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W2000344749 abstract "Stories are the stuff of nursing. Altruism is the heart of our story. Is it time for a change?As an Academy member, I read Fisher and Kalbaugh's article in the May−June 2012 issue of Nursing Outlook, “Altruism in clinical research: Coordinators' orientation to their professional roles” and felt sad. Same old story—altruism in nursing is not necessarily in the patient's interest. According to the researchers, it involves professional identity or a “higher calling” and is important for group survival. They indicate “an altruistic orientation to research…has problematic implications for the profession. Nursing coordinators mobilize altruism as a means of managing their interactions with participants, PI's and others” (Fisher and Kalbaugh, 2012Fisher J.A. Kalbaugh C. Altruism in clinical research: Coordinators' orientation to their professional roles.Nursing Outlook. 2012; 3: 143-148Abstract Full Text Full Text PDF Scopus (12) Google Scholar). Blind altruism interferes with quality patient care. Ask any longtime member of Al Anon. Real altruism demands grounding in self-care, reason and values.Is altruism sometimes a manipulation rooted in weakness rather than honesty based on internal strength and a sense of personal value? Nursing has increased the number of nurses with doctorates, but have we considered nursing's primary value based on what we have learned?Twenty-five years ago, I wrote an editorial for the Journal of Professional Nursing, entitled “Reflections on Altruism and the Practice of Nursing” (Giuffra, 1987Giuffra M.J. Editorial: Reflections on altruism and the practice of nursing.Journal of Professional Nursing. 1987; 3: 1-2Abstract Full Text PDF PubMed Scopus (4) Google Scholar). Eloise Lewis, then editor of the Journal, suggested the editorial during an American Association of Colleges of Nursing conference, where I responded to Pew Memorial Trust's Report of the national panel and work groups on the “Essentials Project in Nursing.” Other respondents enthused about findings and recommendations of the Report. In contrast, I explained that the Pew Report helped clarify what I believe is a major problem in contemporary nursing. A chasm exists between the values of our society and those of our profession (Giuffra, 1987Giuffra M.J. Editorial: Reflections on altruism and the practice of nursing.Journal of Professional Nursing. 1987; 3: 1-2Abstract Full Text PDF PubMed Scopus (4) Google Scholar). Although the Pew Report highlighted altruism as the essential value for nursing, recent breakdowns in major financial institutions, education, and health care dispute that ideal. The chasm between nursing and societal values has clearly deepened.The concept and practice of altruism often are far removed from one another. The concept, putting aside one's self or one's needs in favor of another's, is admirable and reflects the best of human impulses and behaviors. The practice frequently negates the generosity of the act by sacrificing more than is appropriate or healthy for both giver and recipient. A distortion of altruism becomes other-centered rather than other-focused. This “altruistic” behavior is not tempered with reason, theory or self-development (Giuffra, 1987Giuffra M.J. Editorial: Reflections on altruism and the practice of nursing.Journal of Professional Nursing. 1987; 3: 1-2Abstract Full Text PDF PubMed Scopus (4) Google Scholar). Given the research of Fisher and Kalbaugh, altruism is sometimes used to control other people. How and where do nurse coordinators learn to use altruism to control? In the editorial, I note that the aim of education is to produce a fully functioning human being, not a robot who does what he or she is told, accepts orders blindly, and strives so owners can achieve higher profits, who works until he or she becomes exhausted and discouraged from attempting the impossible. Fully functioning human beings don't feel powerless; they realize human nature is what it is, frail and limited, and that their power is within. They feel safe enough and free enough to express that power. Burnout does not cause them to leave nursing (Giuffra, 1987Giuffra M.J. Editorial: Reflections on altruism and the practice of nursing.Journal of Professional Nursing. 1987; 3: 1-2Abstract Full Text PDF PubMed Scopus (4) Google Scholar).Fisher and Kalbaugh, 2012Fisher J.A. Kalbaugh C. Altruism in clinical research: Coordinators' orientation to their professional roles.Nursing Outlook. 2012; 3: 143-148Abstract Full Text Full Text PDF Scopus (12) Google Scholar found that nurse coordinators see their work as part of a higher calling that is invaluable to the clinical research enterprise regardless of whether it is recognized as such. Coordinators speak: “We do a lot of hand holding…Sometimes we get accused of being mothers…But a lot of (participants) they do become our brothers or sons. That's that personal element—that as much as it is science” (Fisher and Kalbaugh, 2012Fisher J.A. Kalbaugh C. Altruism in clinical research: Coordinators' orientation to their professional roles.Nursing Outlook. 