Sep 04, 2015
By Mary Anne Van Os, RN, BScN, MScN

Beautiful buttons

Mary Anne Van Os employs a unique tool to teach students the application of reflective practice

What is nursing to me? I don’t remember thinking about it as a nursing student in the mid-1970s, perhaps because instructors had told us precisely what nursing was: a profession of selfless giving and uniformity. I had accepted that we were to be doctors’ handmaidens, clad in identical white caps, uniforms and shoes. Sameness was key — you, your team and your patients could depend on it. I was joining a regime of interchangeable health-care soldiers and I knew and accepted the associated expectations and certain politics. And if the call of duty necessitated the sacrifice of my individuality, so be it.

As my education and areas of work evolved over the years, I often reflected on new experiences and related them to my past and current practice. My personal and professional growth begat a metamorphosis. Leaving the comfort of sameness behind, I developed a new perspective of my individuality as a nurse. But while I found that my transformation increased my confidence and improved my decision-making skills and relationships with patients, I was also upsetting the balance at work and causing some dissonance. Pausing to question if I was leaving true nursing behind, I was torn. Could I be different and maintain some sameness? Many of my new ideas conflicted with the core values I had been taught. I was resistant to hang up my cap but eager to see where my new-found metaphorical wings would take me.

Today I teach in the practical nursing program at Sheridan College. Every year I opt to join first-semester students on their first clinical rotation. I love this part of my job because it reminds me of my time as a nursing student. In each student’s enthusiasm, awe, fear, joy, confusion and satisfaction, I see and remember myself.

Last September, I incorporated a teaching tool to help students understand what nursing is, one that represents both the sameness of nurses and their individual differences in care philosophies and practices. This tool puts to use my grandmother’s button box: a treasure trove of thousands of buttons of all shapes and sizes.

On this first day of their clinical rotation, the excitement and anticipation are palpable. We’ve met and familiarized ourselves with the surroundings and agenda. The students, in uniforms, are identifiable by their sameness. They wait for words of wisdom. I remove a magnificent gold pouch from my lab coat pocket. There are murmurs…what could the pouch possibly contain? I invite them to draw from it, and buttons of every shape, size and colour appear. Then I ask, “How are these buttons related to being a nurse?” There is a pause, and then they speak in turn.

The discussion that follows is exactly what I had hoped for. Each button is unique, they say, but all have a similar function, just like we do! Although nurses have the same purpose, the same title, they are different in many ways. And despite these differences or maybe because of them, nurses are part of a collective with a shared goal. One student points out that while they have all had the same theoretical background, some probably have different perspectives on how to synthesize and apply the information. Another contemplates whether it would be more efficient and cost-effective, and have the added bonus of interchangeability, if all the buttons were the same.

I prompt them to reflect on the value of having a variety of different buttons at hand. The benefits of having access to differences in perspective, experience, analytical skills and problem-solving are discussed. Before we part ways, I encourage them to consider the uniformity and individuality of the experienced nurses they will encounter (and remain aware of their own) through reflective practice during these clinical rotations and once they embark on their careers. I can see the wheels turning. I couldn’t be happier with the results of my little experiment.

Over time, many of the students become remarkably attached to, even protective of, their buttons. At post-conference, some confess to reaching for them when they are unsure, fearful or frustrated. This act prompts them to pause and consider the appropriate course of action and, later, to reflect on the experience and its impact. I hear the buttons referred to as touchstones and see them gingerly placed in pockets for safekeeping. I witness apprehensive handovers to classmates for inspection and comparison; a vehement defence typically follows, with the owners determined to reclaim their prize. Proudly, they show and tell to their peers, who soon request their own special reminder of what it means to be a nurse.

The remarkable effect of the beautiful buttons on students is touching, and I believe these students fully grasp the objective of the exercise. Good thing my grandmother left me lots of buttons; I will be needing them again.

Mary Anne Van Os, RN, BScN, MScN, is a full-time professor and the coordinator for the Practical Nursing Program at Sheridan College, Davis campus, Brampton, Ont.

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