The GWT Blog

My name is Joan Miller. I have been a nurse for over 35 years. I currently teach in a baccalaureate nursing program at Bloomsburg University, Bloomsburg, PA. I entered the profession with a desire to provide excellent care for my patients. I wanted to be known as a caring nurse, one willing to work hard, listen well, and show that my patients were always my top priority. I've worked hard to foster professional growth and excellence among my students. However, much to my dismay, many new graduates become disillusioned when they enter the work place. In today's changing health care environment, new graduates experience what many call a 'reality shock.' They lament the fact that they do not have time to listen, to be present to those who are vulnerable, and to achieve the level of excellence that they had hoped to achieve.

-What attracted you to the profession?

-Why do you think new graduates become disillusioned when they enter the practice environment?

While preparing for a sabbatical, I read a review of Wendy Fischman's book, Making Good: How Young People Cope with Moral Dilemmas at Work. This book sparked interest in the research being conducted at Good Work Project at Harvard University. Using the Good Work Project research methodology, I studied the perception of good work among nurses at different levels of professional development. I explored how it is that excellent nurses ride out storms in the profession while remaining committed to excellence.

-How do you define good work in nursing?

Veteran nurses talked about the strategies they used to overcome adversity. A Chief Executive Officer for Nursing in a large teaching hospital told me she "had to be a risk taker." She was asked to help stabilize an economic downturn in the hospital. She was unwilling to sacrifice the values that informed her identity as a good nurse and an excellent administrator. Her solution: build a team of leaders who share the same values and commitment to excellence. She stated, "If my nurses are good nurses who do the right thing, people will want to come here for their care." She accomplished her goal and continues to lead nursing into the future at this medical center.

The young nurses I interviewed spoke of the dilemmas they face at the bedside when they are expected to produce more with fewer resources. Early one morning I met a new graduate in the hospital coffee shop after she had finished a 12-hour night shift. This new graduate, whom I will call Jamie, told me how she went home earlier in the week and cried for hours knowing she had not been able to comfort a troubled patient who simply needed a caring presence. When asked if she ever thought of leaving the profession, Jamie responded, "No, I will never leave. I just focus on the reasons I came into nursing. That's what keeps me going."

-What strategies have you used to overcome adversity in the practice environment?

Jamie's experience is not unlike the experience of many nurses around the world. Nurses in every culture are dealing with the global nursing shortage and its impact on patient care, safety, and job satisfaction. It is important to consider reasons nurses enter the profession. What values prompt selection of nursing as a profession? How can we sustain those values? Why do nurses leave the profession? Some nurses, just as Jamie implied, become disillusioned as they transition from the academic to the practice setting.

-Is it possible to arrive at a common definition of good work in nursing across cultures?

I have been using the GoodWork Toolkit® as a curricular strategy to help student nurses focus on the values and vision that initially brought them into the profession. The GoodWork Toolkit® provides an opportunity for beginning students to reflect on themes and strategies that will support good work in nursing. Students learn about the meaning of values, beliefs, and integrity. They reflect on the influence of role models in their lives. They learn a new vocabulary. I believe that students who engage in a dialogue around the concept of good work will be better prepared to cope with the frustration and difficulty they may experience in fulfilling the goals that prompted nursing as a career selection. Dialogue is needed to identify interventions and/or practices that have supported the development and sustaining of values essential to good work in nursing. I suggest that educators consider integrating the GoodWork Toolkit® into the curriculum as a means of promoting good work in nursing.

-What tools do you think new nurses need to overcome adversity?

-How best can we prepare the next generation of nurses for the challenges they will encounter in the work place?