on my very first day of clinical, and if I haven’t told you about it before, sit down a minute and indulge an old bat. It might surprise you. Heck, it surprises me even now.
We were sophomores in college, 18, 19 years old. We picked up our uniforms at the downtown store the week before, individually, sight unseen; we dressed in the dark, and self-consciously made our way by subway or bus to the big hospital, finding the right building, riding the dark and creaky elevator to the sixth floor. We were excited but scared, with the usual wondering whether this was really the good idea it seemed a year –or gosh, a week– ago. We assembled in the hall in front of the nursing station and met our instructor for the first time. We exhaled a sigh of relief when she smiled kindly at us, noticing that we had sort of been holding our collective breaths.
“Good morning. I am Mrs. Vartanian and I will be your clinical instructor on Colly Six.” She read off our names alphabetically and peered at us over her glasses when we said, “Here” in small voices. She showed us the lay of the land and set us to passing out the breakfast trays, following up and down the halls looking for all the world like a big Rhode Island Red hen keeping an eye on eight chicks in the barnyard. After the trays went out she herded us all into the clean utility room. It was a cozy fit.
She showed us where things were, pointing out the various shelves: cath kits, gloves, wound packing supplies, liters of solutions. Then she picked up a huge brown glass bottle labeled “STERILE APPLICATORS” and unscrewed its lid. Applicators, we saw, were sorta like Q-Tips, but 6″ long ones with wooden stems, cotton end down. About about a hundred and fifty of them, about an inch down below the lip of the glass. “How would you get one of these out without contaminating the rest of them?” she said.
Eyes looked rapidly right and left. Feet shuffled a little, quietly, those soft-soled so-white Nursemates. We had done a lab on sterile technique but this wasn’t one of the things we practiced until our gloves were wringing wet inside. What to say? What if we get it wrong? What would happen to us?
Finally one of us said, hesitantly, “Pick one out with sterile forceps?” Mrs. Vartanian smiled and said firmly, “Good. Who can think of another way?”
Another way? What another way? We thought there was only one way to do any nursing task. Hadn’t we just spent a week in lab getting each item on the check-off list perfect? But…she wanted us to think of another way. Slowly, we started thinking. “Sterile gloves?” “The sterile scissors in a suture kit?” “Try to tip one out onto a sterile field? Even if there was more than one?” And as each new answer came, she smiled and nodded.
Standing in the middle of the group I felt a terrific idea forming. It give me goosebumps. We were free to think of different ways to do things, so long as we had a good rationale. No, that’s not it: We had to think of different ways. Knowing the why of things, you know how to apply them. There can be another way.
And so ever since that day I’ve looked for different ways to do things. When I was an ICU nurse I thought about the many physiological processes going on so I could choose a useful intervention. When I taught students I tried to explain things in several different ways, figuring each student would catch on to at least one of them. When I did case management I thought about the why and how of the challenges of explaining to employers and insurance adjusters.
Now I’m in independent practice and I have different challenges. But you know, to this day it surprises me to feel goosebumps when I figure something out. I hear Mrs. Vartanian’s voice just as it was that day, making me bold, defining my whole career, my life! in then-unknowable ways. “Who can think of another way?”