522661
research-article2014
NSQXXX10.1177/0894318414522661Nursing Science QuarterlyMilton / Ethical Issues
Ethical Issues
Stewardship and Leadership in Nursing
Nursing Science Quarterly 2014, Vol. 27(2) 108–110 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0894318414522661 nsq.sagepub.com
Constance L. Milton, RN; PhD1
Abstract The concept or metaphor of stewardship is important to the future of the discipline of nursing. Nurse leaders and scholars of the discipline are entrusted to preserve and hold in trust the value priorities of the discipline as well as the value priorities of others who are living health. The author here offers a discussion of possible meanings and ethical implications for enhancing the discipline’s potential obligations of leadership and stewardship as a basic human science discipline. Keywords ethics, leadership, nursing, stewardship What does it mean to be a good steward or to exhibit actions of stewardship as a scholar and leader of the discipline of nursing? Many contemporary nurse leaders believe that nurses may exercise stewardship with those who are the recipients of services at the point of service in practice and that ever-changing healthcare organizations should move with moment to moment decisions that are imbued with shared value priorities. Authors of a popular leadership book, Porter-O’Grady and Malloch (2002) asserted that healthcare management decision-making has been viewed as the calculation of means-end economics, and they suggested instead that healthcare disciplines must shift to value-based decision-making. A steward may be defined or characterized as a person who preserves and promotes the intrinsic value of a situation, as well as one who engage(s) others in solutions and actions (Haase-Herrick, 2005). Others promote the view that a steward provides leadership through individual and collective reasoning and the articulation of shared value priorities while preserving and promoting the intrinsic values of nursing, including equity and fairness (Murphy & Roberts, 2008). These notions may be appealing to nurse leaders who are willing to choose and exercise stewardship through the notion of a virtue-based ethic. At the same time, these authors note that the articulation of shared value priorities is a complex process with multiple tensions. Making decisions based upon what is known or described as the common good has given way to a dominant view of managerial decision-making known as instrumental reasoning. Instrumental reasoning is commonly defined as the most economical application of means to an end. In healthcare decision-making, the use of high technology is incorporated in practices in order to determine what the best action to take in a situation should be. The technological offerings in healthcare practice dominate healthcare decision priorities to the exclusion of other criteria or values. High technology is often used when humanly
sensitive nursing services may be needed. Thus, the sharing of community values may be put aside in favor of choices that are of instrumental, economical good that is intended for society. Members of healthcare disciplines, and especially the discipline of nursing, should discern the value priorities for which it will practice and display the conduct of stewardship in the discipline, while serving as leaders and scholars who will preserve and protect the values of the discipline for future generations. What are the ethical responsibilities as stewards of the discipline of nursing? Stewardship is a metaphor or expression used to describe the ethical responsibilities and obligations of a discipline. Nurse scholars can be fruitfully imagined as stewards, who hold in trust and care for the vigor, quality, and integrity of the discipline. The Carnegie Foundation has proposed that a steward of a discipline is a person who is a scholar first and foremost, someone who will creatively generate new knowledge, critically conserve valuable ideas, and responsibly transform new understandings through writing, teaching, and application (Golde & Walker, 2006). The concept or metaphor of stewardship may be illuminated as potential ethical convictions that are necessary to be understood as responsible scholars of the discipline of nursing grapple with discerning the knowledge base that will guide research, practice, and education for future generations. Scholars and leaders of the discipline of nursing should be faithful stewards in preserving nursing knowledge and skills.
