How to Nurse

Are you looking for the perfect gift for a nurse on your holiday list?  Or, are you looking for a book that is entirely consistent with the vision of the NurseManifest values and ideals?  Are you still struggling to clearly answer the nagging question: what is nursing? Or do you just need inspiration? Cover How to nurse Look no further this book is the perfect choice – How to Nurse: Relational Inquiry with Individuals and Families in Shifting Contexts.  I reviewed this book for this blog back in January, but I continue to be inspired and encouraged by this book and decided that now is a perfect time to once again bring this book to the attention of NurseManifestors!  Right at the outset, the authors Gwenneth Hartwick Doane and Colleen Varcoe explain what they mean by the term “relational,” and in so doing reveal the close connection with NurseManifest values:

When we use the word “relational” and speak of a relational inquiry approach to nursing practice, many people think we are merely emphasizing the touchy-feely, emotional side of nursing and particularly “nurse–patient” relationships. However, relational inquiry is far more encompassing than that. Although relationships between people are certainly part of relational inquiry, in this book, the term “relational” refers to the complex interplay of human life, the world, and nursing practice. Specifically, relational inquiry involves highly reasoned, skilled action. Relational inquiry  requires (a) a thorough and sound knowledge base; (b) sophisticated inquiry and observational and analytical skills; (c) strong clinical skills including clinical judgment, decision-making skills, and clinical competencies; and knowledge and skills. Rather, a relational consciousness highlights the interplay of a number of factors affecting the point-of-care . . . . This heightened awareness enables more informed decisions and more effective action.

Overall, a relational consciousness

• Sensitizes us to the relational complexities that affect what happens at the point-of-care
• Directs attention toward the “relational transactions” that are occurring within and among people and contexts
• Enables us to be very intentional and consciously choose how to act in response to these complexities and transactions

Specifically, relational consciousness is the action of being mindfully
aware of the relational complexities that are at play in a situation and
intentionally and skillfully working in response to those relational complexities.

(Doane, Gweneth Hartrick; Varcoe, Colleen (2013-12-30). How to Nurse (Page 3-5). LWW. Kindle Edition.)

I cannot recommend this book highly enough!  In addition to this kind of explanation of the principles on which nursing is based, the book is loaded with examples and real-life activities that emphasize what this means in very practical terms.

Let’s start a lively discussion here about the insights that this book offers, and add more insights related to the connections between the perspectives this book offers and our own NurseManifest vision!



Nursing as Practical Magic


Nursing is a practical magic that creates internal and external environments to promote health or a peaceful death through acts that generate transformation. Ancient wisdoms and civilizations create rituals to honor life’s milestones and seasonal changes.


Samhain (pronounced sow-een) is known as the ancient Celtic festival of the dead. Celebrated on the 1st day of November, Samhain is a time of introspection, and remembrance of the ancestors.

How do you remember and honor your ancestors?

Wise women throughout the ages, healers, and witches honor the turning of the wheel of life, the seasons, and the rhythms of the natural universe.

Connecting with the moon, stars, plants, animals, self and spirit they give thanks and set intentions to create healing and the life they dream of.

Consider the symbols and talisman of Halloween. One may see that the Broom symbolizes clearing of the old to make way for new; the Owl for wisdom; the Cat for mystery of the unknown; Ghosts for notions of the other world; and Bats for transformation.

As nurses, we inherently make connections with and for our patients and families. We tap into the power of the universe, as we embrace it we realize there’s a little witch in all of us.

Magic isn’t just spells and potions; its symbols and talisman that have whatever meaning you assign to them. What are the symbols and rituals that hold meaning for you?

Healers use their powers to conjure and create by setting intentions and connecting with the inherent energies of their environments.


The nursing metaparadigm (nurse, person, health, environment) viewed through the Unitary Transformative paradigm conjures an integration of multiple ways of knowing, being and becoming.

As we honor our nursing ancestor Florence Nightengale, we hear her say:

“All disease is a reparative process…an effort to remedy a process of poisoning or decay…I use the word nursing for want of a better. It has been limited to the administration of medicines and applications of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet and diet…”

How do you conjure your environment for healing? How do you create the environment for your patients to heal? What ritual, symbols and talismans and intentions do you use in your self healing and work?

As we connect to our ancestors today, let us begin to reclaim our providence and power as nurse healers.

Listen to you heart, hear the beat of the drum, the drum of your heart as it connects with the hearts of the others and the universe; conjuring, gathering and sending out powers of healing and love to self and universe.

On this day we honor the ancestors, the ancient wisdoms, where we have been and the gifts we have been given.


