Nursing as a service profession
dialogue - danny willis & jennifer allen - spring/summer 09
The insights that I offer stem from the philosophical perspective that nursing exists to serve the needs of persons for humane interactions: in health and illness, choice, quality of life, and healing in living and dying. Service begins with the possibility of altruism and the understanding that we all have life experiences in which we need the help of others. Service uses knowledge about the human condition and awareness, arising out of one's own experiences, of what "being well” and "experiencing suffering” might mean for individuals, families, communities, and societies. That is, according to Donaldson, "the knowledge of the discipline must ultimately support service to clients and the health of society.”
Historically, nurses met the health needs of humans wherever they were—in their homes, in war zones, hospitals, nursing homes, schools, mental health residential settings, etc.—and exercised their special interest in vulnerable populations, or those most in need. Service involves observing and listening to human experiences of transition, challenge, suffering, and healing, so that we know how to proceed most effectively. Service involves recognizing both the person and environmental factors that influence prospects for health and healing and transformation and change even when there are bodily disruptions in biological function, psychosocial functional status, quality of life, and perceived health. Nurses, with their acute observation skills, knowledge of human care, and consequent conception of professional responsibility, are the perfect collaborators. They are able to bring together synoptically a view of the whole that is crucial in the contemporary world given the environmental, economic, and social conditions of our time.
Danny G. Willis, DNSc, MSN, RN is an assistant professor at the Connell School.
I knew that I wanted to be a nurse by the time I was five years old. Maybe it was the nursing cap and pin given to me by my Aunt Peg or seeing the many ways that she was able to help others. During my childhood and young adult years, I never questioned my decision to become a nurse. I believed then, as I do now, that dedicating one's life to serving people experiencing illness was among the most noble things that a person could do. I vividly recall the first time I was present for the birth of a child born to a single mother, and the first time I held the hand of a patient who was dying alone. These experiences left me with an indelible feeling about the sacred connection that can be forged between human beings. People who are complete strangers can transcend the illusion of independence, and experience a deep sense of interconnectedness in these moments.
Over time, my practice has shifted from a focus on individuals to a focus on communities and populations. This shift has been prompted by my appreciation of the ways that social, economic, and environmental forces shape health. It has become increasingly clear to me that some groups—by nature of their socio-economic status, race/ethnicity, sexual orientation, or other characteristics—are systematically denied the resources necessary to maintain their health.
Health disparities are undeniably an issue of social justice and human rights. I have struggled with the notion that, as a highly educated middle-class white woman, I have benefited from the social systems and hierarchies of power from which these disparities arise. My deepening appreciation for this aspect of interconnectedness has altered my sense of what it means to be a member of a service profession. In my work with communities, I do not see myself as the "provider of service,” but rather a partner in pursuit of a shared agenda: health equity. There is a well-known adage: "If you want peace, work for justice.” Work in pursuit of justice is a service, and a benefit, to us all.
Jennifer Dacey Allen, DSc, MPH is an assistant professor at the Connell School.