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Looking Back in Order to Look Forward

Michelle A. Stimson

Ferris State University

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Abstract

Changing roles within a profession can be challenging (Owens, 2014). Reflecting on past

experiences within a role, allows one to view a new role with more clarity and understanding.

The development of nursing knowledge, nursing's uniqueness as a discipline, and the nursing

metaparadigm concepts are explored in this paper. The process of transitioning from a

bachelor's prepared nurse into the role of a mater's prepared academic nurse educator are

discussed.
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Looking back in Order to Look Forward

Changing roles within a profession can be challenging (Owens, 2014). Reflecting on

past experiences within a role, allows one to view a new role with more clarity and

understanding. The ability to communicate these changes to others strengthens the profession

and allows for a smoother transition from one role to the next (Owens, 2014). This can be

especially true when one transitions into an advanced specialty nursing role (Owens, 2014).

This paper will explore how I intend to make the transition from a bachelor's prepared nurse

into the role of a mater's prepared academic nurse educator.

Nursing Knowledge

The profession of nursing has not always been defined as a distinct body of knowledge

(ANA, 2010). Florence Nightingale, the founder of modern nursing, paved the way for

nursing to separate itself from medicine and establish itself as a unique discipline (ANA,

2010). She did this by establishing formal schools of nursing as well as stressing the

importance of collecting empirical evidence (ANA, 2010). Over the past century, as nurses

have become more educated in advanced practice and specialty roles, nursing knowledge has

expanded and developed through research and the development of theories.

Nursing knowledge is rooted in the applied and behavioral sciences such as biology,

pharmacology, physiology, and psychology (ANA, 2010). It is how the knowledge is applied

in the treatment of the patient as a whole person that makes nursing unique. The nurse not

only attends to the physical needs of the patient, but also their spiritual and psychological

needs (Tourville & Ingalls, 2003). Florence Nightingale believed that nurses had a

responsibility to care for the whole person and that caring is essential to nursing practice

(Tourville & Ingalls, 2003). Virginia Henderson believed that the mind and the body are
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inseparable (Tourville & Ingalls, 2003). Brockopp and Hastings-Tolsma (2003) state,

"Nursing has the unique focus of knowing, experiencing, and understanding patients and their

experience of health. No other discipline purports to be concerned with the whole person..."

(p. 11).

Barbara Carper (1978), believed that it was essential for nurses have "knowing" in

four bodies of knowledge. The four bodies of knowledge include: the science of nursing, the

art of nursing, personal knowing in nursing, and moral understanding in nursing (Carper,

1978). These bodies of knowledge allow the nurse to care for the whole person in a

competent and professional manner. Neither one by themselves are enough to sustain an

adequate knowledge base for professional nursing nor enough to approach problems or

questions within the profession of nursing. She believed that these four patterns of knowing

should be emphasized and embedded in nursing curriculum. An academic nurse educator

would play a key role in facilitating that process.

One way nursing knowledge expands and grows is through the development and

testing of theories. Nursing has scholars within the profession who have scientifically proven

nursing's unique contribution to patient outcomes. Florence Nightingale demonstrated

decreased mortality for soldiers within the hospital setting by implementing sanitation

practices (Tourville & Ingalls, 2003). Virginia Henderson developed patient centered care

plans that helped define the scientific basis for nursing interventions (Tourville & Ingalls,

2003). Through her theory of human caring, Jean Watson demonstrated nursing's unique role

in caring for the whole person, not just their physical ailments (Tourville & Ingalls, 2003).
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Significance of a Unique Body of Knowledge

Since the time of Florence Nightingale, nursing theorists have presented and tested

theories (Tourville & Ingalls, 2003). According to Dudley-Brown (1997), "...a nursing

theory is a conceptualization of phenomena and relationships in or pertaining to nursing for

the purpose of describing, explaining, predicting and/or prescribing nursing care" (p. 77). It

was not until the second half of the twentieth century that conceptual frameworks and

paradigms were introduced as a way to categorize the data generated within the discipline of

nursing (Masters, 2012 ). The nursing metaparadigm concepts of health, environment,

nursing, and person allow a theory to align with common values and concepts within the

discipline of nursing. The metaparadigm concepts can be viewed as roots of a tree. They

play a key role in keeping the profession well grounded in its founding principles (Tourville

& Ingalls, 2003). Integrating nursing's values into their students is one responsibility of the

academic nurse educator (NLN, 2012).

