Choosing Nursing

From application to offer and beyond

Cathy Poole

• Publisher: Routledge
• Year: 2015
• Print ISBN: 9780415533775
• eBook ISBN: 9781136289378
• Topic: Medicine
• Subtopic: Health Care Delivery

Becoming a nurse is a life-changing process and making the decision to study nursing at university is the first step. This short guide will help you decide whether it is the right move for you, give you an idea of which field of nursing might suit you best and provide useful tips for making a successful application.

Outlining the academic and clinical support that students can expect during their study, the stresses that they may face, how placements work and the role of the NMC for student nurses, this book includes a wide range of testimonials from nursing students as well as practising nurses.

Most importantly, it shows what is unique about each of the different fields, which include children's nursing, adult nursing, mental health nursing, learning disability and defence nursing. It also looks at what all of these areas have in common – what makes nursing nursing and what makes nursing special.

With a final section looking to the future, with tips for getting your first job and highlighting nursing opportunities around the globe, this is the must-have, no-nonsense career advice book for all those considering nursing as a career option or waiting to start their nursing course or indeed for those nurses who are wishing to return to the nursing profession.

Part 1

Understanding nursing

Chapter 1

Defining nursing

Ann-Marie Dodson

I remember that the reaction when we had to study Nursing History in our training was one of groans and horror. My peers would say ‘Why can’t we spend more time learning about physiology? That’s much more useful to patient care.’ I could appreciate this viewpoint to some extent. I still hear this comment today from some students and of course we all as individuals have our own interests and preferences – that is what makes people so interesting and individual. Now, having been a nurse and teacher for many years (and latterly an Admissions Tutor) I have come to appreciate, that for many reasons, it is important to have some understanding of what a healthcare profession is, how it has developed and what influences exist that will develop it further to shape the National Health Service (NHS) of the future and meet the needs of patients. So, as well as having some knowledge of nursing history, misconceptions about nursing and understanding what nursing is, it is important to understand the educational, sociological and political influences that have an interplay on the profession.

One moment in my career development where this knowledge really helped me was when I had a panel interview for my first senior post as a sister. I was able to talk about the development of the NHS and its management structures. I was able to explain how the NHS had evolved. How various reorganisations had impacted on service delivery and patient care, how things would develop in the future, and how I would develop the sister’s nursing post. I got the job and the feedback was about how impressed the panel were by my knowledge. That was an important reflective or learning moment for me, as it was the moment I was fully aware that to be effective in a system you need to know how it has developed, where you fit into it and how you can influence it. This is why politicians and military leaders often have an interest in history. By learning about the lessons from the past we can influence things in the future. As well as historical factors there are also the sociological and political influences that nurses must be aware of.

The following sections outline how nursing has developed as a profession in the UK, particularly in England. This seemingly narrow and parochial approach is necessary as, although there are similarities with other countries, there are also differences too. For example, although nursing in English-speaking countries such as the US and Australia is extremely similar, there can be distinct differences too in what nurses do and how they are prepared educationally. An example of this was when I spent some time in an American intensive care unit. In Britain, I would decide when I wanted to take a blood sample to check the patient’s oxygen levels and alter the ventilator accordingly. I would not need to consult a doctor unless I had concerns, or needed them to do a review and change the treatment plan. The patients were sedated to make the experience less distressing for them. I had an element of autonomy.

In the US I had to get a ‘Doctor’s order’ to be able to take the blood sample, and the ventilator would then be altered by a Respiratory Technician. The patient was restrained by leather straps as they were not sedated. Yet, the nurses by comparison were very highly educated to degree, Master’s and doctorate level, which we were not at that time, and they were able to clinically assess a patient – which again we did not do.

My experiences lately of travelling in parts of China, India and Nepal have outlined other differences whereby, in some provinces, the role of the nurse is to carry out some of the treatments prescribed by the doctor (what we used to describe historically as the ‘doctor’s hand-maiden role’) and it is the family who stay in the hospital and deliver what we consider to be the nursing care; so they wash, feed and generally meet the care needs of their loved one. In some of these cultures there are not usually any male nurses (see Chapter 2 for more information on men in nursing). Clearly, these differences in nursing across the world develop due to cultural, educational and socio-economic and political factors.