1
Associate Dean and Professor of Nursing, Azusa, CA
Contributing Editor: Constance L. Milton, RN, PhD, Associate Dean and Professor of Nursing, Azusa Pacific University, 701 E. Foothill Blvd., Azusa, CA 91702. Email: [email protected]
Downloaded from nsq.sagepub.com at University of Birmingham on May 28, 2015
109
Milton / Ethical Issues
Stewards of Knowledge and Skills Members of the discipline of nursing and scholars of the discipline must be schooled in knowledge of the discipline as well as knowledge from other healthcare disciplines. Doctoral nursing education must focus on the development and enhancement of nursing knowledge and practice skills that provide the expertise necessary for advancing the discipline of nursing. The knowledge and skills are found embedded in the paradigms and theories that are unique and specific to the discipline of nursing. The diverse paradigms and ontological assumptions, postulates, principles, and concepts of nursing theories guide research, practice, and education for members and future members of the discipline. It is the author’s view that as faithful stewards of the discipline, nurse scholars and educators of doctoral programs should provide doctoral education that is centered on knowledge development in nursing science as the mission for its programs. Members of the discipline must have the scholarly doctoral education and nursing theoretical expertise necessary for advancing nursing knowledge through accomplishing specified lines of inquiry in conducting research, practice, and education with an ethical straight thinking compass that is embedded in the nursing theoretical perspectives. Stewards of the discipline should also be educated with requisite practice skills required of those who coparticipate in nurse-person, nurse-family, nurse-group, and nurse-community relationships. The usage of the term skills should not be marginalized or reduced to categories and functions; but rather, be used to refer to the obligations and responsibilities necessary for scholarly preparation and integrity in advancing nurse practice, research, and education with integrity. Stewards of the discipline should honor the human dignity of persons and respect humankind with the requisite knowledge and skills found in the paradigms, ontologies, epistemologies, and methodologies of the human science discipline of nursing.
Stewards of Future Generations Stewards of a discipline are responsible for more than merely their own work and scholarly endeavors. Rather, they have an ethical obligation and vested interest in the preparation of future scholars of the discipline. As the Carnegie Institute suggested, members of disciplines ought to be engaged in generation, conservation, and transformation (Golde & Walker, 2006). According to The Carnegie Institute, the function of generation points to the role scholars perform best: furthering their field through original and important research (Golde & Walker, 2006). This role signifies that scholars choose discipline-specific interests and ask significant questions for investigation of phenomena of interest that are inextricably linked to the discipline’s scientific body of knowledge. The
chosen paradigms and schools of thought of the discipline guide scientific scholar-investigators to follow methodologies and interpretation of findings that enhance understanding in of the scientific and philosophic underpinnings of the discipline. Formal lines of inquiry are not problem-solving expeditions and answers to cause-effect scenarios, but rather should reflect the scientific rigor befitting the discipline. The future of the discipline of nursing requires that scientific rigor be evident and formal lines of inquiry be guided by discipline-specific nursing ontology, epistemology, and methodologies. Conservation implies that new ideas are not created ex nihilo but evolve from previous knowledge and content areas (Golde & Walker, 2006). Conservation of the discipline of nursing means understanding the traditional, fundamental paradigms, theories, and concepts of the discipline, and recognizing that existing nursing knowledge contributes and lays the foundation for current and future scholarly endeavors. Conservation also includes an understanding of how one’s research and particular area of expertise in the field contributes to the larger healthcare discipline’s landscape beyond the discipline of nursing. It is the author’s view that there are prevailing attitudes and beliefs of current nurse leaders that purports that the discipline of nursing is not a basic healthcare discipline, but rather, an applied practice profession. Nurse leaders may be potentially damaging the future of the discipline and may not be acting as faithful stewards of the discipline when these differing views are espoused and articulated in various educational and healthcare venues. Other members of healthcare disciplines may lose respect for the discipline of nursing and simply view nurses as another budget line of healthcare