Running Head: PERSONAL PHILOSOPHY PAPER

Personal Philosophy Paper

Tiffany Thomas
Bon Secours Memorial College of Nursing
NUR 4142-201415-SP Synthesis of Nursing Practice
Professor Wilkins
March 20, 2015

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Nursing is the use of evidence-based practice and nursing knowledge to oversee and tend
to the physiological, psychosocial, and spiritual care needs of patients while providing them with
high quality, cost-effective, and safe healthcare. There are a list of tenets stated within the Bon
Secours Memorial College of Nursing handbook that help to drive the colleges philosophy. The
tenets of nursing, nursing education, caring, and health speak to and describe my philosophy of
nursing. The tenet of nursing includes holistic care to promote wellness and restore health
(BSMCON Handbook, 2014-2015). I believe that caring for the mind, body and spiritual of a

patient is essential to provide the utmost quality of nursing care. Each of the three aspect of a
patient are important to promote healing and motivate the patient to begin a lifestyle to include
primary prevention strategies. The nursing education tenet encompasses acquiring nursing
knowledge and evidenced-based practices to provide patients with care (BSMCON Handbook,
2014-2015). Being a nurse requires lifelong learning, and a nurse no matter the level of

competency will never know everything. Nursing education as a whole helps to guide a nurses
clinical judgment and helps to provide the nurse with the most recent research on the best
methods for skills and procedures to provide safe care to patients and their families. The caring
tenet involves the utilization of nursing presence with patients and their families. Caring is
needed overall to help patients come to terms with and manage whatever their illness may be.
Caring is one aspect to nursing that makes the practice of nursing so unique and every nurse
should practice with compassion and understanding towards their patient as it helps the
progression to health, wellness, and management of patient conditions. The health tenet is selfexplanatory because nurses work in the healthcare field and tend to the health of patients. As
nurses we address the patients in their entirety including the cognitive, physical, and
emotional/spiritual aspects. These individual characteristics of a patient effect their health as a

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whole, and because nurses provide care in a compassionate manner applying research and
evidence-based practices it nothing less than expected for health to be incorporated in
philosophies of myself and my nursing school. It is clear that my personal philosophy is a
product of my nursing education from Bon Secours Memorial College of Nursing and my
experiences had there.
My nursing philosophy is reflected in all of relationships with nurses, peers, providers,
patients and patients families. With every encounter I have with my patients I address their
clinical issues, as well as any social or emotional discomforts and knowledge deficits they may
have. I implement any procedures and care I provide to my patients keeping in mind any
evidence-based practice I have learned in school, researched myself or designated by hospital
policy. I communicate with other nurses and healthcare providers via SBAR and make sure to
keep the communication lines open in an effort to provide safe and superior patient care. I
incorporate caring into my nursing practice by attempting to provide my nursing presence to my
patients through active listening or sometimes a quiet presence during times of turmoil. I try to
motivate my patients to make healthier lifestyle changes and do so by letting them know that I
care about their wellbeing and overall health. My experiences and time spent in the clinical
setting is consumed with practicing through my philosophy to provide care for patients.
Any of my patient encounters can be used as an example of the application of my nursing
philosophy. I cared for a new congestive heart failure patient and had to manage her condition
physiologically by making sure to balance her intake and output of fluids, cognitively by
explaining to her each of her new medications and providing teaching about daily weights, and
emotionally by helping my patient to cope with the lifestyle changes she would have to make. I
had another patient who was on mother/Infant unit who had issues communicating with some of

