How do we advance the art and science of patient care?
Technological advances and artificial intelligence continue to grab headlines while clinicians’ documentation burdens mount almost daily. Is basic nursing care receding into the background? The American Nurse Journal’s editorial board considered this question during spirited discussions on the current state of nursing and patient-care delivery. They concluded that we need to shift focus back to the basics—the essentials of nursing care.
Hence, my two-part editorial. This month, I’ll tee up the issue; next month, I’ll highlight what we know about creating the environment for nursing excellence. We published content on both topics in a 2015 supplement, The Essence of Nursing: Advancing the Art and Science of Patient Care, Quality, and Safety. Ten years later, it remains relevant.
Let’s start with this question: What’s the essence of nursing? It’s what some call “high-touch” nursing, where the nurse has enough face-to-face time with patients and families to build meaningful, personal connections. Simply put, the essence of nursing is the very heart of nursing.
We all know extraordinary nurses who’ve had a significant impact on patient outcomes and the patient–family experience. But we also know cases in which nurses don’t exhibit the compassionate, competent caregiver persona they aspire to due to productivity pressures and other challenges. This dichotomy underscores my belief that nurses need to get back to the basics—to living and breathing the essence of nursing in every patient encounter.
Certain characteristics and competencies set nursing and nurses apart from other professions and practitioners. What’s distinctive about a nurse’s DNA? How does that distinction manifest when providing safe, high-quality patient care? How can nurses deliver the essence of nursing to its fullest extent? What factors or circumstances enable or prevent nurses from achieving this goal? In fast-paced, high-acuity, multidimensional, and penalty-driven healthcare delivery systems, we must find answers to these and related questions.
Among healthcare professionals, nurses spend the most time with patients and families. For this reason, I believe that presence and vigilance serve as key elements to the essence of nursing. Nurses learn about patients’ and families’ wishes, fears, capabilities, and challenges. Patients confide in them in the middle of the night, and loved ones turn to them for information, support, and solace.
Research proves that nurses with the right preparation and presence, at the right place and time, help to improve patient outcomes. In collaboration with interdisciplinary colleagues, nurses’ highly skilled, competent, compassionate care can help prevent a patient’s functional decline, eliminate knowledge deficits for the patient and family, and promote their engagement in healthcare.
We must validate and quantify nurses’ impact while recognizing their value to healthcare organizations and communities at large. Our ability to uphold the essence of nursing will make or break our efforts. My next editorial will explain how.
American Nurse Journal. 2025; 20(7). Doi: 10.51256/ANJ072504
Lillee Gelinas, DNP, RN, CPPS, FAAN
Editor-in-Chief
3 Comments. Leave new
So often the question of what is nursing really about comes up. This is the question that is what really is the essence of nursing? To me its the basics, the tenants on which our profession was built- caring, advocacy, hands on care, empathy and so much more. All of this is grounded in evidence based practice. The problem is that nurses do not have the time to fully provide these things in many cases. We don’t have time to really delve into our patients and their families which makes it hard to provide that quality patient centered care or the face time as Dr. Gelinas stated. To truly ensure the care patients deserve requires compassionate nurses who advocate for and care for the patients, providing the valuable face-to- face care. The problem is for nurses to do this they need to have time and the way many places schedule staff doesn’t allow for this. Nurses are overworked and carry heavy patient loads which makes it difficult to provide that essence of nursing fully.
I wholeheartedly agree with you. As a nurse of 58 years, retiring after working 55 years, I have had much time to reflect on what made what I did with and for patients valuable. I have had many discussions with other nurses of my generation, as well as younger nurses. Of most importance is that I have been a patient several times for major surgeries having to spend days overnight in some of the “Best Hospitals in the U.S.”
I was actually first taught by nursing nuns through a hospital-based nursing program. In reflection, it was one of the best experiences of my life. I was taught the importance of caring, compassion, personal touch, and of listening. And it was all about the patient…today what we call patient-centered care. I was taught that on morning or evening rounds, never to stand at a doorway of a patient’s room, but to walk inside and lightly touch the patient between the elbow and the shoulder while asking “how was their night/day?” Many times, it brought tears to the eyes of a patient who needed to talk, laughter to others, but most important it showed that we cared about what might be happening in their life that could impact their healing. Yes, it made my 15-minute rounds last longer, but nonetheless, all patients under my care knew that they could rely on me throughout the day/night. I did PM care with my nursing aides, not sitting back in the nursing station. I gave back rubs to each and every patient, helping them wash their face and brush their teeth if they needed help. I changed dressings, gave whatever pre-op surgical care that was order. We applied a clean draw sheet while straightening the bed, gave fresh drinking water…we talked with them and laughed with them. It was called team nursing, the best there was and is. Our patients thanked us, and we thanked them for letting us into their lives during the most vulnerable of times. And yes, I passed meds on 45-60 patients before and after. Was I exhausted? You bet! But I was so fulfilled. I knew I was giving everyone my all, including what little staff I had, because I was sharing of myself and teaching those around me. We all helped each other. Families brought us in pizza, donuts, homemade cookies. I know patients weren’t as sick as they are today due to changing times. I moved from that first job as a new graduate 3-11 charge on a med surg floor to Intensive Care at a major teaching hospital/medical school in the South. I had less patients, but more ill. What I was taught by the nuns never left my side. We had open heart surgery on adults and babies (no separate ICUs then), brain surgery, trauma, burn patients…you get the picture. My nursing care never changed. I added to it. I washed and cut patients’ hair if they needed it or the family requested it. I still did all the other ordered things, but on less patients…because now it was primary care nursing. I still helped others; it was in my DNA. I became a certified case manager after many years of hospital nursing, then managed case managers. But in my teaching and teams, I hope I helped mold case managers to be the most caring, compassionate, listening and tender human nurses. Today in hospitals, the above doesn’t happen. Many/most times patients are left to fend for themselves. If one wants fresh water, it must be requested. I can count on one hand the number of times a nurse, or an aide came to ask me if I needed anything, if I would like a backrub. Others have made similar claims.
What’s missing? Is it in the recruiting of students, is it in the teaching methods in classrooms? I wish I knew, but I would surmise it’s a little of a lot of things. Somewhere dropped was the “patient-centered” concept of what a nurse does. You need the patient to be the biggest part of the picture. Without the patient at the center, the actual care given, the words spoken, listened to and shared, the time spent, and the lives shared becomes just “another job”. Florence Nightengale was known to have said, “For the sick, it is important to have the best.” I would say, “Be the nurse you want to care for you or your family member.”
Dr. Gelinas beautifully captures the heart of the nursing profession by emphasizing compassion, advocacy, and the unwavering commitment to patient-centered care. The Essence of Nursing serves as both an inspiration and a call to action for nurses to remain grounded in the values that define our practice. Her reflections remind us that beyond clinical skills, it is empathy, presence, and integrity that truly shape the patient experience. An excellent read that reinforces why nursing is both an art and a science.