One factor that distinguishes a profession from other careers is by its goal to advance society though making a positive difference in peoples’ lives. In nursing this is reflected in healing, caring, and encouragement of a lifestyle that enable well being, among other actions.
What are the specific characteristics of excellence in nursing that can be articulated? The National League for Nursing states that excellence is a core value:” It is a commitment to continuous growth, improvement and understanding. It is transformation, moving beyond the status quo and mediocrity.”(1)
Caring, knowledge, and skill are the foundation of excellence in the nursing profession. Nurses demonstrate excellence by preventing suffering and complications, they promote health and well being, they save lives and money, they are innovators and leaders. These are accomplished through such skills as patient centered care, evidenced based practice, and collaboration.
There are many nurse led initiatives and examples of attributes of excellence. Simply listing characteristics is not as meaningful as real life examples of nurses who are longstanding professionals. What is their view of excellence? How did they get there? What common themes emerge from their decades long experience as nurses caring for patients?
One theme that surfaced in more than one instance is that the nurse patient relationship is mutually beneficial. Patient experience of the healing process is valid and nursing care can foster progress in effective therapies. For example, the field of pharmacogenetics started from nurse observations of patients’ reaction to medication. Longtime nurses also expressed the attitude that there is always more to learn and education is life long. Not only do nurses learn from patients but they learn from their peers. Lifelong learning and ongoing professional development instill confidence in nursing as the ‘caring science whose knowledge is distinct from the other sciences’(2)
Another way that nursing excellence is demonstrated is when nurses become involved in creative ways to improve their workplaces. Nurses are experienced in effective and courageous communication. Board member Jean Logan and others, facilitated input from staff at Broadlawns Medical Center in Des Moines, Iowa. Because of this open communication the medical center was transformed from a so called poor people’s hospital with frequent ED visits to a primary care center focusing on prevention. In the same vein, Ann Marie Pinkham as a board member with the Free Medical Clinic in Columbia, South Caroline assigned to work with the publicity committee, enabled positive change. The committee felt their input was ignored and she was faced with hostility. Through persistent and dedicated communication they were able to forge a marketing strategy where the community was informed that for every dollar donated $8 in health care was provided. This awareness brought increased donations which encouraged the committee to become more engaged.
Nursing excellence is also demonstrated when nurses advance in leadership and are recognized outside of the nursing profession. One example is the appointment in late 2011 of the first nurse and woman to the rank of Surgeon General and Commander of the US Army.Medical Command, Major General Patricia Horoho.
Loyola University Hospital in Chicago wanted to develop a program to recognize nurses who demonstrated excellence in their work. Unable to locate a useful definition through research of the literature they composed their own attributes by reflecting on a variation of the title of this article: ”What kind of nurse would you want to take care of your mother?” Their first list contained the following: outstanding in care and communication, problem solver, lifelong learner, advocate and collaborator. The list was refined using the Delphi technique into 10 concrete characteristics which included the following: clinical expert, patient advocate, role model, coach/mentor, innovator, researcher and leader. Clinical expertise was demonstrated for example, by critical thinking skills, independence in practice, anticipation of patient needs, and patient education. Role model attributes were exhibited in part by the ability to influence peers and department communication, and having a positive personality. Teamwork and innovation were demonstrated by the ability to establish goals, being proactive, humble, and altruistic.
The promotion of the program detailed the 14 Forces of Magnetism to allow those nurses who wished to nominate their peers to reflect on the demonstrable characteristics of an excellent nurse. These included image of nursing, nurse as teacher, nurse leadership, quality, and autonomy. The 14 characteristics were refined by the American Nurses Credentialing Center into the 5 components of transformational leadership, exemplary professional practice, structural empowerment, and new knowledge, innovation, improvement, which will lead to the fifth, quality outcomes. These factors are interdependent and build on each other to create quality outcomes.
In the first year of the recognition program the committee decided to award 20 nurses which would represent 1% of the nursing staff. They also created the Nurse of the Year Award. The scoring system was a rank of 5 with 5 being the highest score shown by good examples from the nominee’s practice. The article did not give much detail on how the Nurse of the Year was selected. More detail on the selection of Nurse of the Year would have been interesting.
One of the most important aspects of the development of the recognition program was the fact that positive outcomes are a result of excellent nursing. To this end there are many important nurse led initiatives that have increased the quality of care that patients receive and which are a demonstration of nurse excellence. The American Academy of Nursing has their Edge Runners program through their Raise the Voice campaign. Quality and Safety Education for Nurses is a resource that helps new nurses acquire the knowledge, skills, and attitudes that can allow them to positively impact the safety and quality of their workplace. TCAB is a well known nurse led initiative. This partial list only scratches the surface of nursing excellence in the nation.
Every day nurses demonstrate qualities of excellence that make a difference in patients’ lives and inspire their peers. There are nurses who are mentors, who take advantage of teachable moments, and are adaptable. Nurses are patient advocates, defend patient rights and empower them and their caregivers. Nurses are compassionate and culturally aware and sensitive. Nurses have the spirit of inquiry and are supportive emotionally and spiritually. There are many, many unpublicized instances of excellence in nursing that can be found everywhere nurses are employed.
Hassmiller, S. Nurses on Boards American Journal of Nursing. Vol.112 No. 3 March 2012 pp61-66
Jasovsky, D. et al How Do You Define Nursing Excellence? Nursing Management, Vol.41 No. 10 Oct 2010. pp19-24