How Do I Find Reliable Peer-reviewed Scholar Articles on Nursing Leadership

J Prof Nurs. 2021 September-October; 37(five): 1018–1025.

The Exemplary Practice Life of the Nurse

Joan Chiliad. Riley

^aEmmanuel College, Boston, MA 02115, United states of america

Judy A. Beal

^bSimmons University, Boston, MA 02115, 27 Upton St. Unit 2, Boston, MA 02118, United states of America

Patricia Reid Ponte

^cBoston College, Chestnut Loma, MA 02467, U.s.

Abstract

Nurses consistently stand up out in extraordinary means especially during a global crisis, recently confirmed in the current Covid-19 pandemic. What is opportune this time is the call for clarity around what nurses do and what social club tin can look from them. Nurses, as members of a global profession, demand a platform to build a contemporary practice life. This paper proposes the model: The Exemplary Exercise Life of the Nurse. Information technology provides a framework to explicate the essence of the office of the nurse. The model posits iv inter-related essential components or pillars that footing a nurse'due south behavior and commitment: professionalism, leadership, scholarly practice, and stewardship. This uncomplicated, straightforward model is universally applicable for nurses to use in whatever roles they hold and at whatsoever signal in their careers. The use of a holistic model, as a guide across a full career trajectory, supports the nurse's ability to prioritize individual pillars while understanding the inter-relationship and influence amid the four pillars. The authors pose assumptions that form the footing of the registered nurse role and provide the foundation for the exemplary practise life of the nurse. They make recommendations to nurses, the profession, the workplace, the academy, and the community.

Keywords: Function of the nurse, Nursing profession, Conceptual model, Nursing'southward stakeholders, Exemplary practise life of a nurse

Nurses have always been central to managing and abating health crises such as the recent COVID-19 pandemic wellness crisis. They volition go along to be pivotal as the nation heals, all while the urgent need to reduce wellness disparities continues to soar. Nurses carried out their awe-inspiring and innovative piece of work in hundreds of diverse roles and settings. They demonstrated true leadership in the most professional fashion (Rushton & Thompson, 2020). This boggling contribution centers nurses in the midst of a "landmark" multi-year performance in every part of the world. This truly was exemplary nursing practice at its all-time. This recognition amplifies the fact that nurses, as members of a global profession, require a common platform to build a contemporary exemplary practice life.

At the aforementioned time, the profession, while earning the designation every bit a major global workforce in the wellness care manufacture, continues to grapple with 2 key variables. The first is the slow transition inside the United States for the BSN as the preferred degree for entry into the profession. The second is that practice roles are undergoing transformative changes in every part of the health care delivery system. As a result, nurses confront extraordinary challenges to meet the emerging health care needs in a society that has experienced a long response to a global pandemic and faces significant wellness disparities. Nurses are positioned extraordinarily well to design innovative, and new models of care to respond to these challenges with a selfless commitment to remain truthful to the cadre work of the profession.

For 18 years, the American public has acknowledged nursing equally the most trusted profession in the The states (Gallup, 2021; Reinhart, 2020). Every bit the current COVID-nineteen pandemic has demonstrated, nursing is an essential profession whose members are highly valued, trusted, and respected. Merely the practise of nursing remains uneven – a reflection of broad variations in educational training, clinical expertise, and professional person growth among its millions of individual clinicians. Nurses themselves often accept difficulty articulating the essence of their do. It is therefore not surprising that the public it serves has however to fully grasp a consistent understanding of nursing's unique contributions to society much beyond nurses' uniform person-centered caring, comforting presence, reliable judgment, and technical expertise.

The protracted Covid-19 pandemic highlights the need to fully define what nurses do through the lens of what we, the authors, phone call the exemplary practice life for all nurses. Recently there have been calls that recognize the need to clearly describe the roles and expectations of nurses (Godsey et al., 2020; Ulrich et al., 2020). We are proposing a universally applicable, compelling, straightforward conceptual model to explicate what nurses do. This model can guide nurses in their work, in whatsoever setting and in whatever the current stage of their careers. Nosotros believe that a universal holistic model is needed given the complexities of a global economy, the disparities embedded in the health care needs of society, the demand for expanded knowledge development, technological innovation, the stride of change in health care systems, and the public demand to understand the work of nurses.

The aim of this paper is to depict a new holistic conceptual model that visually depicts what constitutes exemplary exercise for a registered nurse formatively educated at the baccalaureate or primary's entry level. To better understand exemplary professional nursing practice, nosotros developed a model that describes such a person'south essential attitude, behavior, and capability within the context of iv independent, nonetheless inter-related, pillars of: professionalism, scholarly practice, leadership, and stewardship. This model is named The Exemplary Practice Life of the Nurse. We define exemplary nursing exercise equally the best of the best of the fine art and science of nursing, and it represents the highest level of knowledge, expertise, and competence. While baccalaureate or master's entry graduates are prepared for an exemplary practice life, this evolves over a full career trajectory and is applicable across all professional person nursing roles and practice settings.