workers who serve and support other healthcare disciplines such as medicine. The current educational focus on practice doctorates seems to exemplify these beliefs in that discipline-specific nursing knowledge is commonly viewed as just one of many theories or models that guide the education and label of what it means to be an advanced practice nurse or what it means to obtain the doctor of nursing practice degree. Indeed, the discipline of nursing is transforming in its mission of stewardship in serving humankind. Transformation occurs as stewards and scholars of a discipline accurately represent and communicate disciplinespecific ideas effectively to diverse groups, including those outside of the academy. As a faithful member of an academic discipline, nurse educators have an obligation to foster discipline-specific knowledge and scholarship in doctoral education with accurate dissemination of ideas. Graduate faculty who may not have been schooled in nursing philosophy and paradigms of nursing that contain nursing ontologies, epistemologies, and methodologies may feel unprepared and illequipped in the responsibilities of educating future nurse scholars. We are living in a transforming educational climate within doctoral education as those with biomedical,
Downloaded from nsq.sagepub.com at University of Birmingham on May 28, 2015
110
Nursing Science Quarterly 27(2)
normative philosophies of science receive priority and research dollars that are focused in the applied sciences. Nursing theoretical research is not seen as a priority in research institutions and thus there is a risk that future scholars of nursing may not be educated about nursing science and nursing knowledge, and instead will be focused on applied biomedical science as a standard for doctoral education and practice. As a faithful steward for future generations of nurses and leaders of the discipline of nursing, the author calls upon the academy to honor and protect that which we know as the discipline of nursing and to honor the advancement of the discipline by fostering discipline-specific knowledge and formal lines of inquiry that will fortify stewardship in practice, research, and education. The discipline of nursing and its leaders are facing critical moments and implications of stewardship for the future generations. Will we be faithful in the journey?
Declaration of Conflicting Interests The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this editorial.
Funding The author received no financial support for the research, authorship, and/or publication of this editorial.
References Golde, C. M., & Walker, G. E. (Eds). (2006). Envisioning the future of doctoral education: Preparing stewards of the discipline. San Francisco: Jossey-Bass. Haase-Herrick, K. S. (2005). The opportunities of stewardship. Nursing Administration Quarterly, 29,115-118. Murphy, N., & Roberts, D. (2008). Nurse leaders as stewards at the point of service. Nursing Ethics, 15(2), 243-253. Porter-O’Grady, T., & Malloch, K. (2002). Quantum leadership: A text of new leadership. Gaithersburg, MD: Aspen.
Downloaded from nsq.sagepub.com at University of Birmingham on May 28, 2015
research-article2014
NSQXXX10.1177/0894318414522661Nursing Science QuarterlyMilton / Ethical Issues
Ethical Issues
Stewardship and Leadership in Nursing
Nursing Science Quarterly 2014, Vol. 27(2) 108–110 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0894318414522661 nsq.sagepub.com
Constance L. Milton, RN; PhD1
Abstract The concept or metaphor of stewardship is important to the future of the discipline of nursing. Nurse leaders and scholars of the discipline are entrusted to preserve and hold in trust the value priorities of the discipline as well as the value priorities of others who are living health. The author here offers a discussion of possible meanings and ethical implications for enhancing the discipline’s potential obligations of leadership and stewardship as a basic human science discipline. Keywords ethics, leadership, nursing, stewardship What does it mean to be a good steward or to exhibit actions of stewardship as a scholar and leader of the discipline of nursing? Many contemporary nurse leaders believe that nurses may exercise stewardship with those who are the recipients of services at the point of service in practice and that ever-changing healthcare organizations should move with moment to moment decisions that are imbued with shared value priorities. Authors of a popular leadership book, Porter-O’Grady and Malloch (2002) asserted that healthcare management decision-making has been viewed as the calculation of means-end economics, and they suggested instead that healthcare disciplines must shift to value-based decision-making. A steward may be defined or characterized as a person who preserves and promotes the intrinsic value of a situation, as well as one who engage(s) others in solutions and actions (Haase-Herrick, 2005). Others promote the view that a steward provides leadership through individual and