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the nurses on the unit. I had offered my nursing presence to this patient and listened to the
patients concerns. I ultimately advocated for the patient to the other nurses what the patients
wishes were in correspondence to the care of her and her newborn child. Just yesterday I placed a
nasogastric tube (Dobb Hoff) in a patient and made sure to review hospital policy as well as the
instructions included with the equipment to make sure the procedure was completed based on the
evidence on such procedure. With this same patient I had to communicate with the nurse
practitioner frequently on change in patient condition and ultimately converted the patient to
comfort care based on patient prognosis and family approval. I helped one of my respiratory
failure patients overcome the anxiety she had about ambulating as it related to her fear of having
become non-weight bearing. These examples and many more that I could offer go to provide
proof of how I practice with my philosophy of nursing at heart. The tenets of nursing, nursing
education, caring and health are all presence. I attend to the entire patient mind, body and spirit. I
continuously incorporate education and verify policy, procedure, and expected assessment
findings. I provide patients with the kind and compassionate care that I would hope to receive,
and I make health, in its entirety a priority with every patient experience.
My initial philosophy of nursing paper was focused mainly on equal care and treat to
patients irregardless of various stereotypes. There was little discussion of what nursing actually
entailed only to care for patients physically and emotionally if possible. In my initial philosophy
of nursing paper I spoke on how the philosophy of the nurse and the organization he or she
works for should be in tandem, and how the values and philosophy of the nurse ultimately
effected the patient and their motivation for lifestyle changes as well as the type of care the
patient received. This philosophy of nursing paper I am writing now has much more detail. I can
speak to the tenets of Bon Secours Memorial College of Nursing and how they apply to my

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professional practice. I feel as if patient culture stereotypes and my personal bias I have learned
how to acknowledge and handle through clinical experience and that the bigger focus of my
philosophy now lies with the safe quality care the patient receives, and the different research and
evidence that we as nurses base our practice on. With my philosophy now I understand that
providing care for the patient physically and emotionally is not an if possible situation, but rather
part of the holistic care that nurses provide and is truly required to produce the best patient
outcomes. In my previous philosophy paper I did not speak to nursing education which I now
view as an everlasting and growing body of knowledge that helps to define and guide the
methods for the skills and procedures we provide with everyday care. Looking back on this paper
that I wrote during my first semester in nursing school I definitely have those same feelings
about my nursing philosophy. However, now being in my final semester I am able to personalize
my nursing philosophy, apply it to my practice thus far, and give detail and insight to how I view
and practice nursing as a profession.
In the book, From Novice to Expert, Benner describes a theory of nursing competency
that involves five levels. Benner categorizes nurses under the proficiency labels of novice,
advanced beginner, competent, proficient, and expert nurse. This model of skill acquisition
describes the transition a nurse makes and how the nurses view on the importance of data,
critical thinking, and involvement in patient care evolve. The first or level described in Benners
theory is novice. By Benners account the novice nurse is a beginner that relies on rules and
guidelines to perform duties (Benner, 2001, p. 20-21). The beginner nurse is very task oriented
and is able to think in terms of attributes. They are unable to determine the more meaningful
aspects of the patient situation or the importance of various tasks or steps in patient care as it
requires prioritization. The novice nurse has no clinical experience and therefore can only judge

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situations based on learned theory and classroom or textbook knowledge, rather than use clinical
judgment gained from real life experiences (Benner, 2001, p. 20-21). The second stage is
advanced beginner. Unlike the novice nurse the advanced beginner has some experience, enough
to think in terms of attributes and aspects of patient care. The advanced beginner nurse is able to
decipher the more meaningful aspects of the patient information, however similar to the novice
nurse they have trouble prioritizing and still utilize guidelines for the completion on their nursing
duties (Benner, 2001, p. 22-25). The third level is competent. The nurse will reach the competent
stage somewhere around two to three years of having similar nursing experiences. This nurse is
fully aware of the attributes and aspects of the patient to a point where he or she can determine
urgent matter from those that can wait (Benner, 2001, p. 25-27). At the competent level the nurse
strives to be more flexible, manage time better, and multitask the nursing responsibilities. The
fourth level or stage is the proficient nurse. The proficient nurse is able to view patient situations
as a whole rather than merely individual parts or tasks. This nurse can view long term the goal
for the patient and can compare a patients situation to previous experiences with other patients
in order to determine the projected path to follow for positive patient outcomes (Benner, 2001,
p. 27-31). After about three to four years with one consistent patient population the nurse can be
leveled a proficient nurse, however depending on the situation or type of patient a proficient
nurse can regress to operating on the level of a competent nurse. The fifth and final stage is the
expert nurse. This nurse is able to view the patient and situation as a whole, but does not need to
necessarily rely on guidelines or past experiences to evaluate a situation (Benner, 2001, p. 3135). With the expert nurse the sense of what is going on with the patient or what needs to be done
for the patient comes from many years of experience. This nurse will have dealt with similar
situations to the point where they are identifiable to him or her, just as the alphabet or numbers

