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International Archives of Nursing and Health Care

DOI: 10.23937/2469-5823/1510017

Illuminating the Mystique of Honor in Nursing

Paulina Van*

School of Nursing, Samuel Merritt University, Oakland, California, USA

*Corresponding author: Paulina Van, PhD, RN, CNE, School of Nursing, Samuel Merritt University, 3100 Telegraph Ave, Oakland, CA 94609, USA, Tel: 510-869-6511, ext. 4705, E-mail:,
Int Arch Nurs Health Care, IANHC-1-017, (Volume 1, Issue 1), Short Commentary; ISSN: 2469-5823
Received: September 17, 2015 | Accepted: November 22, 2015 | Published: November 26, 2015
Citation: Van P (2015) Illuminating the Mystique of Honor in Nursing. Int Arch Nurs Health Care 1:017. 10.23937/2469-5823/1510017
Copyright: © 2015 Van P. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Honor in nursing contributes to the profession and practice of nursing and, more importantly, to the lives nurses touch. HONOR also serves as a mnemonic that can guide nurses as they seek to bring honor to themselves and the profession. Through attention to their hearts, opportunities, never being complacent, providing outstanding care and reflecting, nurses can transform nursing practice and patient encounters into outstanding optimal care, maintaining their standing as the most honorable profession in the United States.


Nursing practice; Self-care, Professional development, Professional practice


She Wants to Be a Nurse

Author Unknown

3-11 shift.

One of those nights. If it can go wrong, it does.

Too many patients.

Never enough of us.

Rushing back to the nurse's station, I'm stopped by a patient's husband.

Standing behind him-barely waist high - his granddaughter.

She is shy, but her eyes are lit, eager, like a racehorse at the gate.

"She wants to be a nurse," he says.

I stop.

And kneel down.

I recognize something in her face.

I know she will be filling my shoes when the time comes.

And that time will come.

She touches my stethoscope with fingers gentle and unafraid.

I place the earpieces in her ears and let her hear her heart beat.

Listen, I tell her.

All the patients you will ever care for are there - in those heartbeats - waiting for you.

But she already knows this.

In a December 2014 Gallup poll, nurses were once again voted the most ethical and honest profession in America [1]. This top honor has been bestowed upon nurses annually since they were first included in 1999, except in 2001, when firemen were honored after the tragedy on September 11. Paradoxically, few publications by or about nurses relate to honor.

Nursing students are familiar with honor as it relates to integrity, such as avoiding plagiarism and reporting errors. However, synonyms for honor also include respect, esteem, reverence, glory, fame, reputation and good name. Moreover, the definition of honor is qualified: great respect, great esteem. As nursing student's transition to professional practice, the meaning of honor evolves to encompass professional honor - emanating from the heart space and contribute to our practice, the profession and more importantly the lives we touch along our journeys. Honor in nursing contributes to the profession and practice of nursing and more importantly to the lives nurses touch.

Nurses are typically or historically honored for various accomplishments. We first become familiar as students with honors related to academic achievement or grade point averages, undergraduate scholarships, or fellowships for graduate students. Other examples include book bundle awards from selected publishers. These legitimate honors are based on competitive processes in which recipients demonstrated educational achievements and financial need.

Stellar examples exist of nurses who have brought or bring honor to the profession or practice. They include Clara Barton, RN, founder of the American Red Cross and Beverly Malone, Ph.D, RN, FAAN, chief executive officer of the National League for Nursing, as well as nurses who may not be as widely known. Dr. Russell Tranbarger is a role model for men in nursing: a leader, author, and army officer with a pioneering spirit to encourage the profession to accept men. The Online Journal of Nursing Informatics recently honored Aliya Rainer, a Florida nurse entrepreneur who, after only 10 years clinical experience, created a successful consulting firm that supports hospitals and physician offices in transitioning to electronic health records [2]. Jacklyn Ratcliff, an Arkansas nurse, was honored with the 2014 Nursing Compassion Award [3]. She cared for a teenage patient who sustained a traumatic brain injury for more than a year before he passed away. The patient's grandmother, his primary caregiver, nominated Jacklyn after being deeply moved by the selfless manner in which she cared for her grandson, taking him to sporting events, movies, the mall and church even though he couldn't move any part of his body or communicate. Among my colleagues and students at Samuel Merritt University (Oakland, California), examples of nurses bringing honor to the profession are at hand. Each student and professional nurse has the potential to bring honor to self and the profession. The use of HONOR as a mnemonic may serve as a guide for doing so.

