Nursing theories offer conceptual bases for nursing practice, and individual theories often serve as a framework for specific schools of nursing. Some health care facilities will adopt a nursing theory for its nursing staff, and in such a case all clinical nursing decisions are ostensibly made through the “lens” of this particular theory.

Nursing theories utilize a logical structure of ideas, hypotheses and assumptions that can be applied to a variety of situations. These theoretical structures can serve as a basis for nursing practice, patient care, professional development, education, nursing research, or administrative decision-making.

As a body of knowledge, nursing theories provide a wide array of conceptual structures on which nurses or organizations can hang their metaphorical hats.

Some well-known nursing theories and theorists include:

Dr. Jean Watson, whose “caring model” emphasizes the humanistic aspects of nursing in combination with scientific knowledge. This theory sees the patient as a holistic being (body, mind and spirit), and recommends treating the patient with positive regard and unconditional acceptance.

Dorothea Orem popularized a theory of centered on the notion that nursing interventions are geared towards assisting patients in re-establishing their ability to provide their own self-care and recover their health from a place of deficit.

Callista Roy propagated the adaptation theory of nursing in which the patient is seen as a “biopsychosocial being” who is constantly adapting to a changing environment.

Although these theories can seem abstract and a far cry from the nuts and bolts of daily nursing practice, theories can provide a very useful framework for your individual practice or your facility’s approach to patient care. If your facility or unit does not adhere to a specific nursing theory, perhaps the exploration of various theories may yield a theory that speaks to your facility’s goals and norms of practice.

Nursing theories are often useful and inspiring. If you avoided them during school, consider how they may positively influence your practice, and find a theory that feels like a good “fit” for your individual way of nursing.

Advanced Practice Nurses

Including Nurse Practitioners, Doctors of Nursing Practice, and Nurse Anesthetists—are at the vanguard of autonomous nursing practice. Advanced Practice Nurses are generally more cost-effective than physicians in terms of salary and benefits, and clinical outcomes are shown to be equal or better than that of physicians.

In some states, Advanced Practice Nurses can function without direct physician oversight, while in other states some supervision is necessary. That said, many APRNs enjoy a great deal of autonomy and prescriptive authority that truly places them in roles that underscore and highlight their well-earned expertise.

Speaking of expertise, APRNs develop considerable advanced expertise in their respective areas of practice, and that expertise brings immeasurable benefit to a variety of patient populations. APRNs may develop advanced expertise in Labor and Delivery, Gerontology, HIV, cardiac and respiratory illnesses, among other areas.

Registered Nurses, Autonomy and Expertise

While some nurses have not pursued advanced practice degrees, they still exercise and enjoy a significant amount of autonomy in their work. Hospice nurses, school nurses and others work in scenarios wherein a physician is not readily available and independent nursing decisions are frequently essential—and often life-saving. While standing orders from physicians provide a safety net for some nursing actions, other actions fall under the Nurse Practice Act, and nurses use their knowledge of their scope of practice to act autonomously.

Nurses—whether LPNs, RNs, Baccalaureate nurses or APRNs—all provide expert care in myriad settings. And that care is informed by levels of nursing expertise, nursing diagnosis, nursing assessment, as well as skills and intuition honed and sharpened over years of practice.

Nurses are experts, and we should embrace and feel pride in that expertise and how we can use it for the greater good of all.

I’ve heard this question more times than I can count in response to my statement that I’m a nurse. It’s painfully obvious that the general public simply doesn’t know that nurses work anywhere but in hospitals, and it appears they also just don’t know what we really do. It’s time for us to fix that.

The public is confused. When they watch TV, they see nurses in the ER and they see nurses in the hospital. When they visit their doctor, their blood pressure is more than likely taken by a medical assistant who fails to identify themselves or their role, so the patient doesn’t even know if this individual is a nurse or not. Meanwhile, the media generally reinforces the stereotype that all nurses work in hospitals, so you can’t really blame anyone for thinking that that’s all we do, right?

Granted, an enormous percentage of nurses work in hospitals, but plenty of us work in other venues, and we want the public to understand that nurses are represented in a large variety of situations.

Some members of the public have opportunity to interact with nurses in non-hospital roles, and this certainly helps us in our cause of spreading the word about our multitude of roles. When a patient enters into hospice or palliative care, he or she interacts with nurses as the primary source of direct care and symptom management. Going home from the hospital after surgery, home care nurses change dressings, provide crucial patient teaching, and monitor the patient’s progress in the home environment.

Meanwhile, nurses care for our children in both public and private schools, provide occupational health resources in factories and workplaces, serve as Public Health Nurses in local health departments, and perform important research in universities and private research institutions. Nurses also work as educators, and many of us are pursuing careers as entrepreneurs and businesspeople.

