Nurse Vulnerability

The current featured ANS article is titled “Vulnerability in Nurses: A Phenomenon That Cuts Across Professional and Private Spheres.” The authors, located in Denmark and Norway, are Sanne Angel, PhD, RN; Solfrid Vatne, PhD, RN; and Bente Martinsen, PhD, RN.  In this very timely article, the authors propose that organizational awareness and intervention could be a key to addressing nurses’ vulnerability – a message that clearly is needed now.  Dr. Angel provided the message below about their work and the insights from it.  You can access the article at no cost while it is featured; we welcome your comments and responses!

Sanne Angel

Nurses vulnerability has never been more present than now with the Corona Pandemic threating nurses’ health and lives as well as those of their kins.

The experience of vulnerability is never stronger than when life is at risk. Still, we know that whether aware or not, nurses are vulnerable because they are human and because they expose themselves in their role as a nurse, not least since they wish to do good.

In this work, we explored nurses’ vulnerability from their perspective which was possible because we used a phenomenological approach. We introduce the paper by saying “As patients’ vulnerability is a core concern in the nursing profession, nurses’ own vulnerability has received only scant scholarly attention”.

Nursing students who were attending a master’s course in advanced phenomenology were invited to be part of the study. This decision was based on the didactic assumption that when teaching students phenomenology, they benefit

Solfrid Vatne

from being exposed to the phenomenon because this makes them reflect upon it in relation to the conduct of a real study. One of the reviewers wrote: I loved seeing the link from teaching through to publication.

We used a descriptive phenomenological approach informed by Giorgi’s theory, and the student conducted interviews with 14 Danish female nurses. The analysis revealed nurses’ experiences of vulnerability in relation to their work.

We found that vulnerability among nurses is a latent feeling that manifests itself by the body being out of control including feeling overwhelmed by feelings and struggling to avoid to be harmed.

Nurses’ experience of vulnerability is latent, and each nurse has a unique threshold of tolerable vulnerability the level of which cannot be predicted. She may reach her personal tolerability threshold when standing face-to-face with

Bente Martinsen

the basic terms of existence or when she experiences something unexpected or unclear or is challenged by an unintelligible tasks or experiences being treated unfairly. Vulnerability shows itself in feeling overwhelmed and losing bodily control. Vulnerability is closely related to professional insecurity, i.e. situations where nurses doubt their own knowledge and competences, or when they feel unable to treat a patient in the best way. This may happen when a nurse takes on a new job, works with seriously ill patients or is confronted with death, i.e. experiences that may exacerbate nurses’ own vulnerability. The experience of vulnerability is an existential feeling that makes the nurse struggle to avoid being harmed. The experience of vulnerability is not limited to the work sphere as it can spread from the professional to the private sphere. In that case, nurses cannot dissociate themselves from the feeling of vulnerability in their spare time, despite the situation provoking vulnerability being connected to their professional life. However, the experience of vulnerability may also be diminished through interaction with patients, relatives, colleagues, co-workers or managers.

Thus, the experience of vulnerability was evident in situations with patients and relatives. The inherent existential vulnerability was further exacerbated by the work conditions. What surprises was that nursing colleagues was also antecedents, transgressing the nurse’s personal boundaries.

One of the reviewers asked these questions and suggested:

“How might ‘we’ as a profession, as educators and/or practitioners support nurses to learn to navigate this aspect of practice and to recognize its impact on the nurse as ‘self’? This idea could be further explored & developed.

This is an important topic that we believe deserves to be a focus in itself.

In our discussion, we explored how to be sensitive and open without being harmed. Here we found support in Petterson’s theory on mature care that emphasizes that the nurse must take care of herself as well. This is not only allowed, but necessary in order to be able to provide authentic care for the patient.

In our search for recommendations on how to handle difficult situations, we found support in Chinn and Kramer’s theory on personal knowledge. According to this theory of personal development, the difficult situations may be experienced as a possibility to growth. Acknowledging that nurses from time to time experience situations that are more than she can handle will reduce the individual nurse’s vulnerability. However, admitting that something is difficult gives the nurse an opportunity to learn. Here, good colleagues are really needed and leaders play an important role in contributing to creating a learning environment.