Assumptions for an Exemplary Exercise Life of the Nurse

The following are a prepare of assumptions that we believe underpin a framework for all nurse work, and as a upshot form the foundation of an exemplary do life. These assumptions have been shaped by the history of the profession of nursing and are relevant to nurses in the nowadays and for the hereafter.

Assumption one

Society can expect that each nurse who has completed determinative education at the baccalaureate or master's entry level will possess cognition, attitude, behavior, and adequacy to treat all who need it regardless of setting.

The complexity of electric current practice environments requires critical thinking skills and a strong foundation in the art and science of nursing that are more completely adult during baccalaureate and main's entry level education. Society can expect that the knowledge, attitude, behavior, and the adequacy of a nurse will deepen over the class of a total career. Career advancement is tied to aspiration, experience, intent, formal education, and professional development. Optimal piece of work settings support nurses throughout their careers to come across their developmental goals.

Assumption ii

Society can expect each nurse to have and value all persons as equal, worthy of respect and with intrinsic worth, regardless of all other considerations.

Nurses are formatively educated with a holistic and generalist framework that sets the background for a career that embraces diverse roles in various settings with and for various people, anywhere and in whatsoever roles to assure the public that healthcare is bachelor for all. Furthermore, nurses are socialized to fulfill the expectation that a humanistic, individualized, person-centered approach to care uses social justice tenets as the foundation of interactions with others.

Assumption three

Society can uniformly expect each nurse to possess a set of role attributes and role functions that guide the scholarly piece of work of all nurses.

Nurses use knowledge that prioritizes the ability to grade therapeutic relationships; they appreciate the necessity to partner with people in their practice; they develop the capacity to teach; they are competent in the use of scientific knowledge and inventiveness to critically clarify phenomena and deliver evidence-based care. Nurses exert their capability to effectively interact with all stakeholders involved with the health and wellness of the public; they accept been educated and socialized to be leaders in communities and within their practice settings. Nurses possess the power to provide expert humanistic and holistic care to self and others that reflects kindness, compassion, respect, and mindfulness in their practice.

Assumption four

Society can expect that each nurse is adaptive to alter and committed to the core tenets of professional person practice regardless of the do setting or role.

Working in circuitous environments that are constantly changing calls upon the nurse to sympathize the essence of the professional part. Leading change in formal and informal processes that issue in improvements is a key part of the nurse and results in continuous learning by self and others. To best serve the health and wellness needs of society, the core of nursing'due south work centers on a strong collaboration with interdisciplinary partners and the people they serve. These collaborations often serve as natural laboratories for the design and implementation of dynamic innovations. Nigh importantly, nurses are committed to alive and conduct practice with integrity, nobility and respect that includes a social, personal, and professional responsibleness and accountability for 1's actions as a member of the profession.

The model: The Exemplary Practise Life of the Nurse

In this model, the exemplary practice life of a nurse is illustrated equally four essential pillars that provide a foundation for nurses equally they evolve professionally. Nosotros envision this model as a holistic guide that affords the nurse the power to prioritize individual pillars while always understanding the relationship and influence of pillars to each other and to the whole. In that location are iv pillars in this model: professionalism, leadership, scholarly practice, and stewardship.

Every bit shown in Fig. 1 , the four pillars in the model support the exemplary practice life of a nurse that, in plow, serves to accelerate the health and wellness of society. The placement of health and wellness of society represents the pinnacle to exist achieved of in terms of exemplary practise. Its position as the highest point in the model serves to recognize the direct touch on of an exemplary practice life of a nurse on society. The pillars link to a cross-directional arrow that represents the inter-related, however contained, relationship among pillars. The model also illustrates the essential characteristics of each pillar. For case, the nurse exercises cadre responsibilities in professionalism when he or she invests in lifelong learning and self-care, accepts responsibleness and accountability for the health and wellness of society, and comports with a potent professional identity. Each pillar of the model is afterward explained in detail.

The Exemplary Practise Life of the Nurse.

In this model, the four core pillars rest on stakeholders. Stakeholders include individuals and groups who have an interest or an investment in supporting the exemplary practice life of the nurse and in plow the health and wellness of social club. These include: the nursing profession (the body of private nurses and professional associations/organizations, regulatory and credentialing bodies); education or the university (colleges and universities that prepare nurses at the formative level); the workplaces (where nurses and inter-professional person health care colleagues are employed); and the community (an essential part of club that shares common characteristics, aspirations, and challenges). These stakeholder groups are represented by the labels: Profession, Education, Workplace, and Community.

