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Nursing culture: Time for a paradigm shift

October’s guest, Donna Cardillo, RN, MA, writes a thought-provoking article on the culture of nursing. 

A few months ago I wrote a blog post about the great opportunities that we are being presented with in nursing and asking the question, “Are we ready to meet the challenges of the future? (https://myamericannurse.com/BlogView.aspx?bl=6268&bp=8214)? It’s an issue that has been weighing heavily on my mind. Why? Because while we, as a group, certainly need to enhance our credentials, communication skills, and image overall, that still isn’t enough to move the profession forward. The most fundamental, and perhaps the most challenging change that is needed, is to change the culture in nursing — that is, shifting from the old oppressed, disenfranchised mentality to one of empowerment and confidence. In other words, we need to let go of what no longer serves us (and is no longer relevant) and embrace new ways of seeing and thinking about the profession… and ourselves.

The word culture can be defined in many ways. But in this context I am referring to an overriding set of beliefs, assumptions, myths, values, tolerated behaviors, and learned responses that unite a group. These elements are formed over time based on personal experience, events, stories told, literature, and other factors. Culture often becomes so embedded in the psyche of the group members that when circumstances change and progress has been made, it can be hard for the members to recognize and embrace those changes. It’s like the old story of the fleas jumping in the covered jar in an attempt to escape; they eventually stop jumping even after the jar lid has been removed. In another words, many times we continue to react as we always have even though old obstacles have been removed and new pathways have been opened.

The last several decades have seen dramatic changes in societal and gender norms in health care and the world in general along with expanding roles and opportunities for nurses. Yet I still hear nurses say, “There is no hope in sight for bedside nurses to improve their lot” or “Nurses get no respect” or “We are our own worst enemy” and so on. Likewise, I recently attended a nursing conference where one of the speakers discussed, ad nauseum, the history of oppression in nursing and how it manifests itself in the workplace. Do we really need yet another lecture on this topic as to causes? I heard nothing about what we do have going for us, suggestions on constructive steps to minimize these and other challenges, or ideas about what we can do to improve our lot and rise to the occasion. Let’s start proactively and creatively talking about solutions rather than whining about problems.

It’s time to create a new reality in nursing. What I am suggesting is not a Pollyannaish approach, nor a denial of any challenges that exist. Rather it is a conscious choice to refocus our gaze, our efforts, and our resources on our strengths and opportunities and discuss how we can build on them. Certainly we want to identify challenges but rather than focusing on the perceived problems, let’s be proactive and brainstorm practical solutions to solve or manage them. Let’s empower every member of the profession to appreciate his or her value and worth in the system.

Admittedly this is not something easy to change. It requires a major paradigm shift, and a commitment, by individual nurses, nursing associations, nursing leaders, and nurse educators. It is akin to a grass roots political or social movement. We have to start telling the stories of empowerment (they are all around us) and putting the spotlight on positive nursing role models. We need to change the dialogue from one of oppression to one of strength and influence. We have to look at what’s working for us and where new opportunities are opening up and find ways to capitalize on that. We need to create a new vision and road map for nursing’s future, a new culture of empowerment, courage, pride, and autonomy.

Donna Wilk Cardillo is the Career Guru for Nurses and “Dear Donna” columnist for Nursing Spectrum, NurseWeek, and www.nurse.com. Donna is also an ‘Expert’ Blogger at DoctorOz.com. She is author of The ULTIMATE Career Guide for Nurses, Your 1st Year as a Nurse, and A Daybook for Beginning Nurses. Ms. Cardillo is creator of the Career Alternatives for Nurses® seminar and home-study program. You can reach her at www.dcardillo.com.


  1. The question we need to answer is: How do we help people become healthy and stay that way? The future of healthcare is HEALTH, not hospital bedside care. The “bedside nurse” of half a century ago was much less empowered than today! Stop feeling sorry for yourselves, and focus on how to help your patients get well and STAY well. Never judge another nurse’s motivation; set practice standards and expect him to meet them. It’s YOUR profession! Own it! Use opportunities to change it for the better!

  2. Nurses who are professional versus those who just work for a paycheck — plus the matter of doing all the work to change the profession after coming exhausted off tough shift after tough shift. I have been a nurse for half a century, and for half a century, I have been seeing these same discussions. I don’t know what the answer is, but I do know this. First we have to formulate the basic question we need to answer,and second we have to stop having half-century discussions that go nowhere.

  3. Empowerment and acceptance in change! That should be ANA’s logo. I live in a state with 80,000 RNs, yet roughly only 2700 are members of their professional organization. Nurses complain of getting no respect. . . They have to make that happen, by being a member of their professional organization, and acting the part!

  4. Things will not change as long as nurses wait for others to fix things. I see too many nurses unwilling to even attempt change – because it’s too hard, “it takes too much time & my family is more important than work”. They are afraid of losing their jobs, or “I don’t get paid for that”. It is easier to be a victim than a leader. We need to fill our ranks with nurses who are engaged in nursing as a professional career, instead of nurses who just think nursing is a just a paycheck.

  5. Agreed. A mature profession is secure in its identity and is not afraid to collaborate because it knows what it has to offer. When we begin to embrace who we are and define ourselves not by the standards of another profession (medicine) by but our ability to collaborate as equal partners in care……we can say that we are progressing.

  6. She’s right – we need to change our language from one of just venting to solutions-based. What needs to change and how can WE make that happen. Grass-roots are powerful – check your flower-bed border for evidence! We need to talk deep often and loud on the subject of solutions – because what affects the nurse affects the patient. In fact, teach the public that small thing and they’ll stand up for us too.

  7. I agree with the total disregard to the concerns of the nurse who has no empowerment to change the situation, even over time. Culture change takes a very long time and we keep modeling the same behaviors to the new nurse, the next nurse.

  8. I agree with the total disregard to the concerns of the nurse who has no empowerment to change the situation, even over time. Culture change takes a very long time and we keep modeling the same behaviors to the new nurse, the next nurse.

  9. The fact of the matter is that the “working unit” in nursing remains overwhelmingly the bedside nurse. If we fail to empower that nurse, if we fail to address the primary concerns of that group, and if we don’t stand up to the administrative abuse which targets that nurse and imposes unrealistic patient loads, inappropriate floating, mandatory overtime, and institutional impotence, then we have abandoned our primary obligation.
    The political fracture lines in nursing are quite evident.


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