2012; 3: 143-148Abstract Full Text Full Text PDF Scopus (12) Google Scholar). Nursing is not the military, where soldiers are programmed to deal with war, or a religious group that sends missionaries to convert. This is a profession. Why is the chasm between nursing and societal values as profound in 2012 as it was in 1987? What nurse coordinators are providing needs to be founded on evidenced-based science, specifically nursing science and the science from other disciplines. What is wrong? In 1987, I suggested the quality of care that other-centered nurses provide is seriously affected and asked: “How can one effectively care for others when he or she is other centered, always focused outside self? In this era of self care and responsibility for one's own health does the value of altruism need reworking?” (Giuffra, 1987Giuffra M.J. Editorial: Reflections on altruism and the practice of nursing.Journal of Professional Nursing. 1987; 3: 1-2Abstract Full Text PDF PubMed Scopus (4) Google Scholar). I recommended that nursing altruism needed reworking 25 years ago. Therefore, it stunned me to read epidemiological research in the official Journal of the American Academy of Nursing and the Council for the Advancement of Nursing Science demonstrating that, in the context of research, nursing altruism is not so much in the best interest of the patient/subject but is an acceptable mechanism to maintain a nursing identity in a professional environment that challenges a traditional care paradigm (2012).Let's study what is involved in a nursing identity and how it flows from professional values and a belief system. At the College of Mount Saint Vincent, where I served as Founding Director, the first course nursing students took was called “Group Process and Development of a Nursing Identity.” No bed-making or listening to heart sounds yet; we wanted them to realize that the essence of nursing is an interpersonal relationship based on knowledge, intuition, and presence. As sophomores, students studied “Research Process in Nursing and Theoretical Frameworks in Nursing.” It was not until junior year, with a solid understanding of the arts and sciences, that nursing majors began study of individual, family, community assessment from birth through death, nursing intervention, and evaluation. To send an altruistic young graduate into a health care system that is fueled by economic, political, and social values that run counter to altruism is cruel and too often unproductive unless his/her values are solidly based on reason and intuition. As I wrote in 1987, altruistic values integrated solely through a socialization process will not suffice in a complex society. An inner sense of power is a prerequisite for altruism. People seek to help others partly to confirm their sense of their own power, not necessarily power over others, simply some noticeable impact on the world.Currently nurse practitioners are prescribing drugs based on medicine and pharmacology. Yet research from behavioral and neurosciences provide evidenced-based ways of being present for patients, clients, and research subjects without acting like their mother or sister. Florence Nightingale emphasized that nursing and medicine have different values. Has the pendulum shifted too far in one direction? In New York State, leaders are encouraging nurses to support legislation allowing nurse practitioners to practice without physician supervision. Yet in the sixties, Martha E. Rogers stood on the steps of the Albany State Capital in a long white mink coat and wearing a nurse's cap surrounded by busloads of nurses. They successfully lobbied their legislators to pass a nurse practice act allowing independent practice for nurses. It is the license under which I practice independently.In the altruistic attempt to expand health care, an advanced practice license was developed in New York State solely for nurse practitioners and supervised by physicians. I was forced to obtain a license in another discipline as a licensed marriage and family therapist to remain in private practice. As a trauma specialist, I supervise certified advanced practice nurses in other states such as Massachusetts who no longer receive insurance reimbursement because they are not nurse practitioners. One woman was in the first group of Psychiatric Clinical Nurse Specialists to be certified for advanced practice. Yet our altruism has made her lose credibility as a provider for insurance companies. Clients have asked if I have an advanced practice license. I do not. Although I have a 60-credit clinical masters in nursing and a PhD in Research and Theory Development in Nursing with certification as a Clinical Specialist in Adult Psychiatric Mental Health Nursing, I have the same RN license as the graduate of a community college. My mother, a nurse who died at age 100 and until her final day ran a large project feeding more than 200 California homeless, often used the expression, “God helps those who help themselves.” Sometimes it feels as if our professional family is so altruistic in caring for society that we neglect our own. Why else would nurse coordinators feel that to be valued they needed to act as mothers or sisters to clients? Does altruism sometimes harbor