The metaparadigm concepts of health, environment, nursing, and person are widely

accepted within the nursing community (Tourville & Ingalls, 2003). They help create

boundaries for the profession and "summarize its intellectual and social missions" (Tourville

& Ingalls, 2003, p. 22). Creating a metaparadigm helped nursing define itself as a unique

discipline. According to Masters (2012 ), "each discipline singles out phenomena of interest

that it will deal with in a unique manner” (p. 3). Without that structure, information learned

from the testing of theories would be less "...meaningful for practice, research, and further

knowledge development" (Masters, 2012, p 3). This framework allows for consistency in

nursing research, education, and practice (Masters, 2012).

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The person is the one with whom the nurse interacts with in a professional and

therapeutic manner (Tourville & Ingalls, 2003). This could be a single person or a group of

people (Tourville & Ingalls, 2003). Environment is where the therapeutic relationship occurs

(Tourville & Ingalls, 2003). A hospital, outpatient clinic, community center, or a patient's

home are all examples of environments of care (Tourville & Ingalls, 2003). According to

Tourville & Ingalls (2003), health is defined "as the optimal level of one's potential relating to

the environment" (p. 22). Betty Neuman believed (as cited in Tourville & Ingalls, 2003), "the

role of the nurse is to help restore or maintain the stability of the person's health and coping

ability" (p. 26). A person who is restored back to their optimal level of functioning related to

their illness or injury is considered healthy. Nursing can influence persons, environment, and

the health of individuals or the community in which they reside. Nurses incorporate all

aspects of the person while planning their care.

According to Jacqueline Fawcett (Butts, Rich, & Fawcett, 2012), the survival of

nursing is dependent on the "understanding of the nature and structure of nursing knowledge"

(p. 152). Part of that structure includes the metaparadigm concepts. She believes that each

nurse needs to have a strong understanding of nursing conceptual models and theories.

Nursing theories provide an explanation for what we do and why we do it. They define us as

a profession. If they are not aligned with our values and mission, nursing will not continue to

exist as a profession, but instead as a trade (Butts et. al, 2012). Therefore, it is necessary that

the four metaparadigm concepts be defined in all nursing theories. They are the basis on

which nursing knowledge is created. According to the National League for Nursing [NLN]

(2012), the academic nurse educator is responsible for developing curriculum that teaches

nursing theoretical concepts.

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The American Nurses Association [ANA] states, "nursing interventions are intended

to produce beneficial effects, contribute to quality outcomes, and above all, do no harm"

(p. 4). Nurses accomplish this by evaluating "the effectiveness of their care in relation to

identified outcomes and use evidence-based practice to improve care" (ANA, 2010, p. 4).

Knowledge generated from the testing of theories is used to guide practice. Doing this

produces optimal results for patients cared for by nurses. Florence Nightingale believed

human beings had a responsibility to improve human conditions (Tourville & Ingalls, 2003).

By using the nursing process to establish plans of care based on the assessment and diagnosis

of each individual or group, nursing carries out that mission and influences the human

condition for the better (Tourville & Ingalls, 2003). According to Martha Rogers (as cited in

Tourville & Ingalls, 2003), "the purpose of nursing is to help the individual achieve his/her

maximum well-being through the use of scientific knowledge and the art of nursing" (p.30).

