Having a philosophy of patient-care delivery gives nurses a framework, values, and beliefs to guide their professional practice. The philosophy should directly reflect the relationships through which care is planned, coordinated, and delivered. Identifying nurses’ top values is a critical first step in formulating a philosophy of nursing practice that has relevance and meaning for all nursing staff.

As nursing leaders at our hospital prepared for Magnet™ redesignation, they were particularly interested in exploring such a philosophy. Overall goals were to:

• identify the relevance of the existing philosophy to nurses, particularly those providing bedside care
• engage nurses at all levels in developing a new philosophy of nursing—one that reflects core values from their perspective.

Before the formal project was implemented, the chief nursing officer (CNO) asked staff nurses about their understanding of the existing philosophy of nursing. The CNO found they had little awareness of the philosophy and saw it as only barely related to the care they provided.

Phase 1: Planning

The formal project had two phases—planning and research. During early 2007, two forums were held to generate discussion about the need for a more clinically relevant philosophy that was meaningful to direct patient care. The first discussion occurred among nursing leaders (directors and nurse managers) at a regularly scheduled meeting. Then during Nurses Week, nurses were asked to list concepts relevant to nursing care. Next, a task force was appointed to launch a formal survey among all nurses.

A literature review found that no similar projects had been conducted. It did find several papers focused on creating healthy work environments. However, while these reports were relevant to the nursing department’s overall goals, they weren’t specific to the philosophy of nursing project, and thus aren’t included in this report.

Phase 2: Research

In August 2007, the task force designed a formal survey and distributed it to all registered nurses (RNs) employed at the hospital. The survey focused on identifying the values nurses considered most important to the care they provided. (See Understanding the study methods by clicking on the pdf icon above.)

Results

Of the 1,800 surveys distributed, 839 responses were returned, for a response rate of 46.6%. Clinical nurses accounted for 81% of respondents; nurse leaders, advance practice nurses, and educators accounted for 19%.

RNs from all inpatient and ambulatory care areas were represented, including medicine, surgery, heart hospital, maternal-child health, psychiatry, transplant, and rehabilitation. Nurses from the risk management, hospital quality, infection control, and research departments also were represented. Respondents’ years of experience as an RN ranged from 1 to 54; 29% had less than 10 years’ experience, 22% had 11 to 20 years, 28% had 21 to 30 years, and 17% had more than 30 years.

Frequently reported nursing-care values

The five most frequently reported nursing-care values were:

• respect and teamwork (each identified by 30% of respondents)
• caring (identified by 26%)
• integrity (26%)
• compassion (24%).

Less frequently reported values were:

• professional compensation/benefits (13%)
• education; safety (11% each)
• competence; nurse/patient ratio (10% each)
• quality (9%)
• dedication; knowledge (7% each)
• patient satisfaction; excellence (6% each)
• autonomy (5%).

All other values listed were identified by less than 5% of respondents.

When it came to the value of teamwork, researchers found a significant difference based on years of experience: RNs who had less experience were more likely to identify teamwork as a value than those with more experience.

Departmental and position differences

Nursing-care values also differed significantly by department:

• Nurses in medicine, surgery, rehabilitation, and ambulatory units more often identified respect as a value.
• Nurses in the heart and medicine units more often identified caring as a value.
• Nurses in the heart hospital more often identified integrity as a value.
• Nurses in the psychiatry and transplant units more commonly identified compassion as a value.

Researchers also found significant differences in values based on the respondent’s position. Those in leadership roles (nurse educators, managers, and nurse practitioners) were more likely than others to identify competence, research, and evidence-based practice as core values.

Implications

Developing and revising a philosophy of nursing care hinges on clinical nursing staff involvement. For the work to have direct relevance and meaning in guiding everyday clinical practice, stakeholders at all levels must be involved.

Outcome

After analysis of the research data, each nurse received a clip badge listing the top five nursing-care values to add to her or his nametag. Immediate plans are to add unit plaques with the top nursing values and to disseminate information about core nursing values throughout the hospital system in grand rounds and research day presentations. In a qualitative study component subsequently initiated, nurses from each unit were asked how the top-identified values guide their nursing care; data will be available to inform the next phase of the study.

Nurse leaders in other hospitals have expressed interest in replicating the study so they can update their facilities’ nursing philosophy. Comparative analyses are likely to be initiated to determine similarities and differences based on hospital type, patient and nurse characteristics, and facility mission and goals. Based on presentation of this project’s core research at an international nursing conference, cross-cultural projects are likely to be initiated as well.

The authors were members of the Philosophy of Nursing Task Force at the Department of Nursing, Mt. Sinai Hospital, New York, New York, when this article was written.