Studying the old masters of nursing: A critical student experience for
developing nursing identity
Jacinta Kelly a, *, Roger Watson b, James Watson a, Malachi Needham a, Laura O. Driscoll a

a Anglia Ruskin University, East Road Campus, Young Street Site, Cambridge CB1 1PT, UK
b School of Nursing and Midwifery, University of Hull, UK

a b s t r a c t

Article history:
Received 4 March 2015
Received in revised form
10 May 2016
Accepted 27 June 2017

In the past professional identity in nursing was inculcated in students alongside institutional pride. A
strong sense of professional identity is key to staff retention and recruitment and key to the delivery of
quality nursing care. With the wholesale transfer of pre-registration nursing education to the third level
sector, however, the reality is that students now divide their affiliations between university and
healthcare institutions and professional identity development may be stymied. For this reason, there is
need to explore alternative means of developing professional identity. Exposure to nursing history may
counteract this tendency. Based on adult nursing students’ reflections of a visit to the Florence Nightingale Museum, we discuss the potential of this activity in aiding development of critical professional
identity.

Keywords:
Museum
Masters of nursing
Professionalism
Nursing history
Pre-registration students
Identity

1. Introduction
Reports suggest that having an historical perspective in nursing
in preparatory nurse programmes can influence critical professional identity development (Lewenson, 2005; Happell, 2007;
Padilha and Nelson, 2009; Borsay, 2009; Toman and Thifault,
2011). Nursing history, however, has been side-lined in successive
nursing curricula (Smith et al., 2014), due in much part to nursing
history jockeying for position in curricula dominated by statutory
science subjects, coupled with the lack of expertise in teaching
nursing history and the sustained media campaigns for more focus
on practical and technical instruction in nurse education (Kelly and
Watson, 2015). In this paper, we discuss the value of a nursing
history museum experience for pre-registration nursing students
in aiding development of critical nursing identity. Specifically, we
base our position paper on a recent tutor accompanied visit to the
Florence Nightingale Museum at St Thomas's Hospital, London in
the United Kingdom. In concluding, we offer suggestions for
contemporary practice and for future research.
2. Background
The importance of developing critical nursing staff is clear when
* Corresponding author.
E-mail address: jacinta.kelly@anglia.ac.uk (J. Kelly).
http://dx.doi.org/10.1016/j.nepr.2017.06.010
1471-5953/© 2017 Elsevier Ltd. All rights reserved.