In the following sections, nosotros depict each of the pillars and provide evidence for the choice of each in the model.

Professionalism

To understand professionalism every bit one of the pillars of an exemplary practice life of a nurse, we recognize the varied and rich history of nursing. Early historians noted that nursing'southward initial primary work centered on a sense of obligation to community through service of others (Donahue, 1996). Over time, nurses, individually and collectively, engaged in societal struggle to address the demand for equity (Dock & Stewart, 1938). The term professionalism was rarely used in the literature prior to the 20th century. Just what is informally described in the historical narratives are behaviors and characteristics used in the practice work of nurses during such times. The narratives connect the past to the nowadays and offer guidance for the future.

Although controversial in the historical record, Florence Nightingale, with strong views about health and wellness and the unwillingness to take the dictates of the politics of the mean solar day, brought professionalism into the lexicon of nurse work (Donahue, 1996). She advocated for nurses to move beyond benevolence as the model of care to 1 where pedagogy preceded practice; where practise was a duty to society; where the character, values, passion for the care of the sick and their communities were frequently stated ethics for nurses. Nightingale recognized the importance of full nurse date, a positive approach to health promotion and informed determination making, and the pursuit of social justice as the bedrock of a professional person life (Beck, 2010; MacQueen, 2007; Wagner & Whaite, 2010;).

Ii centuries subsequently, the concept of professionalism continues every bit both multifaceted and complex.

Studies identify a wide range of dimensions, attributes and influences linked to the development of professionalism (Ali et al., 2020; Garcia-Moyano et al., 2019; Ohlen & Segesten, 1998). The International Society for Professional Identity in Nursing (ISPIN) has committed its core work to developing the science to guild to empathize identity formation in nurses (Godfrey, 2020; Joseph et al., 2021). Their piece of work is grounded in a concept of professionalism that incorporates two distinct professional paradigms, social and psychological, into the nurse'southward professional identity (Crigger & Godfrey, 2014).

Nurses often express the view that professionalism is easier for them to describe every bit situationally related actions than to define as a complete set of behaviors. There is no universally accepted definition of professionalism. This fact is not surprising given the complexity of the concept. Johnson (2015) reported counting 60 words or concepts in an informal review of the term professionalism. Regardless, professionalism remains a personally important concept for nurses. To explain its significant, i needs to begin with the fact that no ane is built-in a professional. Rather, it is an intentional process of development that begins in formative education, transitions into the workplace, and continues through the major stages of a nurse's career. "Developing and nurturing professionalism in nursing takes fourth dimension, authentic presence of leaders, engagement of colleagues and somehow creating a feel of value in the contribution of each nurse, from the bedside to the boardroom" (p. 266, Leclerc, 2017). Professionalism is a purposively evolving mode of thinking and acting (Johnson, 2015).

There is recognition that professionalism requires the private nurse to act equally the fully accountable agent of professional person responsibility, throughout their career. Stakeholders, who are invested in the practice life of the nurse, are also recognized as important influencers because they back up the development and promotion of weather condition that are conducive to sustaining professionalism (American Nurses Association, 2014). Professionalism offers a covenant with society as to what mental attitude, behavior, and process govern the piece of work of nurses no matter where they practice and whatever their practice role.

As such, we posit that professionalism is a multidimensional lived experience that includes a combination of characteristics, values, deport and deportment. Professionalism includes identity formation, comportment, credence and accountability for professional responsibilities and expectations. Reflection, the need to form a therapeutic relationship integral to the caring human relationship, passion for the work of a scholarly practice, as well as civic and social responsibility further define the understanding of professionalism. Nurses prioritize being bachelor for others: for people, patients and families, colleagues, peers, workplace, and communities.

Professionalism informs the design for educational programs, statements of workplace expectations and signposts for the nurse to incorporate into the other pillars of an exemplary practice life of the nurse. The newly canonical AACN Essentials details the domain of Professionalism with its related descriptors, contextual statements, and competencies to be accomplished during formative education (AACN, 2021). Professionalism, in all its dimensions, clearly is an essential pillar of an exemplary practise life of the nurse.