See the vibrant colors of the Autumn; red, yellow, orange, and brown. Smell the earthly aromas of patchouli, sandalwood, musk, spice and copal. Hear the rustle of leaves as they fall and fly.

Let your nursing be a practical magic. Conjure a spell and send your intentions off on the winds, allowing the vibrant leaves of red, orange and yellow carry your wishes of health and healing to the earth, animals and humans.


Nightingale, F. (1859). Notes of Nursing; What is it and What it is not. Barnes & Noble (2003): New York, NY (pp 1-2).


The Promise of Nursing: Social Justice and Health

Those of us who have been involved in the Nurse Manifest Project are deeply committed to the idea of social justice – the notion that reaching for social justice is fundamental to human health and well-being and that social justice is central to our purpose.  It is the promise we make to individuals and to communities when we claim to care for each and every person for whom we care. But like many other social concepts and ideals, the meaning of social justice often alludes us. So I decided to ask all of our NurseManifest bloggers to share, in just a couple of sentences, their concept of social justice!  Here is what they sent: 

Elizabeth: On my walk the morning, I recall thinking that “social justice” is not a noun but a verb. It is not something that is, rather it is what you do. It is one’s life’s work. Well, it is my life’s work.

Carey: I think in nursing we can view social justice as our ethical obligation to support the healing of those who are suffering due to social inequities and the promotion of equality and human rights in the society which we serve.

Sue: My belief is that social justice is the process of questioning privilege and whose interest is being served.  Of course, there’s also courage– to question, to act, to be vulnerable, and to be part of a collective that holds social justice dear.

Marlaine: Social justice is about creating compassionate social, political and economic structures (such as laws, policies, organizations) that preserve dignity, equity, equality and human flourishing.

Danny: Social justice in nursing means that nurses keep their focus on facilitating humanization whereby every person is provided the means for health, meaning, and well-being in both living and dying and treated with moral respect and dignity. Social justice in nursing necessarily requires nurses to examine and address the underlying person-environment root causes of dehumanization and social injustices that prevent human flourishing and individual and societal well-being.

Richard: Social justice is an expression of a society that values, appreciates, and fosters the freedom and equanimity of all peoples and all creatures to live fully in accord with their greatest and highest good, health, and well-being.

Olga: Social justice is an ideal or core value that emphasizes the creation of conditions that ensure human dignity for all. Social justice (human dignity) can be achieved under conditions of extreme poverty or ill health, and also can be destroyed under seemingly optimal economic conditions, or by well-intentioned (i.e., paternalistic) actions.  

Lisa: Social justice is the equitable distribution of resources and power whereby no individual or group is privileged over another and all have a fair opportunity to contribute, receive, and flourish.

Wendy: Social justice is the embodiment of personal and professional values that uphold and protect the sacred and inherent worth of all human beings to live their lives in freedom; Freedom to express, develop and explore ones individual and unique self on all levels, without religious, societal and hegemonic constraints or condemnation. Nurses advocate for social justice when they address barriers that restrict freedom for self, others, patients and families.

Jane: For me social justice means simply treating others as we would like to be treated. It means creating a society where people feel empowered to succeed and live well emotionally and physically – in every possible aspect of life. It means building on people’s strengths, not weaknesses, so that they can become even stronger.  I tend to think of things in terms of health, but I truly believe the preceding applies to work, relationships, and everything else people experience in society.

Adeline: For me social justice is both an ideal of an equitable (not to be confused with equal) distribution of societal resources and advantages and an ethic that requires us to work towards achieving the ideal.   

For me (Peggy), social justice is all of these things – and my fundamental perspective rests in the understanding that we all participate in the structures that create and sustain social injustice in the world.  Some of these structures we cannot change – after all we live and participate in societies that inherently structure advantage for some and disadvantage for others.  For me our first step toward creating social justice is to understand the ways in which the healthcare systems in which we participate create and sustain injustice, then work with utter dedication to changing what we can.  As noted in the reflections above, social justice is a verb, it is action, and it takes courage!  May our words of reflection lend courage to your dedication to this human endeavor!

social justice wordle

Nurses Who Soar Like Eagles

This post contributed by Adeline Falk-Rafael

For the past several years I have taught leadership to internationally educated nurses in a 4th-year BScN course. Given professional and disciplinary expectations that nurses demonstrate leadership, regardless of their practice role, the course is designed to provide related knowledge and skill development through classroom and experiential learning.

