Mar 06, 2016
By Claudia Steinke, RN, M.Sc., PhD , A. R. Elangovan, PhD

Elemental nursing: Knowing, doing, being

A reminder that what is so often missing from discussions about nursing practice is its art

When we sift through the characteristics that make for an outstanding nurse and for an outstanding experience for those on the receiving end of nursing care, we are reminded that there is both a science and an art to nursing.

The science of nursing pertains to what is done and how; the art of nursing focuses on who is doing it and why. Given the nuanced complexity of these four elements, it is troubling that so much of the discussion about nursing practice focuses mostly on the science: the activities a nurse needs to do and the correct way of doing them, the breaking down of each activity into steps and training the nurse to do each one well. The emphasis on the science of nursing starts in college or university, follows the graduate into practice and ends up on a pedestal in the form of protocols, assessments and metrics. This focus is narrow and yields, at most, only half the picture.

For nurses, a preoccupation with the science of nursing can lead to impersonal (albeit technically skilled) performance and in reducing people to their specific conditions (e.g., seeing and even referring to a patient as an abdominal pain or a maternity). In health-care facilities, we see this preoccupation reflected in broader structural and systems indicators, including staffing levels, absenteeism, admissions, discharges and handovers. In the health system, performance metrics are relied on to reassure management that activities — and those who carry them out — are on track; we are all familiar with the indicators of nursing care quality, including health-care-associated infections, pressure ulcers, falls, drug administration errors and patient complaints. Quantifiable measurements are useful and important but also seductive, and we would be well advised to pay heed to the adage that not everything that can be counted counts and not everything that counts can be counted.

The science of nursing has pushed the art of nursing into the background. Some nurses feel the loss of the missing elements in the convergence of their professional and personal identities and in a gradually fading understanding of why they entered the profession in the first place. The who and why of nursing are deeply personal and subjective, an internally driven quest of self-discovery rather than an externally driven acquisition of nursing knowledge and skills. The quest requires a deep self-reflection that brings an understanding of the reason they do what they do and of the central role their practice plays in shaping their sense of self.

Among educators and regulators, there is a push for standardization in how nursing knowledge and skills are acquired, but there is not nearly enough thought being put into ways to assist nurses in finding personal meaning in the profession and in their workplace. The result is that many of those who enter the profession for reasons of the heart often eventually lose heart in their troubled, demanding and sometimes toxic work environments.

Merging the science and art of nursing in one’s practice is not easy to maintain. It takes a lot of strength, courage and a clear sense of self to be a nurse; simply knowing what to do and how to do it will never be enough. If you feel that you are no longer bringing the best of who you are to your work, that you have become complacent or that work is less meaningful than it once was, your challenge is to find a way to reconnect with all four elements of nursing and reclaim your passion for nursing as one of the most important of human endeavours.

Claudia Steinke, RN, M.Sc., PhD, is an associate professor in the faculties of health sciences and management at the University of Lethbridge. She maintains her practice as an emergency nurse.

A. R. Elangovan, PhD, is a professor and director of international programs in the Gustavson school of business at the University of Victoria.

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