Scholarly practice

Scholarly practice has consistently been part of the discussion surrounding the essential components of nursing practise. Since 1922, Sigma Theta Tau, the International Nursing Honor Society has recognized and promoted nursing scholarship as one of its major tenets (Sigma Theta Tau, 2020). Cynic's (1978) seminal work formulated what she coined "nurses' patterns of knowing" which set the foundation for scholarly do. Benner'south model From Novice to Expert further advanced this give-and-take every bit an explanation of how knowledge and skills are acquired and practical to nursing do (Benner, 1982, Benner, 1984). While the dialogue on how to ascertain scholarly practice continues to evolve, the message of its importance to the profession and to quality patient care outcomes remains consistently stiff. Riley et al. (2002), described a universal holistic model of scholarly nursing practice consisting of the scholarship of knowing teaching, practise, and service. This model evolved later to include the role attributes of "who I am" and "what I practise" (Riley et al., 2008). Participants (N = 36) in this qualitative study shared that they remember of themselves as: ane) available for others, 2) active learners, three) out of the box thinkers, 4) passionate about nursing, and 5) confident. They bear these values while leading, caring, sharing cognition, and beingness self-cogitating. We believe that scholarly practice includes the characteristics of developing new knowledge, improving practice, basing practise decisions on evidence, designing, and implementing innovative practices, using artistic approaches to individualize the needs of the people we serve, and advancing system-broad priorities and initiatives.

There is professional consensus that formative nursing pedagogy programs take the responsibility to gear up their graduates for a scholarly practice. The competencies attained by baccalaureate and master'due south entry prepared nurses within their formative educational activity are driven by the National League for Nursing (NLN) and the American Association of Colleges of Nursing (AACN). These competencies set the stage for a lifetime of scholarly practise. The National League for Nursing (2021) identifies 4 core competencies for all graduates of all formative educational programs, ii of which support the expectation of scholarly practice. These include the spirit of enquiry and nursing judgment both of which prepare graduates for a "do that is informed by a torso of knowledge and ensures that all members of the public receive condom, quality care" (NLN, 2021). The approved 2021 AACN Essentials (AACN, 2021) labels this competency as 'Scholarship for the Nursing Subject field' and defines information technology as "the generation, synthesis, translation, application and dissemination of nursing knowledge to ameliorate wellness and transform health care" p.11. The related sub-competencies include: advancing the scholarship of nursing; integrating best testify and promoting the upstanding comport of scholarly activities.

After completing formative pedagogy at the baccalaureate or master'due south entry level, nurses, in partnership with the workplace and other stakeholders, assume responsibility for edifice on the foundation for scholarly practice competency attained in nursing education. Equally nurses transition into practice settings across a diverse and complex healthcare system, it is imperative that practice settings, in partnership with individual nurses and professional associations, fully support and help shape, evolve, and brand a commitment to implementation of scholarly practice. Organizational credentialing bodies such as the American Nurses Credentialing Center (ANCC) and others promote the development of scholarly practice through a culture of individual and organizational scholarly practise. ANCC's include the ANCC Magnet Recognition Programme, The ANCC Pathway to Excellence Plan and The Practice Transition Accreditation Plan (PTAP). While not all wellness care organizations are magnet designated, we believe that each individual nurse must commit to scholarly do wherever they practise.

Scholarly practice is as much most attitude as it is nigh using a systematic approach to program and deliver care and conduct other work of professional person nurses. This attitude or mindset includes a commitment to systematic inquiry with the post-obit questions in mind: How tin can nosotros do this amend? What does the prove at all levels tell us? How can we do this in a mode that meets the needs of this particular person or groups of people? How can what nosotros acquire exist applied to broader groups of people within lodge served in a diverseness of contexts?

We believe that all nurses are capable of engaging in a scholarly practice. This chapters matures throughout a nurse'due south career. Nurses and the public take been socialized to think of scholars as educators and researchers employed by colleges and universities. Co-ordinate to Broome (2021), "Despite our ain internal conversations, the public does non think of us as scholars and scientists…" p. 250. Because of this prevailing belief, many nurses have been reluctant to embrace themselves as do scholars and capable of scholarly exercise. Nurses, however, exercise call up of themselves as highly creative, resilient, and accountable for seeking information, and scientific and aesthetic evidence to help formulate their plans, decisions, and actions.

Nurses with a scholarly practice prioritize learning; they know the people they care for; they believe that knowledge is ever evolving. Nurses recognize that, for them to be at their best, they need to continually learn in formal and informal ways. They collaborate and partner with others including the people they serve to find solutions to healthcare and societal challenges. This is scholarly practice!

As such, nurses with a scholarly practice have responsibility for implementing and disseminating new noesis for the advancement of the health and wellness of gild. This important process occurs in the clinical intendance setting, in the classroom, in the conduct of research, in any setting and role the nurse holds. Scholarly practise with its direct connection to the wellness and wellness of gild is an essential pillar of an exemplary exercise life of the nurse.