 After the initial exploration of contemporary leadership theories we begin development of some related skills, the first being communication and collaboration. At the outset of the eaglecourse, students are assigned to a group of 7 or 8 students. Each group is expected to complete a project by the end of the term, but the primary purpose of the group is to provide an opportunity for applying leadership principles and practicing related skills, such as effective communication, (for more information, see my “Peace and Power blog post

 It is the difficulties that students experience in this practice and application that provides an opportunity to reflect on why that is – on how we have been taught to how to act, communicate and be in relationship as nurses in the health care environment and women and men in our society. It is about at this time, that I show them the parable of the chicken and the eagle, which you can watch below!

The basic premise of this parable is that a young eagle has found itself in a chicken yard and learns to believe it is a chicken and thus behaves like a chicken. Although I have seen various versions of this parable, in this particular one, although an eagle tries to “mentor” the young bird into realizing its potential as an eagle, it retreats into the safety of the chicken barn to live out its life as a chicken.

My belief is that it is irresponsible to emphasize the professional imperative for leadership without examining some of the systemic barriers to enacting that leadership; what stands in the way of us fulfilling our potential as eagles, how have we been taught to think of ourselves and behave as chickens – or less than we are? It is only in recognizing the barriers that we can begin to discover ways of overcoming them. Throughout the remainder of the course, it seems that whether we are speaking of communication, collaboration, advocacy, change agency, conflict resolution, or visioning for the future, we encounter “chicken” messages or confining structures that need to be overcome before we can soar like eagles.

What keeps us from working to our full scope of practice, for example? Is it the safety /comfort/ security of working within a defined job description? To what extent have we internalized an identity of an ancillary medical worker?

What keeps nurses so often from being acknowledged as credible knowers? In 2003, I was President of the Registered Nurses Association of Ontario, during the SARS outbreak in Toronto. At one point, officials deemed the outbreak over, but nurses in one hospital began seeing patients present with the same symptoms and warned of possible new cases. They were silenced with the words, “if I need an expert, I’ll ask for one.” (For more information, see “Lessons Learned from SARS”)

Ceci,1 in a brilliant analysis of the proceedings of an inquest into the deaths of 12 children who underwent cardiac surgery at the Winnipeg Health Sciences Centre, in Manitoba, Canada, similarly described dismissals to nurses’ repeated expressed concerns with the competence of the surgeon, leading the judge presiding for the inquest to observe that the nurses eventually silenced themselves. Ceci concluded: “nurses were presumed to be, acted upon as if they were, the sorts of persons whose concerns need not be taken seriously and gender ideology was a resource that could be strategically drawn upon to make the presumption true” (p. 76).

My guess is that most nurses reading this would be able to recount similar incidents, although more than 10 years have passed since these events. It is a challenge to keep believing and acting like an eagle when you continually get messages that you are a chicken! It is all too easy to become discouraged and give up but in the words of May, “What becomes important for nurses is not that we somehow expect that we may free ourselves of the effects of gendered, gendering discourses, but that we begin to understand how these work in constituting our experiences, . . . that we begin to understand their hold on us and try to make choices about what, if anything, we want to do about this” (cited in Ceci, p.80)

1Ceci, C. (2004). Gender, power, nursing: A case analysis. Nursing Inquiry, 11(2), 72-81.



A Nursing Textbook Worthy of NurseManifest Endorsement

Several months ago I had the honor of writing the Foreword to a new nursing textbook by Gweneth Hartrick Doane and Colleen Varcoe titled “How to Nurse: Relational Inquiry with Individuals and Families in Changing Health and Health Care Context.” In their Preface, they state the goal of the text very clearly – one that reflects elegantly the ideals of the Cover How to nurseNurseManifest vision:

“Our goal is to help readers engage in a thoughtful process of inquiry to more intentionally and consciously develop their knowledge and nursing practice, develop their confidence and ability to act in alignment with their nursing values, and to navigate the complexities of contemporary health care settings as they care for patients and families.” (p. x)

There are particular features of the book that are notable from “NurseManifest” perspective.  One is that the book accomplishes something typically missing in textbooks – it fully engages the reader as a participant.  In essence, the book “models” the title — it is relational.  Throughout the book there are features that engage the reader in the content, for example encouraging the reader to “try it out” and providing guidelines for “this week in pracice.” The “Relational Inquiry Toolbox” features at the end of most of the chapters provide guidance for the reader in focusing on using the tools presented in the chapter in practice.  For example, at the end of Chapter 2 – one of the tools is to “Enlist a critical feminist filter to see how gender dynamics are intersecting with other forms of oppression and affecting health and health care.”

In short, this is a marvelous book.  Get your copy today .. even as a person who is not enrolled as a nursing student, I guarantee you will learn a lot and see vast possibilities for nursing that will amaze you!