collective reasoning and the articulation of shared value priorities while preserving and promoting the intrinsic values of nursing, including equity and fairness (Murphy & Roberts, 2008). These notions may be appealing to nurse leaders who are willing to choose and exercise stewardship through the notion of a virtue-based ethic. At the same time, these authors note that the articulation of shared value priorities is a complex process with multiple tensions. Making decisions based upon what is known or described as the common good has given way to a dominant view of managerial decision-making known as instrumental reasoning. Instrumental reasoning is commonly defined as the most economical application of means to an end. In healthcare decision-making, the use of high technology is incorporated in practices in order to determine what the best action to take in a situation should be. The technological offerings in healthcare practice dominate healthcare decision priorities to the exclusion of other criteria or values. High technology is often used when humanly
sensitive nursing services may be needed. Thus, the sharing of community values may be put aside in favor of choices that are of instrumental, economical good that is intended for society. Members of healthcare disciplines, and especially the discipline of nursing, should discern the value priorities for which it will practice and display the conduct of stewardship in the discipline, while serving as leaders and scholars who will preserve and protect the values of the discipline for future generations. What are the ethical responsibilities as stewards of the discipline of nursing? Stewardship is a metaphor or expression used to describe the ethical responsibilities and obligations of a discipline. Nurse scholars can be fruitfully imagined as stewards, who hold in trust and care for the vigor, quality, and integrity of the discipline. The Carnegie Foundation has proposed that a steward of a discipline is a person who is a scholar first and foremost, someone who will creatively generate new knowledge, critically conserve valuable ideas, and responsibly transform new understandings through writing, teaching, and application (Golde & Walker, 2006). The concept or metaphor of stewardship may be illuminated as potential ethical convictions that are necessary to be understood as responsible scholars of the discipline of nursing grapple with discerning the knowledge base that will guide research, practice, and education for future generations. Scholars and leaders of the discipline of nursing should be faithful stewards in preserving nursing knowledge and skills.
1
Associate Dean and Professor of Nursing, Azusa, CA
Contributing Editor: Constance L. Milton, RN, PhD, Associate Dean and Professor of Nursing, Azusa Pacific University, 701 E. Foothill Blvd., Azusa, CA 91702. Email: [email protected]
Downloaded from nsq.sagepub.com at University of Birmingham on May 28, 2015
109
Milton / Ethical Issues
Stewards of Knowledge and Skills Members of the discipline of nursing and scholars of the discipline must be schooled in knowledge of the discipline as well as knowledge from other healthcare disciplines. Doctoral nursing education must focus on the development and enhancement of nursing knowledge and practice skills that provide the expertise necessary for advancing the discipline of nursing. The knowledge and skills are found embedded in the paradigms and theories that are unique and specific to the discipline of nursing. The diverse paradigms and ontological assumptions, postulates, principles, and concepts of nursing theories guide research, practice, and education for members and future members of the discipline. It is the author’s view that as faithful stewards of the discipline, nurse scholars and educators of doctoral programs should provide doctoral education that is centered on knowledge development in nursing science as the mission for its programs. Members of the discipline must have the scholarly doctoral education and nursing theoretical expertise necessary for advancing nursing knowledge through accomplishing specified lines of inquiry in conducting research, practice, and education with an ethical straight thinking compass that is embedded in the nursing theoretical perspectives. Stewards of the discipline should also be educated with requisite practice skills required of those who coparticipate in nurse-person, nurse-family, nurse-group, and nurse-community relationships. The usage of the term skills should not be marginalized or reduced to categories and functions; but rather, be used to refer to the obligations and responsibilities necessary for scholarly preparation and integrity in advancing nurse practice, research, and education with integrity. Stewards of the discipline should honor the human dignity of persons and respect humankind with the requisite knowledge and skills found in the paradigms, ontologies, epistemologies, and methodologies of the human science discipline of nursing.