Nursing is a multifaceted profession of which the general public has little understanding. If we want that viewpoint to grow and expand, it’s up to us to educate the public and the media about what nurses really do, who we are, and the myriad roles that we fulfill.

National Nurses Week has been set aside as a time to recognize nurses for their service and care. However, it’s easy to see how Nurses Week is frequently reduced to the lowest common denominator of thoughtful yet expendable trinkets that employers share as tokens of their gratitude.

What does National Nurses Week mean to you? How is it recognized—or not recognized—at your place of work? Does the occasion hold meaning for you, or does it seem like just another time when nurses don’t necessarily get what they truly deserve? Do you roll your eyes when you think of National Nurses Week, or is it a time that you look forward to and enjoy?

Instead of the ubiquitous mugs, pins and other flotsam and jetsam that facilities provide for nurses during National Nurses Week, here are some suggestions of what would truly support nurses in a concrete and meaningful way:

• Salaries that are commensurate with experience and skill
• Significant and meaningful cost of living raises
• Programs and services for burnout prevention
• Adequate mentorship and guidance for new nurses
• Support for career advancement and education
• A culture of support and compassion for one another
• Zero tolerance for bullying and “horizontal violence”
• Support for improved nurse-physician relations

These are just some ideas, and I would be delighted to also hear yours. Please feel free to leave a comment and let us know what you think and what would make you feel most supported during National Nurses Week.

When novice nurses begin their new careers, they enter the profession with many questions—and often a great deal of fear and anxiety. New nurses can feel like imposters, uncertain of their skills and unsure how to navigate the new world that they’re entering.

Meanwhile, seasoned nurses can tend to feel resentful of the needs of new nurses, and some can go so far as to ignore the obvious mentoring that new nurses need. Sometimes, outright bullying and intimidation play a part in this unfortunate situation.

While it’s the responsibility of experienced nurses to mentor and train new nurses, it is also beholden on new nurses to ask for what they need so that their entry into the profession is as smooth as possible. Here are a few ideas for new nurses as they begin this journey:

1) Demand proper precepting and mentoring: New nurses do not deserve to be thrown directly into the fire. They need mentoring relationships that ease them into their positions and allow them to slowly digest all that their new career entails. Proper mentoring paves the way for the novice nurse as he or she has the opportunity to lean on the superior knowledge of an experienced nurse and begins to undertake additional responsibilities and sharpen new skills.

2) Refuse to tolerate bullying and intimidation: Bullying is a reality among nurses, and although it is not common among all nurses, there are those that resort to bullying, intimidation and “horizontal violence” when it comes to relationships with new nurses. Standing up to bullying takes determination, excellent and direct communication skills, and the willingness to enlist allies in the ranks of administration and fellow colleagues when necessary.

3) Ask for help: There’s nothing wrong with asking for help when you need it. Admitting to not knowing how to perform a task or care for a particular situation is a sign of strength, not weakness. When you’re faced with a new medication, condition or situation that requires knowledge that you do not fully possess, recruit a more experienced nurse to assist you and educate you. This will allow you to work more calmly and get a new skill under your belt as you learn.

Being a new nurse is a challenging passage in a new career, and using good communication skills and admitting your areas of weakness and need for support is truly a strength. Meanwhile, standing up to bullying and intimidation is essential—for your own survival and also for the survival and health of our profession.

New nurses are the lifeblood of nursing, and many of us experienced nurses welcome that new blood as an injection of renewal into the health care industry. Experienced nurses and novice nurses can work together for the good of all, and we will collectively reap the benefits of that alliance—both nurses, other health care providers, and patients alike.

When a new nurse steps onto the unit or into the office, he or she has a lot at stake. They’ve spent a great deal of time and money to earn their degree, and they’re nervous about doing well and not making any grave mistakes. The new nurse is worried about the perceptions of his or her colleagues, and they certainly want to do a great job. It’s a nerve-wracking business, and we’ve all been there.

So, when a new nurse enters your unit or place of work, do you roll your eyes, turn your back, avoid eye contact, or go out of your way to be unfriendly or unhelpful? Do your colleagues engage in these passive-aggressive behaviors, perhaps? Have you seen colleagues actually bully or intimidate new nurses? Do you notice that some nurses feel that it’s actually a spectator sport, or perhaps some weird hazing ritual that must be fulfilled? Let’s break that cycle and change the paradigm that perpetuates such behavior.

Here are some ideas:

1. Walk in their shoes: Do you remember how it felt? Can you empathize with the new nurse’s position? Take a moment to see your workplace through the new nurse’s eyes. How friendly and welcoming is it? Do the systems make sense, or is it confusing? How easy or intuitive is it to find things and get oriented? Have empathy for the new person and show them around.