Leadership

The early literature on leadership was primarily driven by leaders and scholars from the earth of business (Kouzes and Posner, 2003). More than recently, other professional disciplines including nursing have joined in the evolution and analysis of the theories and practise of leadership. There remains considerable debate near what leadership really is and how it differs from management. Equally a result, in that location is a plethora of definitions of leadership from both within and outside nursing. Diers (2004), in one of her classic editorials, wrote that leadership is viewed as multi-dimensional, encompassing the wise use of ability, managerial functions, and human relations processes. We believe that leadership is a gear up of actions and behaviors used by individuals or groups of individuals inside their environment that facilitates the establishment and acquisition/achievement of shared goals (MA Department of Higher Teaching, 2016).

The following review of the literature centers on understanding leadership and its expected behaviors. From the globe of business, Kouzes and Posner accept been writing near exemplary leadership since 2003. In their seminal work, they ascertain essential leadership practices that are of import to promoting growth of an individual and an organization. This definition includes engaging and empowering all members in the organization to found sustainable outcomes intentionally and collaboratively. They describe five leadership practices: i) 'modeling the way', 2) 'inspiring a shared vision', 3) 'challenging the process', 4) 'enabling others to act', and five) 'encouraging the heart'. While 'encouraging the center' has not typically been viewed as a leadership competency, executive autobus Daskell (2017) wrote that love is a leadership competency. By leading with pity, delivery, kindness, and competence one tin can motivate others toward achieving greatness.

The long running and highly effective Robert Wood Johnson Executive Nurse Fellows Plan (1997–2017) identified core competencies for nurse leaders (Bellack & Morjikian, 2005). These include:

• Self-noesis, or self-awareness is the ability to understand and develop oneself in the context of organizational challenges, interpersonal demands, and private motivation.
• Strategic Visioning is the power to connect broad social, economical, and political changes to the strategic direction of organizations. Strategic nurse leaders are always thinking about the next step.
• Risk-taking and Creativity is the power to transform both oneself and the arrangement by moving exterior the traditional and patterned ways of success. A leader who is a adventure taker often feels uncomfortable and learns to take this discomfort.
• Interpersonal and Communication Effectiveness is the ability to translate a strategic vision into compelling and motivating messages. Great leaders intendance about people with whom they work. They stay on mission simply are always listening to divergent voices.
• Inspiring and Leading Change is the ability to inspire, structure, pb and effectively implement organizational alter in an inclusive way. Great nurse leaders lead from their values. Their personal integrity and moral courage are the cornerstones of their legacies.

While the RWJ programme was a formal program directed toward nurses aspiring to advance in their leadership roles, we believe that these five constructs are applicable to leadership development of all nurses, regardless of title or work setting.

Leadership identity has typically been associated with a hierarchical, authoritative, and formal position (deZuleuta, 2015; Van de Mieroop et al., 2020). However, there is support in the nursing literature for the importance of breezy leadership where the leader may not have a formal titular position or authority over a group of individuals. Informal leadership roles are exercised by those individuals who are situationally willing to step up and take actions; they are the "go-to nurses" (Clifton, 2014, p. 68). Within the civilisation of workplace organizations, an breezy leader has been described as anyone who directs/guides a grouping toward accomplishing desired outcomes (Ross, 2014). Nurses, who engage in scholarly practice throughout the healthcare enterprise, assume breezy leadership roles in best-selling and unacknowledged ways.

Riley et al. (2008) in their written report that explored perspectives of thirty- vi experienced nurses' descriptions of their scholarly nursing practice, plant that participants' perspectives of leadership differed from more traditional views of formal leadership. Participants spoke to a non-hierarchical approach to leadership that they repeatedly called "stepping up the plate over and over again to guarantee the highest level of care…to develop others and to accelerate practice" (pg. 431). Informal leadership was their expectation for their exemplary practice life. We believe that breezy leadership needs to non only exist farther developed and supported but included in the performance expectations for every nurse in every workplace.

Based on experience, enquiry, and a synthesis of the literature, we believe that all nurses educated at the baccalaureate or master's entry level are prepared to be leaders. Whether in informal or formal leadership positions, nurses are held to the following expectations: developing oneself and others; embracing cultural humility, inclusivity, and diversity; modeling professional practice and beliefs with a non-hierarchical approach; communicating with colleagues and others with clarity and purpose; managing resources effectively; and collaborating with others to advance the practise and profession of nursing and health care for the benefit of society. Nurses as leaders are cogitating, visionary, and strategic thinkers who experience comfy taking risks and innovating in fifty-fifty the well-nigh challenging situations (Bellack & Morjikian, 2005).

We believe that both the formal and breezy nurse leader is obligated to advance oneself, others, and the profession with humility, inclusivity, and generosity of spirit. Whatsoever the role, a nurse leader has the ability to influence others and build consensus toward a mutually shared goal or decision on both the micro and macro level. For example, the nurse leader has the responsibility to advocate for advancing health equity for all by removing practice barriers and supporting nurses in their efforts to empathize the affect of the social determinants of health (NASEM, 2021). For these many reasons, leadership is one of the four pillars that supports the exemplary practice life of the nurse.