So what is nursing? The next section will set out some ideas to help you define what you think nursing is.

As an Admissions Tutor, part of my role is to ascertain if prospective candidates have the necessary qualities and attributes to be a nurse, as well as meeting the required educational qualifications. The interviewing teams will try to draw out what the candidate understands to be the role of the nurse and what nursing is. This is important for two reasons. First, we want to ensure that the candidate has undertaken some research and is making an informed choice for the right reasons. Further information relating to this is discussed in depth in Part 3 ‘How to become a nurse’. Nursing is hard physical work and can be psychologically demanding, involving long and unsocial hours. Choosing nursing needs to be an appropriate choice for you, but also for the patients who you will be looking after.

Secondly, as each university place carries an NHS bursary it is important that there is a strong likelihood that you will be able to cope with the academic level of the training, successfully complete the clinical placements, and qualify as a Registered Nurse. Some candidates are extremely well prepared and have an excellent understanding of what nursing ‘is’ and what nurses ‘do’. However some do not. This chapter may help give you some insight into these aspects and help you prepare more effectively.

I had always wanted to be a nurse since the age of three or four. This surely wasn’t because I knew what nursing was. As I grew older this desire did not diminish. I liked looking after people, being helpful, easing discomfort and problem solving. I was the one that friends and peers came to if they needed to discuss a problem. I dealt with accidents from a young age and was calm in a crisis. I truly believe that if you can find the match between your personality and the job, then you too will have a lifetime of happiness and satisfaction, and be good at what you do.

However, neither my parents nor my school wanted me to pursue my dream, as nursing was considered a waste of a good education and was just a job or an occupation – and certainly not a profession. Some of these preconceptions and myths will be explored later.

What is nursing?

A first-year nursing student said to me recently that nursing ‘was about putting the patient first and going the extra mile’. I think about it being a ‘social interaction’ whereby I can do something for someone else which they cannot do themselves. Or I can help them find new ways of doing something, in the case of disability or poor health. Increasingly, nursing is about empowering individuals to be able to live healthily and access health services.

‘Nursing’ and ‘caring’ are synonymous but caring is not necessarily unique to nursing, as doctors and radiographers feel they are caring and deliver care. Indeed, there has been media criticism that many nurses are ‘uncaring’, and there is debate about how and if this attribute or quality can be taught.

Caring is a fundamental human attribute that is necessary for human growth, development and, most importantly, survival. Brown et al. (1992: 31) said that ‘a capacity for caring is part of human nature’. As a nurse, this involves the ability to understand some of the situation the other person is in and to be able to feel for that other person. Psychologists and counsellors describe this as empathy. Like mastering any other skill, it needs to be worked at, understood, refined and made sense of. The relationship of caring to nursing needs to be understood. The nurse could be described as a ‘professional carer’ and nursing as the professionalisation of caring. Leninger, an influential American nurse theorist, believes that caring is ‘the central and unifying domain for the body of knowledge practices in Nursing’ (1981: 3).

Nursing is an ‘art’ and ‘science’. The ‘art’ is a collection of the soft caring and communication skills. The ‘science’ is all the underpinning theoretical knowledge from the sciences, such as physiology and pharmacology. The good nurse will be able to balance the science and the art so that care given is both competent and effective and of a quality recognised by both patients and professionals. The good nurse will be altering these aspects according to the situation and the patient being nursed.

What do academics say that nursing is? How is it defined?

Henderson (1966) provided a classic and seminal definition of nursing which focuses on the unique function of the nurse in terms of assisting individuals whether sick or well to be able to perform a defined list of activities which contribute to health or recovery or indeed to a peaceful death. Henderson further explains that nurses play a role in helping individuals to gain independence as rapidly as possible.

This definition acknowledges implicitly that life is a continuum from birth to death and implies that, as nurses, we can’t always make things better and have happy endings, but what we can do is our best for the patient (and their family or loved ones) in every situation.

The Royal College of Nursing appears to have built on Henderson’s 1966 definition, by defining nursing as:

the use of clinical judgement in the provision of care to enable people to improve, maintain or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death.