2. Be helpful and encouraging: There’s nothing worse than new colleagues who barely seem to register your existence, offering little or no support or encouragement. If your unit or office doesn’t have an official mentoring system, create one, or just mentor your new colleague unofficially. That colleague will be so grateful, and you both will have a new ally in your respective corners.

3. Stand up to bullying and intimidation: If you notice a coworker bullying or intimidating a new nurse, stand up to that person and call their attention to what they’re doing. Use strong and effective communication to make it clear that you will not tolerate such behavior in your workplace. If you need to, bring it to a supervisor or bring it out in the open at a staff meeting. Silence is complicity, so speak up.

4. Offer constructive advice and feedback, not criticism: A new nurses is nervous enough. Even if you feel annoyed by their mistakes, show compassion and offer your feedback in a constructive form. Harsh criticism bruises fragile egos and does little in terms of offering new ideas or ways of doing things. Ask how they’re doing, and offer feedback where appropriate.

5. Offer praise: Constructive criticism is one thing, and praise is another. When your new colleague does well, praise him or her. A little praise and positive feedback can go a long way, and everyone needs to hear that they’re doing well once in a while.

Can you add to this list?

When it comes to new nurses, there are plenty of myths, legends, superstitions, misconceptions, and judgments galore. How many nurses do you know who will roll their eyes and complain when a student nurse is assigned to shadow them on their rounds? How many nurses complain and moan about having to orient or precept a new nurse who is just out of school and starting his or her career?

Contrary to how some disgruntled seasoned nurses feel, new nurses are the lifeblood of our profession. Just as medical residents and interns breathe new life into the medical field as they make their way through their training on the way to full-fledged “doctorhood”, new nurses also need to make their way, and we nurses can either nurture them in the process or thwart their professional growth as fledgling nurses.

1. They May Care For Us Someday

As we age, a number of us older nurses will eventually end up in surgery or the hospital, and guess who will care for us? That’s right. Nurses younger than us—and perhaps less experienced than us—may be taking our vitals, prepping us for surgery, and otherwise providing nursing care when we are at our most vulnerable and need it most. Isn’t that a good enough reason to treat new nurses right?

2. They May Care for Our Loved Ones

These new nurses may also care for our loved ones and friends when they need nursing, and we want our loved ones to receive the best possible care, right?

3. They Care for the World

If we think about this with level heads and open hearts, we will realize that every nurse who graduates from nursing school will be laying her or his hands on patients for years to come. Whether those patients are us, our loved ones, or perfect strangers, the care provided by every nurse reflects on the profession as a whole. Nurses provide care for so many people around the world, and while we American nurses enjoy the consistent trust of our fellow citizens in poll after poll, it’s a consistency that we must continue to nurture, and one way to nurture it is to make sure our new nurses are the best they can be.

4. Nursing is a Part of the Whole

Nursing is said to be the backbone of the healthcare industry, and that is most likely a very accurate statement. Since we as a profession carry the responsibility of delivering so much direct patient care, then we also carry a responsibility of representing the entire healthcare industry as a whole.

That being said, our mentorship of new nurses actively feeds skilled, productive and critically-thinking care providers into the (relatively) well-oiled machine of the healthcare system, and that constant influx of well-trained nurses is essential as the population ages and demand grows.

Our schools can certainly churn out thousands of nurses each year, but nursing education doesn’t end with graduation—it begins—and we are the ersatz professors to these new nurses who look to us for guidance and understanding of their novice position.

New nurses need and deserve our respect and encouragement for the career choice they have made and the sacrifices it took for them to accomplish their goal of becoming nurses. We owe it to them (and ourselves and the society at large) to welcome them into the fold with open arms, patient minds, and our own nurses’ hearts.

It’s easy to not eat, drink or otherwise care for yourself during work hours, but self care is essential to health. Even under the greatest duress, you have to stay hydrated for your own well-being. But do you?

Nurses understand the importance of hydration, and we often monitor the intake and output of patients with cardiac conditions, kidney failure, and other illnesses.

I have heard anecdotal stories of nurses working in the hospital who actually end up with urinary tract infections from not allowing themselves
the time to stay properly hydrated during shifts, and this is a tell-tale sign that things are certainly amiss.

So, even though we all know what dehydration can do to our patients, let’s think in terms of us at work. What can be the potential consequences of dehydration—or at least poor hydration—for nurses?

Decreased urine output: While this may seem like a good thing when you rarely have time to take a bathroom break, decreased urine output is not healthy for your kidneys. This will increase your heart rate and constrict your blood vessels unnecessarily, not to mention stress your urinary system.

Risk of UTI: As mentioned above, UTIs are much more likely when you are dehydrated—or heading in that direction. The flow of healthy urine through the kidneys and urinary tract is essential to good health.

