Personal philosophies of nursing and the experience of leaving the profession: A phenomenological inquiry

The nursing profession entered the 21st century facing another recruitment and retention crisis.{09}Fewer students choose nursing as a career and many of the nurses currently in practice, are either leaving or considering leaving the profession. Nursing education continues to vary in scope, preparing students in traditional hospital-based programs, associate degree and baccalaureate degree programs. Successful graduates enter the work force with a disparate knowledge base and skill set. Nurses are expected to function in an increasingly complex health care system facing ethical and professional issues as well as providing patient care. This study examined the development of personal philosophies of nursing with a sample of nurses who chose to leave the profession. This phenomenological study examined the journey into and out of the profession of nursing for eight nurses in a Midwest city. The participants were asked to share experiences from their education and practice as nurses through personal interviews. The transcripts were analyzed according to a VanManen's (1990) methodology. Salsberry's (1994) format for a philosophy of nursing, including ontology, epistemology and ethics, provided the evaluative framework. Carper's (1978) four Patterns of Knowing were utilized as the epistemic model and the American Nurses Association Code of Ethics for Nurses was used as the ethical model. All participants demonstrated use of all patterns of knowledge, though some described certain patterns more frequently than others. Ontology was described early in their professional careers; epistemic support was not described until they progressed through school and into practice. The primary challenge for participants occurred in situations which contradicted their ontological understanding of nursing. The majority of nursing in this study felt they were still nurses even though they were not in practice. Additional studies into the development and use of personal philosophies of nursing in professional nurses who remain in practice are needed. Additionally, educators should foster in students an appreciation for the development of a philosophy of nursing. Employers should develop clear and consistent expectations for professional and ethical behaviors in all hospital staff, providing a supportive and respectful environment which incorporates the advocacy and care ethics which underlie the nursing profession.