Nursing Models for the Future: Acknowledging the Political Nature of Nursing

Adeline Falk-Rafael, PhD, RN, FAAN in her guest editorial for the current issue of ANS makes a strong case for nursing models that ground practice in our own disciplinary knowledge, and makes nursing work visible and credible.  Dr. Falk-Rafael serves as a member of the ANS Advisory Board, and is a renowned nurse author/scholar whose work focuses on critical caring and social justice. She has shared these reflections on the message conveyed in her guest editorial (available here):

Adeline Falk-Rafael

I first learned to be a nurse in a hospital “training” program in the early 1960s. During that time, I learned what nursing was in relation to medicine – what nursing care was in the context of specific medical diagnoses and treatments. Likewise, the relatively minimal attention to health promotion focused almost entirely on disease prevention. A substantial amount of the content of many of the program’s courses was delivered in the form of a physician’s lecture. Ethics was medical ethics and taught by the hospital’s priest. The nursing scope of practice was defined by employers as largely an ancillary medical service that also had some usefulness as a supplementary housekeeping service (cleaning linen and utility rooms and carbolizing the beds of discharged patients were required duties) as well as providing cheap labor in the guise of an educational experience through rotations that including several weeks of making and sterilizing infant formulas and filling individual dietary requests through short-order cooking. Little wonder that as a Registered Nurse, I had difficulty articulating what nursing was, let alone what nurses knew!

While much has changed, thankfully, in the education of nurses, I do not find that nurses practicing at point of service are much more proficient today in clearly articulating the valuable and often unique contribution they make to the health and healing of patients and populations. Because most nurses continue to be employees in bureaucratic organizations and/or large corporate structures, their scope of practice typically remains heavily influenced by prevailing medical and business models.

Nurses are still, in the words of Susan Reverby¹, “ordered to care in a society that refuses to value caring.” For this reason, I am a strong apologist for nursing models. I believe they have a strong potential to strengthen nurses’ sense of identity as professionals who make a complimentary but unique contribution to health and health care. As such, nursing models can be tools of empowerment by grounding nurses solidly in disciplinary knowledge and naming aspects of nursing work, thus giving nurses language and credibility to make their work more visible. Grand theories help shape our values and belief systems about what caring for human beings means. Mid-range and micro theories provide more focused approaches to the provision of care that can and must be tested through research and linked to patient/health outcomes. To be useful, nursing models must be seen to be relevant and useful to nurses at point-of-practice, for example, as “apps” that can provide a quick resource when needed. But nursing models of the future must also have a critical perspective. They must serve as tools of resistance by assisting nurses to examine and challenge the larger societal and political forces that advantage a few while disadvantaging many others, whether those others are patients or nurses.

¹Reverby S. Ordered to Care: The Dilemma of American Nursing, 1850-1945. New York, NY: Cambridge University Press: 1987.