Profiles in Nursing

Dorothy Smith and Nursing Education

She believed the heart of nursing remained the relationship with the patient.

By Elizabeth Hanink, RN, PHN, BSN
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Profiles in Nursing: SmithWhen you were in school, did you wonder how much actual patient care your instructor did? Did you ever see the teacher start an IV or circulate during surgery? When you were a new graduate, did you find it shocking how much practice varied from theory? I certainly did. Learning about Dorothy Smith, RN, BS, M.Ed., FAAN convinced me I am not alone.

While in school, Dorothy Smith saw this sort of separation of theory and practice as a problem. She never lost sight of the intellectual challenge of clinical nursing and considered it the core of academic achievement and credentialing. In her mind, the heart of nursing remained the relationship with the patient.

Smith was a graduate of Quincy City Hospital School of Nursing in Massachusetts. She received a bachelor’s degree from Columbia and a master's from Harvard University. Her textbook, System of Nursing Practice, co-authored with E. P. Becknell, appeared in 1975, but her most lasting contribution was at the University of Florida from 1956-1971, where she was the founding Dean of the College of Nursing. It was there that Smith laid the groundwork for the unification of education and practice, a most important advance in nursing higher education.

Smith had several areas of concern. One was that as a nurse became more experienced, the only route to advancement was to leave the bedside and become an administrator or teacher. Nurse practitioners and clinical specialists are now an accepted part of healthcare — this is largely a result of Smith’s endeavors. Secondly, she worked to integrate nursing more fully with mainstream higher education, so that nursing faculty provided the administration, staffing and instruction at teaching hospitals and clinics. Thirdly, Smith strongly promoted efforts to elevate research and establish nursing practice as evidence–based.

With over 30 articles to her credit, Smith truly is an educator grounded in reality. One of her core beliefs was that those who teach nursing should be directly involved in it. For the whole of Smith’s tenure as dean, she was also chief of nursing practice at Shands Hospital at the University of Florida.

At the 1996 meeting of the American Academy of Nursing that honored Smith as a Living Legend, she said, “As clinical instructors, we rarely used lectures, but rather practiced nursing care so that students could watch us.” Smith’s work shows a nurse who believed and practiced clear thinking. “We just can’t talk about ‘caring,’ for example. Everybody cares, even people we don’t like care. Caring must be reduced to behavioral skill.” In her article “Thoughts About Nursing,” she wrote: “The distinguishing characteristic of professional nursing is clinical thinking. Every patient, whether well, getting sick, being sick or getting well, has the right to a nurse, who by virtue of this clinical nursing thinking, manages the nursing care, and is accountable for that care. Clinical thinking involves data collection, problem setting, care planning, implementation and evaluation. Substantiated evidence of this care must appear on the chart, in a computer or on a yet to be invented device so that it can be retrieved for learning and research.” Hence, Smith’s pioneering work on assessment tools and care plans.

In 1997, shortly after receiving the Mary Adelaide Nutting Award from the National League for Nursing, Dorothy Smith died. In 1998, she was a posthumous inductee into the American Nurses Association’s Hall of Fame, and today, to honor her vision, the University of Florida hosts the biennial Dorothy M. Smith Nursing Leadership Conference.

Elizabeth Hanink, RN, PHN, BSN is a freelance writer with extensive hospital and community-based nursing.

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