Stewardship

Identifying stewardship equally i of the 4 pillars supporting the exemplary practice life of the nurse is both timely and necessary. Nursing is charged with preparing for its future while living in the nowadays. All nurses are chosen upon to assume a stewardship responsibility for the conservation of the ideals of nursing while leading consequential changes in wellness care environments that bear upon the wellness and wellness of society.

The concept of stewardship, outside the boundaries of a profession, has a long history. When the word stewardship starting time appeared in the English language during the Heart Ages, it functioned as a job description, denoting the office of a steward, or director of a big household (Merriam-Webster, 2020). Over the centuries, the understanding of stewardship expanded to include the oversight past the courts and many organizations. In contempo years, the long-established "management" sense of stewardship has evolved into a positive significant emphasizing "careful and responsible direction" (Merriam-Webster, 2020). The historical evolution of stewardship carries forward a fix of ideals that include duties, shared responsibilities, oversight, resources preservation, prudence, and advancement into a mod era.

Twenty kickoff century stewardship ideals are addressed in business concern as integrated leader behaviors that place long term best interests of the business entity and stakeholders over cocky-interest (Hernandez, 2008; Hernandez, 2012). Leaders, committed to their office every bit steward, meet the do good of this telescopic of social responsibility to their workforce and to society. Hernandez (2012) calls stewardship behaviors a "type of prosocial action" that carries with it a positive outcome on people. Although primarily associated within a formal leadership office, there is current recognition that stewardship tin and should live in all levels of organizations, adopted by all individuals, regardless of positional power (Dalcher, 2019).

In a traditional view of stewardship, nurse leaders and scholars are entrusted to preserve and hold in trust the value priorities of stakeholders (Milton, 2014). Co-ordinate to Haase-Herrick (2005) the simple essence of the multifariousness of stewardship actions for nurse leaders is grounded in the imperative to leave a profession, discipline, and scholarly practice in a better place than where information technology was found. This imperative does not utilise only to nurses who are in formal leadership or scholar roles.

In broadening the responsibleness of stewardship to include all nurses, the do of stewardship deportment becomes a transformative experience that assures transparency and accountability for conserving what is essential in the profession and beneficial to society. With a more than inclusive view of stewardship, all nurses, equally stewards of the profession, practise their responsibility to preserve what is intrinsically good and valuable in the profession, while promoting what noesis and practice benefits the health of society (Murphy, 2009; White potato & Roberts, 2008).

Stewardship is non a ane size fits all paradigm. Nurses are advocates at the signal of do or wherever they do their piece of work. The consistent outcome of their advocacy is to preserve the core values of a practice profession while embracing practice changes that better feel and outcomes of care. For educators, curricular learning opportunities that reinforce the expectations and responsibilities of being a steward of the profession begin to emerge at the point of formation of future nurses. For leaders of the profession, opportunities emerge at the nexus of transforming practice environments to come across society'southward current and futurity wellness needs. For researchers, stewardship implies a commitment to use their requisite abilities and marvel to delve into the report of core nursing phenomena that address health bug that burden society. Existence a steward of the profession stems from a nurse'south passion and a sense of responsibleness to accelerate the profession's work.

In a national study of chief bookish nursing officers (Beal & Riley, 2015), participants shared that they believed that every nurse, regardless of role or do setting, is a steward of the nursing profession and of scholarly practice. Participants' commonage vision for the time to come of baccalaureate educational activity was that educational programs would place more focus on "helping students think about themselves as members and future stewards of the profession" (Beal & Riley, 2015, p. 382). In a recent national study, senior nurse leaders in magnet hospitals confirmed that "nursing civilisation is both significant and consequential to the nursing milieu as well as the overall organisation" (Beal & Riley, 2019, p.192). Embedding expectations of stewardship for all nurses, not merely leaders, into the nursing culture of health systems adds potential for significant influence within the organization.

The cardinal question then becomes: Who is responsible for stewardship of the profession? We believe the expectation for stewardship must exist expanded to include a responsibility for all nurses, operationalized in different ways, across the lifetime of a career. This expectation broadens meaningful actions to include sharing cognition with others, mentoring, and teaching, using knowledge of the concern of healthcare to specifically impact health policy, regulation, ethical and financial decisions. These are deportment that back up the essence of the profession. Every bit a touchstone for both preservation and change, stewardship in today'south health care enterprise, leads to a broad range of critical opportunities for all nurses. We therefore believe that this expanded stewardship epitome earns its placement equally a supporting pillar for the exemplary practice life of a nurse. The legacy of stewardship is a futurity workforce that is comfortable with their professional person heritage still sensitively responsive to the changing healthcare needs of society.

