Journal of Professional Nursing

Courage as integral to advancing nursing practice 

Deb Spence, RN, RM, PhD, Joint Head of Nursing, School of Health Care Practice, Auckland University of Technology, Auckland
Liz Smythe, RN, RM, PhD, Associate Professor, School of Health Care Practice, Auckland University of Technology, Auckland

Reference:  Spence, D., & Smythe, L. (2007). Courage as integral to advancing nursing practice. Nursing Praxis in New Zealand, 23(2), 43-55.


Courage is an elusive but fundamental component of nursing. Yet it is seldom mentioned in professional texts and other literature nor is it often recognised and supported in practice. This paper focuses on the illumination of courage in nursing. Data from a hermeneutic analysis of nurses’ practice stories is integrated with literature to assist deeper understanding of the meaning of courage in contemporary nursing practice. The purpose is to make visible a phenomenon that needs to be actively fostered or ‘en-courage-d’ if nursing is to effectively contribute to an improved health service.

Courage, nursing practice, philosophical hermeneutics

Introduction and background
Courage has captured our attention. In earlier research focused on illuminating the qualities essential for advancing nursing practice, Spence (2004a) identified several key “C” words including: confidence, cognitive capacity and clinical credibility. Yet there seemed to be something missing. Something else was required to overcome the myriad of factors that constrained the advancement of practice. Further thinking, dialogue and reading suggested that another, perhaps more significant quality, that of courage (Spence, 2004b) was critically important. In the nature of hermeneutic research we begin by recalling our own stories of ‘being courageous’. Deb tells her story from a time she returned to clinical nursing while completing her doctoral research:As part time staff nurse, I was concerned for the safety of a woman with an insulin infusion who had been admitted to the orthopaedic ward because there were insufficient beds in the medical ward. Knowing that the orthopaedic nurses lacked the high level expertise to respond adequately should she deteriorate, I decided I had to speak up. Standing at the head of the bed, beside the woman and her infusion pump, I faced the physician, registrar and 2 medical students and systematically outlined the reasons for transferring the woman as soon as a medical bed was available. When the physician turned to his colleagues and said: “This is the sort of nurse that you listen to” and then asked the registrar to make the necessary arrangements, I was amazed and humbled. I had been courageous enough to speak up and was being heard.The confidence that Deb had developed through practice and advanced education had enabled her to use her courage to promote safer care for this client.

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