Stewards of Future Generations Stewards of a discipline are responsible for more than merely their own work and scholarly endeavors. Rather, they have an ethical obligation and vested interest in the preparation of future scholars of the discipline. As the Carnegie Institute suggested, members of disciplines ought to be engaged in generation, conservation, and transformation (Golde & Walker, 2006). According to The Carnegie Institute, the function of generation points to the role scholars perform best: furthering their field through original and important research (Golde & Walker, 2006). This role signifies that scholars choose discipline-specific interests and ask significant questions for investigation of phenomena of interest that are inextricably linked to the discipline’s scientific body of knowledge. The
chosen paradigms and schools of thought of the discipline guide scientific scholar-investigators to follow methodologies and interpretation of findings that enhance understanding in of the scientific and philosophic underpinnings of the discipline. Formal lines of inquiry are not problem-solving expeditions and answers to cause-effect scenarios, but rather should reflect the scientific rigor befitting the discipline. The future of the discipline of nursing requires that scientific rigor be evident and formal lines of inquiry be guided by discipline-specific nursing ontology, epistemology, and methodologies. Conservation implies that new ideas are not created ex nihilo but evolve from previous knowledge and content areas (Golde & Walker, 2006). Conservation of the discipline of nursing means understanding the traditional, fundamental paradigms, theories, and concepts of the discipline, and recognizing that existing nursing knowledge contributes and lays the foundation for current and future scholarly endeavors. Conservation also includes an understanding of how one’s research and particular area of expertise in the field contributes to the larger healthcare discipline’s landscape beyond the discipline of nursing. It is the author’s view that there are prevailing attitudes and beliefs of current nurse leaders that purports that the discipline of nursing is not a basic healthcare discipline, but rather, an applied practice profession. Nurse leaders may be potentially damaging the future of the discipline and may not be acting as faithful stewards of the discipline when these differing views are espoused and articulated in various educational and healthcare venues. Other members of healthcare disciplines may lose respect for the discipline of nursing and simply view nurses as another budget line of healthcare workers who serve and support other healthcare disciplines such as medicine. The current educational focus on practice doctorates seems to exemplify these beliefs in that discipline-specific nursing knowledge is commonly viewed as just one of many theories or models that guide the education and label of what it means to be an advanced practice nurse or what it means to obtain the doctor of nursing practice degree. Indeed, the discipline of nursing is transforming in its mission of stewardship in serving humankind. Transformation occurs as stewards and scholars of a discipline accurately represent and communicate disciplinespecific ideas effectively to diverse groups, including those outside of the academy. As a faithful member of an academic discipline, nurse educators have an obligation to foster discipline-specific knowledge and scholarship in doctoral education with accurate dissemination of ideas. Graduate faculty who may not have been schooled in nursing philosophy and paradigms of nursing that contain nursing ontologies, epistemologies, and methodologies may feel unprepared and illequipped in the responsibilities of educating future nurse scholars. We are living in a transforming educational climate within doctoral education as those with biomedical,
Downloaded from nsq.sagepub.com at University of Birmingham on May 28, 2015
110
Nursing Science Quarterly 27(2)
normative philosophies of science receive priority and research dollars that are focused in the applied sciences. Nursing theoretical research is not seen as a priority in research institutions and thus there is a risk that future scholars of nursing may not be educated about nursing science and nursing knowledge, and instead will be focused on applied biomedical science as a standard for doctoral education and practice. As a faithful steward for future generations of nurses and leaders of the discipline of nursing, the author calls upon the academy to honor and protect that which we know as the discipline of nursing and to honor the advancement of the discipline by fostering discipline-specific knowledge and formal lines of inquiry that will fortify stewardship in practice, research, and education. The discipline of nursing and its leaders are facing critical moments and implications of stewardship for the future generations. Will we be faithful in the journey?
Declaration of Conflicting Interests The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this editorial.
Funding The author received no financial support for the research, authorship, and/or publication of this editorial.
References Golde, C. M., & Walker, G. E. (Eds). (2006). Envisioning the future of doctoral education: Preparing stewards of the discipline. San Francisco: Jossey-Bass. Haase-Herrick, K. S. (2005). The opportunities of stewardship. Nursing Administration Quarterly, 29,115-118. Murphy, N., & Roberts, D. (2008). Nurse leaders as stewards at the point of service. Nursing Ethics, 15(2), 243-253. Porter-O’Grady, T., & Malloch, K. (2002). Quantum leadership: A text of new leadership. Gaithersburg, MD: Aspen.
Downloaded from nsq.sagepub.com at University of Birmingham on May 28, 2015