Summary of the model

The holistic model The Exemplary Practise Life of the Nurse calls for nurses to commit to developing an exemplary exercise throughout ane's career. Table 1 : Core Commitments with the Holistic Model: Exemplary Practice Life of the Nurse summarizes the essential attitudes, behaviors, and capabilities within the context of the four independent but inter-related pillars.

Table 1

Core commitments with the holistic model: exemplary practice life of the nurse.

Professionalism	• Participates in an intentional procedure of development that begins in formative education, transitions into the workplace, and continues through the major stages of a nurse's career. • Lives a practice life that includes a combination of characteristics, values, comport and actions. • Acts responsibly and accountably for ane'south professional life. • Knows and applies ethical principles and standards to guide practice. • Has passion for the work of a scholarly practice.
Scholarly practice	• Consistently engages in a scholarly practice and knows that chapters for scholarly practice matures throughout a career trajectory. • Appreciates that scholarly practise is as much nearly attitude as it is well-nigh using a systematic approach to plan and deliver care and conduct other work of professional nurses. • Knows the people ane cares for; is competent in whatever part assumed; continually develops areas of practice expertise; continuously improves evidence-based practice. • Collaborates and partners with others including the people they serve to find solutions to healthcare and societal challenges. • Shares the responsibility for implementing and disseminating new knowledge for the advancement of the health and wellness of lodge in whatsoever setting and role the nurse holds.
Leadership	• Acts as an effective and mindful leader through cultural humility, inclusivity, respect, kindness, and courage in both formal and breezy leadership situations while empowering others for growth. • Holds to the following expectations: developing oneself and others; embracing inclusivity and diversity; modeling professional exercise and behavior with a non-hierarchical approach; advancing practice and the profession of nursing; managing resources effectively; collaborating with others to address health disparities for the do good of lodge; and advocating to advance health equity for all. • Appreciates and supports the use of breezy leadership roles, as exercised in the situationally centered opportunities where one is willing to stride upward and take actions.
Stewardship	• Recognizes stewardship equally a responsibility for all nurses, operationalized in different ways, across the lifetime of a career. • Intentionally exercises stewardship responsibility to preserve what is intrinsically skilful and valuable in the profession and while promoting knowledge and humanistic practice that benefits the wellness and wellness agenda of society. • Equally a touchstone for both preservation and alter, advocates at the point of practice wherever nurse work is done. • Assures transparency and accountability for both using and conserving resources. • Engages in actions that support the essence of the profession: using knowledge of the business of healthcare to specifically touch health policy, regulation, ethical and financial decisions.

Discussion

The proposed model emanates from nursing's historical roots, respectful of its by while positing perspectives to guide the profession to meet current and time to come societal needs. Understanding the relationship betwixt and among pillars represents the essence of an exemplary practice life. A holistic model adds equipoise in the components of nurse work. The model allows for counterbalancing the essential components while offering guidance to nurses in the whatever the state of affairs that they confront in meeting the universally stated goal of health and wellness of all members of society. Considering of the nature of their work, nurses need a holistic model to serve as foundational to their practice life. Such a model transcends all roles and work-settings and offers stability within an ever-changing health care environment. An unexpected benefit could be that the order will more than clearly understand the essential elements of a nurse's practice life.

Each of the four pillars of this model has been separately described in the literature. What was not discussed in the literature was the inter-human relationship of these four essential pillars to each other and how, equally independent merely inter-related entities, they holistically back up the exemplary practice life of the nurse. The importance and value of breezy leadership has also been overlooked. Iii pillars (Professionalism, Leadership, and Scholarly Practise) are incorporated into competencies that bulldoze determinative instruction, advanced pedagogy, and workplace norms. Their relationship to each other, within these systems, even so, is non well articulated within the competencies. Historically, stewardship, the fourth pillar, has been assigned and well-described for executive levels of leadership but not addressed every bit a responsibility for all nurses. At that place has been a recent call to make stewardship an explicit component of PhD education programs (Morris et al., 2021). While important, the telephone call must exist expanded to include educating all students to be stewards of the profession.

Nosotros fully acknowledge the significant contributions of the academy and professional person organizations over decades of dedication to the advocacy of nursing education (AACN, 2021; NLN, 2021). We recognize that they take a long-standing commitment to the development of specific essential competencies and principles for educating nurses. Faculty have developed curricula guided by the professional educational standards of these organizations. The complexity of today'southward nursing curricula calls for a elementary, concise, and holistic translation the nursing competencies for each pupil and nurse to internalize what it ways to have an exemplary practice life. Nosotros believe that this is the ultimate goal of nursing education at the baccalaureate and chief's entry levels. To accomplish this translation, and at the same time provide a seamless transition to exercise, kinesthesia should integrate and emphasize the four pillars of this proposed model into education/learning experiences throughout the curriculum. The model offers a pragmatic framework to guide and back up a nurse's exercise life. Currently nosotros know of no model or framework that captures the essence of exemplary practice life in a elementary, concise, and holistic manner.