H is for heart

The heart itself is mystical, marvelous, magnificent, and essential for life. Its importance is often devalued or perhaps even invisible within the profession of nursing. The heart is 100,000 times electrically stronger and 5,000 times magnetically stronger than the brain [4]. Although a body of knowledge and superb judgment [brain power] is essential for professional nursing, the passion coming from the heart is of equal importance as it relates to caring and promoting healing among patients. As we look at the heart as an energy center - the heart chakra - we learn how having an open and healthy heart space contributes to enhanced effectiveness in the caring situation. We must begin by loving and forgiving ourselves and showing ourselves compassion. In this way, we will open our hearts to love, forgive, and show compassion for others.

Nurturing a healthy heart space helps us deal more effectively with negative emotions, such as stress and anger. It also helps us to heal ourselves and therefore come from a nurturing space when healing others. As the familiar adage goes, "People don't care how much you know until they know how much you care." We must use our hearts to recapture the passion that led us to nursing and use our minds to recreate it each and every day. Our thoughts today become who we are tomorrow.

We connect with our heart spaces and listen to our hearts regularly. "Listen to your heart beat, all of the patients you will ever care for are there - in those heartbeats - waiting for you." Dr. Jean Watson, a nursing icon, has devoted her life to helping caregivers practice from the heart to transform healthcare. Her Human Caring Theory has been used as the foundation to develop Caring Science, the 10 Caritas Processes, and the Caring Science Institute [5]. The International Journal for Human Caring is a multidisciplinary peer-reviewed journal that seeks to advance the body of knowledge of human care [6].

O is for opportunities

We seek opportunities for growth, becoming lifelong learners beyond continuing education requirements. The nursing profession has received guidance from the Robert Wood Johnson Foundation and the Institute of Medicine (2010) regarding preparing nurses to practice in complex healthcare environments in the 21st century and beyond [7]. Roles, responsibilities and expectations will continue to evolve and require modified strategies for educating nurses to deliver higher levels of care (quality and safety) in settings beyond the acute care hospital setting. Evolving nursing roles in complex environments and new settings require that we commit to seeking diverse learning opportunities; pursuing specialty certification, advanced education and excellence as a generalist are equally valuable choices. We keep abreast of current literature and join professional organizations offering resources for growth. We network with others, finding opportunities to discuss innovations in practice and opportunities to enhance patient care, self care and the profession.

N is for never being complacent

We strive to bring a sense of newness, passion, and innovation to each encounter and every patient. Each nurse is unique. As we companion our patients during the most vulnerable times in their lives, they deserve the benefit of our unique gifts and talents. Perhaps we've learned a secret to starting IVs or inserting NG tubes with minimal discomfort or have a repertoire of natural techniques to supplement pain medication. Can we share an inspirational story to lift a patient's spirits? Are we gifted with a voice and song that might lull a pediatric patient to sleep? We strive to be creative and confident and invest the energy that makes a difference during each encounter.

To create change, we take risks, challenging the status quo and finding a mentor to guide us. Our clients and their conditions demand more in an environment where less is available.

O is for providing outstanding care

Excellence is the only goal. The healthcare environment has changed significantly, especially over the last six to eight years and it will continue to change as access to care expands. The pace of care becomes ever more urgent--but shortcuts are not an option. Outstanding, state-of-the-art, evidence-based, compassionate care is our goal, even though care settings or systems may accept care that fails to meet professional standards. As individuals, we maintain the highest practice and ethical standards.

R is for reflection

Reflection drives individuals to improve their nursing practice, moving from novice to expert nurse [8]. Reflective practice fosters an understanding of practice events and how one's own approach, personality, and personal history contributed to the way situations arose and how they were dealt with [9]. For expert nurses, reflection facilitates intuitive practice to solve problems and discover unique solutions. For all nurses, reflection is crucial to preventing professional burnout and reflective professional coping strategies such as root analysis, handoffs, reports and debriefings allow us to return the next day, ready and motivated to serve and care.

Self-reflection is self-soothing. Being nurses with honor means opening our hearts to every interaction; reflection heals the inevitable scars. Self-reflective practices such as mindfulness, yoga, meditation, HeartMath® [10] and journaling help us continue to be mentally and emotionally present. Myriad evidence exists about the role they can play in our well-being and therapeutic effectiveness: reducing stress, increasing resiliency and well-being, promoting work-life balance, improving relationships with patients and others, enhancing problem-solving skills, promoting presence during health care interaction, high quality care delivery and self-care [11-20]. In mindfulness practice, we learn to be present without judgment; an ancient Buddhist tradition, it was introduced to Western healthcare in 1979 [21,22].