an intellectual laziness?In the original 1987 response to the “Essentials Project” Values in Nursing Report, I identified a split between the values of nursing leadership and the values of nursing rank and file as a variable in distortions around altruism. Those comments were eliminated from the published article due to space constraints. I suggested that the values of nursing leadership were different from those of rank-and-file nurses. I still feel that way. Having served on the boards of three medical centers and four community health agencies, I noted a lack of mentoring for staff nurses. Nurse leaders dress professionally when attending board meetings, why don't they coach young nurses presenting projects to boards about professional behavior and appearance? I cringed when a bright articulate young nurse presented at a board meeting in nursing scrubs, pants and top covered with little animals and dirty white clogs on her feet. When I mentioned it afterwards, the nursing administrator looked confused, although she was attired in an elegant navy suit. Again, the administrator's altruism reached to patients but there was little altruism in her preparation of the young nurse for this foray into policy making venues.How do we narrow the gulf between our professional values and those society holds? Reworking the practice of altruism would be a major step. Students and educators alike must carefully study nursing's historical values to see how they have helped and hindered our development. As a teacher and administrator, I am convinced that my role is to stimulate faculty and students to carefully learn values to see both their negative and positive aspects. Are we truly honest in the way we teach values, the values we espouse, and the values we live? Failure to incorporate all aspects of the values one holds can leave students vulnerable to eventual disillusionment. Such careful, thoughtful study will help provide students with the intellectual and emotional flexibility they will need to narrow the gulf or bridge it (Giuffra, 1987Giuffra M.J. Editorial: Reflections on altruism and the practice of nursing.Journal of Professional Nursing. 1987; 3: 1-2Abstract Full Text PDF PubMed Scopus (4) Google Scholar).The reality that nursing is a profession providing a community service is overshadowed by the patina of altruism. We are stuck in a rut, the same rut as in 1987. Now is the time for nurse leaders to spearhead research on altruism and nursing. I am concerned about losing idealistic young nurses to a satisfying nursing career because they burned out on altruism. Stories are the stuff of nursing. Altruism is the heart of our story. Is it time for a change? As an Academy member, I read Fisher and Kalbaugh's article in the May−June 2012 issue of Nursing Outlook, “Altruism in clinical research: Coordinators' orientation to their professional roles” and felt sad. Same old story—altruism in nursing is not necessarily in the patient's interest. According to the researchers, it involves professional identity or a “higher calling” and is important for group survival. They indicate “an altruistic orientation to research…has problematic implications for the profession. Nursing coordinators mobilize altruism as a means of managing their interactions with participants, PI's and others” (Fisher and Kalbaugh, 2012Fisher J.A. Kalbaugh C. Altruism in clinical research: Coordinators' orientation to their professional roles.Nursing Outlook. 2012; 3: 143-148Abstract Full Text Full Text PDF Scopus (12) Google Scholar). Blind altruism interferes with quality patient care. Ask any longtime member of Al Anon. Real altruism demands grounding in self-care, reason and values. Is altruism sometimes a manipulation rooted in weakness rather than honesty based on internal strength and a sense of personal value? Nursing has increased the number of nurses with doctorates, but have we considered nursing's primary value based on what we have learned? Twenty-five years ago, I wrote an editorial for the Journal of Professional Nursing, entitled “Reflections on Altruism and the Practice of Nursing” (Giuffra, 1987Giuffra M.J. Editorial: Reflections on altruism and the practice of nursing.Journal of Professional Nursing. 1987; 3: 1-2Abstract Full Text PDF PubMed Scopus (4) Google Scholar). Eloise Lewis, then editor of the Journal, suggested the editorial during an American Association of Colleges of Nursing conference, where I responded to Pew Memorial Trust's Report of the national panel and work groups on the “Essentials Project in Nursing.” Other respondents enthused about findings and recommendations of the Report. In contrast, I explained that the Pew Report helped clarify what I believe is a major problem in contemporary nursing. A chasm exists between the values of our society and those of our profession (Giuffra, 1987Giuffra M.J. Editorial: Reflections on altruism and the practice of nursing.Journal of Professional Nursing. 