Lightheadedness and weakness: The last thing you want is to be dizzy or weak at work while you’re drawing up immunizations, starting IVs, passing meds, or otherwise doing things that require concentration and focus.

Electrolyte abnormalities: Electrolyte balance is crucial for the function of so many aspects of human physiology, and this applies to nurses, too!

While none of this is new information to any nurse, we often feel that we don’t need to practice what we preach to our patients. But when it comes to basic self care at work—like hydration and nutrition and proper body mechanics—we really shouldn’t cut corners.

You’ve heard the saying, “Healer, heal thyself“? Well, let’s also remember, “Nurse, hydrate thyself.”

Patient Rooms

In patient rooms, high-touch areas are everywhere. Door handles and light switches are two obvious places, but we also must take into account patients’ bed tables, telephones, urinals, bedclothes, bed controls, televisions, remotes, as well as all of the patient care materials in and around the bed. These areas should be disinfected regularly, and nurses and hospital personnel should use gloves when touching most of these surfaces.

Bathrooms

In patient and staff bathrooms, faucets, door handles and light switches are easy culprits, as are toilet seats, sinks, toilet handles, and soap and paper towel dispensers.

Hallways

Hallways receive a lot of traffic, and rails along the walls are constantly touched by staff, visitors and patients. Items in the hallway—like wheelchairs, beds, and portable computer stations and ECG carts—are also high-touch culprits. Elevators are also places where potentially infected hands are busy at work.

Nursing Stations

Nursing stations are where everyone comes to literally “touch base” before and after patient care. Computer keyboards, telephones, communal snacks, patient charts, pens, wastebaskets, shelving and counters, chairs and writing utensils all carry the burden of frequent touch by ungloved hands.

It Begins With Awareness

How often do you touch a variety of the surfaces named above and then touch your mouth, nose or eyes without even thinking? How often do you fail to wash your hands following patient contact, or use your stethoscope to listen to a patient’s lungs or heart without washing your hands first? That said, how often do you disinfect your stethoscope?

Awareness is key to battling the ongoing skirmishes that we wage with nosocomial infections. And while we desire to protect our patients from unnecessary infection, we also have to protect ourselves as well. Visitors, staff, patients and vendors traverse the halls of hospitals and nursing homes every day, and our hands are the vehicles that can deliver both deadly and non-lethal bacteria and viruses directly to patients and others.

Handwashing is, as always, the key to protection and the prevention of the spread of illness, but knowledge of common high-touch areas and the motivation to disinfect them frequently are also crucial.

Be aware of high-touch areas and objects, and do your best to not contribute to the unnecessary spread of infection.

So, what are three things to love about home care? Here’s my list:

1. Autonomy

If you’re a nurse who loves autonomy, home care nursing is a great place to get your fix. Nurses who work in home care spend many hours of each day out on the road, driving from one patient’s home to the next.

The home health nurse lives out of his or her car, carrying supplies, notes, laptop, books, lunch, drinks, snacks, and all manner of nursing flotsam and jetsam.

Although schedules can be tight and visits can sometimes take longer than planned, the nurse can set his or her own schedule (for the most part), stop and do documentation in a park, cafe, restaurant or library, and practice a form of nursing that involves independent decision-making and the ability to function comfortably on your own.

If you love that sort of autonomy and independence, you’ll love home health nursing.

2. Time to Talk To Patients

Unlike the hospital, where call bells and other interruptions limit the ability of the nurse to actually connect with patients for any length of time, being in a patient’s home provides you with one-on-one contact with your patient and their family and loved ones.

While homes can be chaotic, dirty or otherwise dysfunctional, that time with your patient is sacred and important to your relationship, and there are never any other patients, nurses or doctors to distract you from your work (unless your phone rings, of course).

3. Novelty

In home care, there’s a great deal of novelty. Patients change, schedules change, and you’re out in the world facing changes in the weather and the seasons. For a nurse who is easily bored by routine and by reporting to the same place every day, home care nursing offers the opportunity to have a position where the characters, faces and responsibilities change on a regular basis.

Depending on what type of home health you’re doing— hospice, palliative care, post-surgical wounds, psychiatric home visits—things are bound to change and you will have little opportunity to be bored.

Its Not For Everyone

Home health nursing is not for everyone. If you like knowing what to expect and being in the relative comfort of the hospital, office or clinic while the snow falls and the rains come down, then home care may not be right for you. If you like having colleagues on hand to double-check a wound, share a laugh, or give you a second opinion on the lung sounds you think you’re hearing, home care may feel uncomfortably lonely.

Every nurse has certain things she or he likes about their work, and certain patterns or ways of doing things that work well. The autonomy and novelty of home health is very attractive to some, and repugnant to others. If you are slightly interested in home health nursing, shadow a home health nurse or do an informational interview to see if what you hear speaks to you, your personality, and your unique career aspirations.