We introduced this newspaper with the important recognition that club again acknowledges nursing as the most trusted profession in the United States (Gallup, 2021; Reinhart, 2020). Globally, the International Year of the Nurse and Midwife continues to link the exemplary life of the nurse with stories of gimmicky exemplary do. At the same fourth dimension, at that place are reports in contempo literature about three distinct but related calls for nurses and the profession that are discussed in the following paragraphs: ane. The demand to claim an authoritative role as leaders in wellness care services; two. The need to claim a complete and accurate professional person image for nurses; iii. The need to reclaim values foundational to the profession.

While nurses are clearly viewed equally trustworthy, we are not perceived by the public as leaders, scholars, or innovators who make major contributions to healthcare delivery (American Nurses Association, American Organization of Nurse Leaders, Johnson and Johnson, 2020; Broome, 2021; Prybil et al., 2019). The study findings of Godsey et al. (2020) address the need for change in the make paradigm of the nurse. These findings written report factors contributing to the inconsistent and oft negative image of nursing. They posit that variability in educational preparation, lack of visionary leadership, lack of leadership development, and an inconsistent professional person image are significant contributors to the disability of the profession to demonstrate full leadership throughout the healthcare system.

The 2020–21 Covid-19 pandemic exposed fractures and vulnerabilities in our health intendance delivery arrangement (Ulrich et al., 2020) that include oppressive and discriminatory structures that are embedded in the organizations in which nurses work (NASEM, 2021). These papers telephone call for the demand for nurses to pace forward to lead substantive institutional reform. This will require an increased emphasis on supporting nurses in these endeavors (NASEM, 2021). This phone call is an urgent message to see, as ane endpoint in the pandemic, an opportunity to reclaim "values foundational to our profession and to constitute new norms of communication and teamwork, intentionally address [ing] disparities" (p. 843, Ulrich et al., 2020).

These calls offering some insights that are germane to the proposed model. The Exemplary Do Life of the Nurse is a simple yet compelling description of the essential work of every nurse integrated into iv inter-related pillars. The model answers the calls for a potent professional prototype and compelling leadership that embrace the foundational values of the profession. Information technology is consequential for determinative education at the baccalaureate and master's entry level education. About importantly the model acknowledges a consistent universal recognition of what nurses do in all roles, in all work-settings and within our global society. This model can be part of the solution of clearly describing the important work of nurses.

Recommendations

Proposing the model

The Exemplary Exercise Life of the Nurse, in conjunction with the greatest public health crunch since the 1918 flu epidemic, provided an opportunity to reflect on the rich past, the present, and the emerging future or our profession. Guided past this perspective nosotros provide recommendations for the utilize of this model for individual nurses, the workplace, the university, the profession, and the community. Specifically;

• Nosotros inquire all nurses to consider re-framing their practice life to include the inter-related pillars of professionalism, scholarly practice, leadership, and stewardship. Nosotros recognize that the implementation of this model may look different at specific stages of a nurse's career.
• We ask that workplace leaders commit to examining and integrating this model every bit a machinery to support all nurses throughout early, mid, and late career phases. We ask them to consider the integration of the model in systematic performance evaluation matrices that foster an exemplary do surround.
• For the academy, we enquire that leaders commit to conducting a systematic curricular appraisal to ensure that the model components are every bit integrated throughout educational formation. Formative clinical learning needs to shift from a predominately skill acquisition model to a model that recognizes a more equitable distribution of the four essential pillars equally the foundation for developing an exemplary nurse. Accomplishing the integration of this model into the curriculum is the outset step in preparing the nurse of the future.
• We ask the leaders of professional associations to utilize their commonage phonation to advocate for the privilege of all nurses to take an exemplary practice life. The right of all members of society to have their wellness and wellness needs met equally requires no less than all nurses having an exemplary exercise life. Furthermore, nosotros ask that professional associations piece of work collaboratively with certification, accreditation, legislative and regulatory bodies to commit to advancing the BSN as the preferred professional person nursing degree. While efforts take been made in the by, there is a greater sense of urgency as the complexity of care continues to increase.
• For communities, we recognize their position equally a guardian and supporter of society's health and wellness needs. We ask for continued support in new and emerging ways that reflect the weather condition, commitments, changes, and requirements that must be confronted.

In conclusion, we ask service and bookish leaders, and individual nurses, every bit partners, to review, implement and evaluate this model to seamlessly back up career transition and the development of an exemplary practice life for all nurses.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8435935/