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are to the layperson. This is not meant to be taken as the expert nurse is never wrong, but to
explain that the expert nurse will reach a point where they have all the guidelines and analytical
thought processes but does not always have to rely on them. The key point that Benner makes
when explaining all of the stages is that at any point a nurse can regress from one stage to
another when faced with a new problem or type of patient that he or she has never faced before.
When floated to a different unit with a different patient population the expert nurse can revert
back to a proficient or competent level which proves no nurse, whether new graduate or one with
ten years of experience, will ever know everything.
With me nearing graduation in two months it is obvious that I am within the lower stages
of the Benner model. In my honest opinion I believe that I fluctuate between the novice and
advanced beginner nursing levels of skill acquisition. There are some days or immersion when I
have a respiratory failure patient when I feel that my skill level is that of an advanced beginner.
No I am not a master of all that is respiratory failure, however visualizing lower oxygen
saturation levels and labored breathing would not send me into a quick uproar. Because I have
had more than a few respiratory failure patients I take the time to compare my findings to their
baseline and may spend a few more minutes with the patient working on breathing techniques
before I run to alert other nurses that my patient is at 88% O2. There are times when I have had
to do procedure like place a nasogastric tube, where even though I had never physically done one
I had seen them placed many times and after looking up the procedure, I felt ready to handle the
situation and felt that I could analyze it from the prospective of an advanced beginner. There are
other times when I feel that I function as a novice nurse. The instances during immersion when I
have gotten the opportunity to work with neuro patients or patients with LVADs I have on those
days felt like a novice nurse. I have not had as much experience so I make sure to go through

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everything assessment piece as is written and the slightest change in patient vital sign or
Glasgow Coma Scale and I am alerting my preceptor and questioning what it means. I remember
seeing a LVAD for the first time and having asked the patient what the cords and machine was
connecting to. I had no idea what this meant for the patient as far as functionality and had to look
up information about the LVAD. Overall I agree with Benner that the skill acquisition of a nurse,
any nurse, will largely depend on the situation and whether it is new territory or not.
Having defined where I feel I fall within the model of skill acquisition, I know that as a
new graduate nurse I will be mostly functioning at the level of advanced beginner, given my
immersion experiences. I would definitely like to transition through the different levels of skill
acquisition although I know it will take time. In order to move to the next stages as described in
Benners theory I will have to be able to recognize the different aspects and attributes of patient
situations, learn to prioritize my time and nursing duties, and be open to learn from my
experiences. Throughout my journey in nursing I would like to believe I could reach the expert
level. Every nurse is not skilled enough to reach that level so in progressing through the stages of
skill acquisition I know the first step would be to master the skills of advanced beginner and
reach a level where I am able to decipher urgent from less important data as it relates to patient
condition. After or while doing so I know I will also need to be able to prioritize my patients via
acuity, as well as become flexible and learn how to manage my time with patients, charting, and
everything else that goes on during a shift. The most important thing that I could do during my
student nurse experiences and with every experience I have as a nurse is to learn from those
experiences. I feel the only way to become a proficient or expert nurse is through time and
experience, but especially learning from different situations. What was done, or what else could
be done. To continue to further my education and learn from my nursing experiences both fall in

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line with my nursing philosophy. So hopefully, and according to Benners theory, practicing with
my nursing philosophy and with time and experience in a matter of years I will be functioning at
the level of a proficient nurse.

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10

References

Benner, P. E. (2001). From novice to expert: Excellence and power in clinical nursing practice.
Upper Saddle River, NJ: Prentice Hall.

(BSMCON Handbook, 2014-2015)