1987; 3: 1-2Abstract Full Text PDF PubMed Scopus (4) Google Scholar). Although the Pew Report highlighted altruism as the essential value for nursing, recent breakdowns in major financial institutions, education, and health care dispute that ideal. The chasm between nursing and societal values has clearly deepened. The concept and practice of altruism often are far removed from one another. The concept, putting aside one's self or one's needs in favor of another's, is admirable and reflects the best of human impulses and behaviors. The practice frequently negates the generosity of the act by sacrificing more than is appropriate or healthy for both giver and recipient. A distortion of altruism becomes other-centered rather than other-focused. This “altruistic” behavior is not tempered with reason, theory or self-development (Giuffra, 1987Giuffra M.J. Editorial: Reflections on altruism and the practice of nursing.Journal of Professional Nursing. 1987; 3: 1-2Abstract Full Text PDF PubMed Scopus (4) Google Scholar). Given the research of Fisher and Kalbaugh, altruism is sometimes used to control other people. How and where do nurse coordinators learn to use altruism to control? In the editorial, I note that the aim of education is to produce a fully functioning human being, not a robot who does what he or she is told, accepts orders blindly, and strives so owners can achieve higher profits, who works until he or she becomes exhausted and discouraged from attempting the impossible. Fully functioning human beings don't feel powerless; they realize human nature is what it is, frail and limited, and that their power is within. They feel safe enough and free enough to express that power. Burnout does not cause them to leave nursing (Giuffra, 1987Giuffra M.J. Editorial: Reflections on altruism and the practice of nursing.Journal of Professional Nursing. 1987; 3: 1-2Abstract Full Text PDF PubMed Scopus (4) Google Scholar). Fisher and Kalbaugh, 2012Fisher J.A. Kalbaugh C. Altruism in clinical research: Coordinators' orientation to their professional roles.Nursing Outlook. 2012; 3: 143-148Abstract Full Text Full Text PDF Scopus (12) Google Scholar found that nurse coordinators see their work as part of a higher calling that is invaluable to the clinical research enterprise regardless of whether it is recognized as such. Coordinators speak: “We do a lot of hand holding…Sometimes we get accused of being mothers…But a lot of (participants) they do become our brothers or sons. That's that personal element—that as much as it is science” (Fisher and Kalbaugh, 2012Fisher J.A. Kalbaugh C. Altruism in clinical research: Coordinators' orientation to their professional roles.Nursing Outlook. 2012; 3: 143-148Abstract Full Text Full Text PDF Scopus (12) Google Scholar). Nursing is not the military, where soldiers are programmed to deal with war, or a religious group that sends missionaries to convert. This is a profession. Why is the chasm between nursing and societal values as profound in 2012 as it was in 1987? What nurse coordinators are providing needs to be founded on evidenced-based science, specifically nursing science and the science from other disciplines. What is wrong? In 1987, I suggested the quality of care that other-centered nurses provide is seriously affected and asked: “How can one effectively care for others when he or she is other centered, always focused outside self? In this era of self care and responsibility for one's own health does the value of altruism need reworking?” (Giuffra, 1987Giuffra M.J. Editorial: Reflections on altruism and the practice of nursing.Journal of Professional Nursing. 1987; 3: 1-2Abstract Full Text PDF PubMed Scopus (4) Google Scholar). I recommended that nursing altruism needed reworking 25 years ago. Therefore, it stunned me to read epidemiological research in the official Journal of the American Academy of Nursing and the Council for the Advancement of Nursing Science demonstrating that, in the context of research, nursing altruism is not so much in the best interest of the patient/subject but is an acceptable mechanism to maintain a nursing identity in a professional environment that challenges a traditional care paradigm (2012). Let's study what is involved in a nursing identity and how it flows from professional values and a belief system. At the College of Mount Saint Vincent, where I served as Founding Director, the first course nursing students took was called “Group Process and Development of a Nursing Identity.” No bed-making or listening to heart sounds yet; we wanted them to realize that the essence of nursing is an interpersonal relationship based on knowledge, intuition, and presence. As sophomores, students studied “Research Process in Nursing and Theoretical Frameworks in Nursing.” It was not until junior year, with a solid understanding of the arts and sciences, that nursing majors began study of individual, family, community assessment from birth through death, nursing intervention, and evaluation. To send an altruistic young graduate into a health care system that is fueled by economic, political, and social values that run counter to altruism is cruel and too often unproductive unless his/her values are solidly based on reason and intuition. As I wrote in 1987, altruistic values integrated solely through a socialization process will not suffice in a complex society. An inner sense of power is a prerequisite