Role Development

The role of the academic nurse educator has been slow to develop (NLN, 2012). In

the past, nursing education occurred much differently than it does today. A majority of the

training happened in poorhouses and on battlefields (ANA, 2010). It was Florence

Nightingale who laid the groundwork for formal nursing education (NLN, 2012). She

believed nurses should practice independently and separate from medicine (Tourville &

Ingalls, 2003). The focus on theoretical concepts as the foundation of nursing education

stems from Florence Nightingale (NLN, 2012). Through advanced education in nursing,

theoretical knowledge and nursing research has grown and developed (ANA, 2010). As

nursing education has shifted from hospital-based venues into the academic arena, the role of

the academic nurse educator has become increasingly necessary (NLN, 2012).
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The academic nurse educator is an advanced specialty role within the profession of

nursing (NLN, 2012). After proper education and training, one would qualify for

employment as a faculty member within the academic setting. Educational requirements

include a master's and/or doctoral degree concentrating in nursing science and educational

theory and instruction (NLN, 2012) The role is multi-dimensional and requires competency

in eight defined areas of practice (NLN, 2012). Examples include: the facilitation of learning,

functioning as a change agent, participation in curriculum design, and evaluating program

outcomes (NLN, 2012). Developing mastery within the role takes time. This can be

achieved through mentoring, continued professional development, and practice (NLN, 2012).

In her article, From Bedside to Classroom: The Nurse Educator Transition Model,

Anne Schoening (2013) discusses the transition process from a bachelor's prepared bedside

nurse into the role of an academic nurse educator. She acknowledges one's unfamiliarity with

the academic environment can serve as a barrier to a successful role transition. Also, the lack

of a structured orientation and minimal professional guidance can be burdensome to new

faculty. Participants in her study felt unprepared for their new role even with a master's level

education. They recognized work experience within the clinical setting alone did not prepare

them for their role as an educator. According to her research, a successful transition into the

role of the academic nurse educator includes: establishing boundaries with students,

integrating the role of "teacher" and "nurse", focusing on the process of learning rather than

the end product, and understanding that ambiguity exists within the academic setting. She

recommends seeking out coursework in curricular design and other advanced concepts as one

way to prepare for the role. The academic institution needs a structured, in-depth orientation
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process and mentoring programs in place for new faculty. Both of these concepts are

considered hallmarks of excellence in nursing education by the NLN (NLN, 2012).

Currently, I am enrolled in a master's level nursing education program with the goal of

becoming an academic nurse educator upon its completion. The program includes class work

in nursing theory, critique of nursing research, curriculum design, educational theory, and

professional nursing. These meet the standards of the NLN, as well as, line up with the

recommendations made by Schoening (2103). Schoening (2013) also found that unrealistic

expectations of the academic nurse educator role hinders a successful transition. I have been

employed by the same community college as an adjunct faculty member in the division of

nursing for the past twelve years. I currently teach within the clinical and simulation lab

environment. Through my employment, I have developed great insight into the role of the

academic nurse educator. I am aware of the challenges and rewards of the role and have been

successfully functioning within the academic environment for quite some time. Although, I

have taught minimally inside the classroom, my hope is to have more exposure in this area

during my "role immersion experience" through graduate school. Through that experience, I

will be paired with a professor in order to gain knowledge and understanding of teaching

within the classroom environment. I also hope to gain experience with curriculum

development and educational delivery methods. I have many peers who are full-time

professors and have offered to provide me with a structured orientation and mentorship. I

have already accepted a mentorships from a peer while I am completing graduate school.

Through that mentorship, I have gained more exposure to other areas of the nursing program

such as community outreach and concept-based curriculum teaching strategies. My ultimate

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goal is to be hired into a full-time professor role within a college a nursing. Through that role,

I hope to partake in the transformation of nursing education design and delivery.

Conclusion

It was Florence Nightingale who believed nurses should practice independently from

medicine. To do so, she established formal nursing training programs. She emphasized

professional nursing and the need for grounding interventions in science and empirical data.

With her guidance, one's journey into the profession of nursing begins as a formal education,

rather than a "training". The role of the academic nurse educator has evolved from the need

to teach nurses theoretical principles and care based on scientific evidence. Barbara Carper

(1978) expressed concern that nursing science has not developed or on par with other applied

sciences. More scientifically proven evidence of nursing's unique contributions to the patient

as whole and how nursing applies its knowledge within that experience is needed to further

define the profession and its unique body of knowledge. The role of the academic nurse

educator can further that mission through research, scholarship, and the education of students

entering the profession.

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References

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