All reflective practices require some initial training and ongoing support, which is available online [23,24]. The benefits of initial training tend to persist for months beyond the initial training event. Present in each moment, our awareness increases of both intuitive knowledge and habitual responses - we can choose action over reaction. We can more easily tune out distractions, fully engaging in accurate assessments, effective responses and safe practices; we become catalysts for therapeutic relationships and communication. Mindfulness practices help us function with ease, calm, and compassion and promise a profession filled with healthy individuals providing optimal care to patients.

Questions for future research related to reflection include:

• What support is needed to practice a reflective approach to life?

• How can the interventions be most accessible and most useful?

• What benefits and challenges are experienced over time?

• Are reflective practice choices dictated by age group, professional nurse education, practice specialty, staff or leadership position status, type of setting?

• Should the selection of a reflective practice consider these variables in order to be most effective?

• What does ongoing support for reflective practices look like for practicing nurses?

Embracing these strategies to bring honor to ourselves and our profession can help translate nursing core values into practice and care in the 21st century and beyond. The fervor with which we imbue nursing with honor will transform our practice and patient encounters to outstanding optimal care, maintaining our standing as the most honorable profession in the United States.

  1. Rebecca Riffkin (2014) Americans rate nurses highest on honesty, ethical standards.

  2. (2011) Silver Virtual Award Recipient: Aliya Rainer. In: Online Journal of Nursing Informatics. HIMSS Foundation: June 2011.

  3. (2014) Nursing Compassion Award. In: ASBN Update. Litlle Rock, AR: Arkansas State Board of Nursing: June 2014.

  4. (2012) Your heart is the real brain. Tacfit Academy.

  5. (2015) Watson Caring Science Institute.

  6. (2015) International Journal for Human Caring. International Association for Human Caring.

  7. Institute of Medicine (2011) The future of nursing: leading change, advancing health. Washington, DC: National Academies Press.

  8. Tanner CA (2006) Thinking like a nurse: a research-based model of clinical judgment in nursing. J Nurs Educ 45: 204-211.

  9. Oelofsen N (2012) Using reflective practice in frontlne nursing. In: Nursing Times. London: EMAP Publishing Limited Company: 2012.

  10. Childre D, Rozman D (2005) Transforming Stress: The Heartmath Solution for Relieving Worry, Fatigue, and Tension. Oakland, CA: New Harbinger Publications; 2005.

  11. Bedell W, Kaszkin-Bettag M (2010) Coherence and health care cost--RCA actuarial study: a cost-effectiveness cohort study. Altern Ther Health Med 16: 26-31.

  12. Morrow M (2014) Caring Science, Mindful Practice: Implementing Watson's Human Caring Theory by Sitzman K and Watson J (New York: Springer, 2014). Nurs Sci Q 27: 263-264.

  13. Cohen-Katz J, Wiley SD, Capuano T, Baker DM, Kimmel S, et al. (2005) The effects of mindfulness-based stress reduction on nurse stress and burnout, Part II: A quantitative and qualitative study. Holist Nurs Pract 19: 26-35.

  14. Cohen-Katz J, Wiley S, Capuano T, Baker DM, Deitrick L, et al. (2005) The effects of mindfulness-based stress reduction on nurse stress and burnout: a qualitative and quantitative study, part III. Holist Nurs Pract 19: 78-86.

  15. Horner JK, Piercy BS, Eure L, Woodard EK (2014) A pilot study to evaluate mindfulness as a strategy to improve inpatient nurse and patient experiences. Appl Nurs Res 27: 198-201.

  16. Raingruber B, Robinson C (2007) The effectiveness of Tai Chi, yoga, meditation, and Reiki healing sessions in promoting health and enhancing problem solving abilities of registered nurses. Issues Ment Health Nurs 28: 1141-1155.

  17. Geary C, Rosenthal SL (2011) Sustained impact of MBSR on stress, well-being, and daily spiritual experiences for 1 year in academic health care employees. J Altern Complement Med 17: 939-944.

  18. Fortney L, Luchterhand C, Zakletskaia L, Zgierska A, Rakel D (2013) Abbreviated mindfulness intervention for job satisfaction, quality of life, and compassion in primary care clinicians: a pilot study. Ann Fam Med 11: 412-420.

  19. Martin-Asuero A, Garcia-Banda G (2010) The Mindfulness-based Stress Reduction program (MBSR) reduces stress-related psychological distress in healthcare professionals. Span J Psychol 13: 897-905.

  20. (2009) Mindfulness for the Nursing Professional.

  21. White L (2014) Mindfulness in nursing: an evolutionary concept analysis. J Adv Nurs 70: 282-294.

  22. Kabat-Zinn J, Hanh TN (1990) Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. Crystal Lake, IL: Delta; 1990.

  23. (2015) The Chopra Center.

  24. (2014) Discover the art of mindful living.

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