for altruism. People seek to help others partly to confirm their sense of their own power, not necessarily power over others, simply some noticeable impact on the world. Currently nurse practitioners are prescribing drugs based on medicine and pharmacology. Yet research from behavioral and neurosciences provide evidenced-based ways of being present for patients, clients, and research subjects without acting like their mother or sister. Florence Nightingale emphasized that nursing and medicine have different values. Has the pendulum shifted too far in one direction? In New York State, leaders are encouraging nurses to support legislation allowing nurse practitioners to practice without physician supervision. Yet in the sixties, Martha E. Rogers stood on the steps of the Albany State Capital in a long white mink coat and wearing a nurse's cap surrounded by busloads of nurses. They successfully lobbied their legislators to pass a nurse practice act allowing independent practice for nurses. It is the license under which I practice independently. In the altruistic attempt to expand health care, an advanced practice license was developed in New York State solely for nurse practitioners and supervised by physicians. I was forced to obtain a license in another discipline as a licensed marriage and family therapist to remain in private practice. As a trauma specialist, I supervise certified advanced practice nurses in other states such as Massachusetts who no longer receive insurance reimbursement because they are not nurse practitioners. One woman was in the first group of Psychiatric Clinical Nurse Specialists to be certified for advanced practice. Yet our altruism has made her lose credibility as a provider for insurance companies. Clients have asked if I have an advanced practice license. I do not. Although I have a 60-credit clinical masters in nursing and a PhD in Research and Theory Development in Nursing with certification as a Clinical Specialist in Adult Psychiatric Mental Health Nursing, I have the same RN license as the graduate of a community college. My mother, a nurse who died at age 100 and until her final day ran a large project feeding more than 200 California homeless, often used the expression, “God helps those who help themselves.” Sometimes it feels as if our professional family is so altruistic in caring for society that we neglect our own. Why else would nurse coordinators feel that to be valued they needed to act as mothers or sisters to clients? Does altruism sometimes harbor an intellectual laziness? In the original 1987 response to the “Essentials Project” Values in Nursing Report, I identified a split between the values of nursing leadership and the values of nursing rank and file as a variable in distortions around altruism. Those comments were eliminated from the published article due to space constraints. I suggested that the values of nursing leadership were different from those of rank-and-file nurses. I still feel that way. Having served on the boards of three medical centers and four community health agencies, I noted a lack of mentoring for staff nurses. Nurse leaders dress professionally when attending board meetings, why don't they coach young nurses presenting projects to boards about professional behavior and appearance? I cringed when a bright articulate young nurse presented at a board meeting in nursing scrubs, pants and top covered with little animals and dirty white clogs on her feet. When I mentioned it afterwards, the nursing administrator looked confused, although she was attired in an elegant navy suit. Again, the administrator's altruism reached to patients but there was little altruism in her preparation of the young nurse for this foray into policy making venues. How do we narrow the gulf between our professional values and those society holds? Reworking the practice of altruism would be a major step. Students and educators alike must carefully study nursing's historical values to see how they have helped and hindered our development. As a teacher and administrator, I am convinced that my role is to stimulate faculty and students to carefully learn values to see both their negative and positive aspects. Are we truly honest in the way we teach values, the values we espouse, and the values we live? Failure to incorporate all aspects of the values one holds can leave students vulnerable to eventual disillusionment. Such careful, thoughtful study will help provide students with the intellectual and emotional flexibility they will need to narrow the gulf or bridge it (Giuffra, 1987Giuffra M.J. Editorial: Reflections on altruism and the practice of nursing.Journal of Professional Nursing. 1987; 3: 1-2Abstract Full Text PDF PubMed Scopus (4) Google Scholar). The reality that nursing is a profession providing a community service is overshadowed by the patina of altruism. We are stuck in a rut, the same rut as in 1987. Now is the time for nurse leaders to spearhead research on altruism and nursing. I am concerned about losing idealistic young nurses to a satisfying nursing career because they burned out on altruism." @default.
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