(RCN 2003: 3)

The regulatory body, the Nursing and Midwifery Council (NMC), that protects the public and sets the standards for pre-registration Nursing and Midwifery programmes also utilised the RCN (2003) definition. In the NMC standards for pre-registration programmes it states that the nurse should be:

a safe, caring, and competent decision maker, willing to accept personal and professional accountability for his/her actions and continuous learning.

(NMC 2010: 11)

Recently, the Chief Nursing Officer for England, Jane Cummings (DH 2012a), introduced the concept of the 6 C’s to restore publicly the notion of compassion and caring, which nurses have been accused of losing.

You can see from the various definitions that nursing is made up of many roles, attributes, attitudes and skills. There are currently four fields of nursing (adult, child, mental health, and learning disability) at preregistration level, which will be discussed in Part 2 of this book. After qualifying, nurses will go and study further and perhaps specialise (see Part 5). There are so many different types of nurses – School Nurses, Diabetic Specialist Nurses, and Intensive Care Nurses, for example. What unites them is their ability to communicate and form relationships with patients, in order to assess, plan, and deliver and evaluate care. They need to be able to draw on a wide knowledge base, teach, promote health, and make decisions. They need to be able to problem solve, delegate, supervise and manage care. The current NMC (2010) standards for pre-registration nursing education document has outlined various professional and clinical competencies which are gathered into four domains of practice:

• Professional values

• Communications and interpersonal skills

• Nursing practice and decision making

• Leadership, management and team working.

Now that there has been some exploration of what caring and nursing are in general terms, the following section gives some context to the history and development of nursing.

Overview of the history of nursing

Caring, healing and nursing (derived from the Latin for ‘nourishing’) are all intertwined historically. There is not always a consensus in the literature. For instance, the Feminist writers feel that history is written from a male paternalistic perspective (Baly 1995). Additionally, not until recent times has Mary Seacole, a Black Jamaican nurse, been recognised for her contribution to nursing, which equals that of Florence Nightingale.

It is not possible to cover every aspect of the historical evolution of nursing as we would need to cover thousands of years of development across the world. Therefore, the main points will be covered to give a broad overview.

Where have we come from as a profession?

Nursing has been struggling to be viewed as a true profession, partly because traditionally nurses have not possessed a unique knowledge base or full autonomy. Doctors on the other hand diagnose and prescribe medications and treatments. However this position is changing, and the development of nurses’ roles are such that Donahue (1996: 2) said that ‘Nursing has been called the oldest of the arts and the youngest of the professions.’

Mothering and nursing are synonymous and instinctual, in women particularly (although this does not mean that men cannot be caring), and untrained ‘nurses’ are as old as the human race. Initially, it was predominantly about caring for infants and being home based. It was a sensible division of labour, as the men were out hunting and defending the property, whilst the women were bringing up the children. This is still the pattern in many more rural economies in the world.

There was a time when we were much closer to nature, and herbs, leaves and seeds were used as magical cures. As early as 20,000 BC there were depictions in caves of Shamanistic activities (Keegan 1988). At one time a mother would pass down such knowledge of healing and herbs to her daughters. Later men got involved in this esoteric knowledge and skill as bone-setters, medicine men, witch doctors or Shamans. This art of healing set them aside from the tribe and there was the development of this medicine, not just for healing and good, but also for bad, as ‘occult’ medicine.

By 500 BC in Greece, Hippocrates had developed a scientific medicine through rationality and observation. Healing and caring had moved out of the home and become a broader function. The Greeks and Romans were influential in the development of medicine and nursing. Nursing pre-dated medicine, but the two became interwoven as time elapsed. Around 100 BC the Romans constr...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Dedication
• Contents
• List of figures
• List of boxes
• Foreword
• Preface
• Acknowledgements
• Abbreviations
• Contributors
• Introduction
• Part 1 Understanding nursing
• Part 2 Researching the fields of nursing
• Part 3 How to become a nurse
• Part 4 What and where you will learn
• Part 5 Beyond nurse training
• Glossary
• Index