The business of Nursing?

By Philip Darbyshire (

We are told constantly that health care is a business and that nursing should follow more business-like principles. As a health service or hospital is indeed a multi-million dollar organisation that needs to be well managed, there are no arguments from me on that score.

If we are in business however, then let us be absolutely clear about the nature of our business as nurses. We are in the transformation business and the ‘making a difference’ business. Nurses don’t just make the tea and coffee they make decisions. We need to appreciate the importance of processes and structures, but more importantly, we need a laser focus and a near-reverence for tangible and valued outcomes that improve patients’ experiences.

We are in the transformation business. As a clinician, you are not in the injections business or the dressing-changing business or the putting up IVs business or the bathing business.

Instead, as Kerfoot notes, we transform

“We transform a frightened 4-year-old girl in the emergency room into a little person who now feels she has some measure of control and can stop crying. We transform a 50-year-old father with out-of-control diabetes into a person who has the confidence to manage his condition. And we transform the frightening and painful experience of childbirth into a beautiful memory of ecstasy for a family that has created a new person. When life ends, we transform those final moments of life into sacred, beautiful transitions of passage for families to complete the circle of life.”

As a nurse educator, you are not in the business of ‘lecturing’, ‘marking’, ‘supporting students’, or ‘writing curricula’. You are in the transformation business.

We transform students into safe, skilled and self-confident practitioners.

We transform apathy and cynicism into enthusiasm and robust idealism.

We transform clinical, interpersonal and ethical problems from potential career-ending setbacks, into opportunities for deep learning and personal and professional mastery.

We transform patient and client experiences from everyday anecdote into the bedrock of clinical judgement and service quality.

We foster and build confidence and self-belief where this been eroded, damaged or has never developed while also challenging an equally dangerous overconfidence, arrogance or narcissism.

As a nurse researcher, you are not in the business of interviewing, administering surveys or managing data.

We transform the glib stereotype of the ‘ivory-tower’ academic by our meaningful, productive and mutually advantageous collaborations with clinical colleagues and service areas.

We challenge the prejudice that academics and their research has little relevance or use in the ‘real world’ of health policy and politics by our focus on knowledge translation, transfer and research impact and by the demonstrable profile and presence that our work has in numerous key areas of health policy and politics.

We are in the transformation business and the ‘making a difference’ business.

All over the world, nurses are making rhetorical notions of ‘The Patient Experience’, Quality & Safety and Improved Outcomes very, very real:

Somewhere a nurse is helping a struggling and despairing new mum to learn all of the messages and nuances that her new baby is signalling,

Somewhere a nurse is bearing witness to another mother’s dying, and comforting her during her last moments on this earth,

Somewhere a nurse is inserting a child’s IV and helping them and their family begin their journey into the world of chemotherapy,

Somewhere a nurse is listening to an Alzheimer’s patient tell a story and trying to help them piece together who they really are,

Somewhere a nurse is helping a new student learn from a patient encounter and is passing on the wisdom of our art,

Somewhere a nurse is turning a hunch or a problem into a question that will eventually be researched and provide new knowledge and understanding,

Somewhere a nurse is managing a service with the passion and enthusiasm that enables her staff to thrive and to appreciate why they wanted to become nurses in the first place,

And somewhere a nurse is working in a war zone, helping service personnel and villagers alike.

These ‘quiet’ or ‘unrecorded’ heroisms surely deserve our acknowledgement and appreciation.

The above article is a part of a publication titled Nursing heroism in the 21st Century’. Click the link below to read the complete paper. It is very enlightening

Nursing heroism in the 21st Century’  .



Lead Nurse Africa is a Pan-African nursing organization dedicated to public health promotion and professional development.

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