examining the outcomes of well publicised investigations into poor
nursing care in the UK (DH, 2012; Francis, 2013). Moreover, the
successful development of critical professional identity is crucial as
it has a direct relationship to student retention and therefore ultimately the numbers of those entering and remaining in the profession (Worthington et al., 2013). It is suggested that education is a
key formative period for developing nursing identity as this is when
intending nurses gain the knowledge and skills that separate
nurses as professional healthcare workers from lay people (Johnson
et al., 2012). One problem in this regard is that since the progressive
move away from hospital based apprenticeship, developing nursing
identity is now fragmented between the university and the
healthcare institution which have their differing philosophies, with
universities constructing intending nurses as critically thinking and
knowing care givers, protecting against ritualised care, and health
service organisations viewing new graduates as organisational
operatives providing a nursing service and institutional protection
(Hamilton, 2005; Brennan and Timmins, 2012). The formation of
professional identity is a complex phenomenon primarily formed
through socialisation and conformity to an organisation (Brennan
and Timmins, 2012) and can easily be disrupted by marginalization and antagonism (Berry, 2011; Cantey, 2012, 2013). How universities can help foster professional identity and prepare students
for entry to the workplace is an area of interest in fields beyond
nursing (Grealish and Trevitt, 2005; Roskell, 2013). It is recognised
that both clinical practice and academic staff can exemplify behaviours and attitudes that directly influence a student's development of professional identity (Felstead, 2013). Clinical teachers
help students acquire professional values by acting as role models
in practice (Brown et al., 2012) and both positive and negative
behaviours of registered nurses can significantly influence students' development of professional identity (Cantey, 2012; Keeling
and Templeman, 2013). There are a number of other key factors
which can have a significant influence on professional identity
development including uniform design (Shaw and Timmons, 2010),
participation in nursing organisations (Lapidus-Graham, 2012) and
exposure to interprofessional learning (Coster et al., 2008; Hood
et al., 2014). Most interestingly, a study in Australia where first
year nursing students were invited to act as ambassadors at a
celebratory event on International Nurses Day, it was reported that
those taking part developed a stronger nursing identity through
historical learning (McAllister et al., 2011).
It is believed that historical learning contributes to critical
identity development as it aids intending nurses' socialisation and
orientation to the nursing profession and attending professional
expectations (Church, 1990). Historical learning for students of
nursing is valuable in identity development as it helps nurses understand people and societies (Stearns, 1993). The study of the
history of nursing contributes to development of professional
moral understanding and is instrumental in helping to shape minds
hospitable to new ideas, values and experiences (Lynaugh, 1993 pg
1). Moreover, knowing nursing's past allows nurses imagine possibilities in nurses' day to day world’ (Lynaugh, 1993 pg 1). Historical perspectives help the profession know what nursing is now
and how it can evolve in the future (Kalisch and Kalisch, 1976;
Lewenson, 2005; Madsen, 2008). McLuhan (1967) likened historical learning to looking in the rear view mirror; not merely for the
purpose of looking back but as a useful vehicle for seeing what is
coming up from behind. Historical learning is not just trying to
resurrect the past but about harnessing it to develop something
new. For students in education and developing their craft, the
history of the professionalization of nursing and institutional histories and, most especially, the history of nursing practice and
historical leaders are worthy of study as intending nurses seek to
achieve artistry and mastery in nursing. Derrick (2008 pg1) supported this where he stated that ‘mastering any art form inevitably
requires studying the old masters of that form; a composer with no
knowledge of Mozart, a writer with no appreciation of Shakespeare
or a filmmaker with no knowledge of Hitchcock are all poor artists’.
From an interdisciplinary working perspective, developing historical awareness and in turn nursing identity can help illuminate
nursing's distinct contribution to healthcare (McNamara et al.,
2011). Further to this, Sokol (2008) stated that a knowledge of
professional healthcare history can provide students with a sense of
perspective and connectedness with the past, better professional
judgment and reasoning together with humility, a deeper appreciation of professionalism, greater emotional wisdom, and a more
critical approach to contemporary healthcare (Sokol, 2008). Keeling
(2001) argues that historical learning helps students base clinical
decision making not solely on technical knowledge but helps
expand students' thinking and increases tolerance. In sum, appreciation of nursing history supports sustained vibrant and dynamic
environments for clinical and academic scholars helping to educate
nurses more comprehensively for future healthcare leadership
roles (Lewenson, 2005).
While historical learning earns universal praise and numerous
schools around the world have buildings named after historical
nursing leaders and iconic nursing leaders such as Florence
Nightingale and Mary Seacole continue to attract following from as
far away as Japan (Takada, 1984; Yagi, 1986), reports suggest that
students of nursing do not enjoy meaningful dialogue about the

history of nursing during preparatory programmes (AAHN, 2001;
Wolff, 2002; Padilha and Nelson, 2009; McAllister et al., 2010;
Hackmann, 2001; Smith et al., 2014), most ironically in the UK
(Kelly and Watson, 2015). It is argued that this insufficiency impacts
on the development of critical nursing identity essentially as ‘skilled knowers and doers’ (Kelly et al., 2012) and the advancement of
the profession in the public's interest in many areas, chief among
them being healthcare reform, emerging health technologies and
practice development (Canadian Nurses' Association, 2007).
Despite the reported rewards of studying professional history, in
contrast to for example, law, medicine or education, however, the
study of nursing history is ‘pitifully meagre’. Attributes this lack of
interest to nursing being more ‘action-oriented’ and perhaps due to
nursing education's reputation for dull fact-filled’ history of nursing
classroom based instruction. In an effort to secure an action filled
exercise outside of the traditional classroom, a field trip to a substantive nursing history museum in the UK was offered to preregistration nursing students.
3. An approach to the provision of nursing history experience
Museums and galleries are a source of both formal and informal
education and commonly provide a range of exhibits and learning
opportunities for individuals and groups (Allon, 1999; Knight,
2010). The majority of the literature related to visits to art galleries where it was identified that visits were influential in developing acuity in clinical observation and assessment skills (Pardue,
2005; Pellico et al., 2009; Klugman et al., 2011), improving stu€ m and Svide
n, 2007;
dents' communication skills (Wilkstro
Klugman et al., 2011), in the teaching of spirituality (Mooney and
€ m, 2012) and promoting
Timmins, 2007), reflection (Wikstro
aesthetic knowledge development. Delaney (2003) exposing student nurses to museum exhibits relating to the history of nursing
may help instil a sense of professional self. A visit to the Florence
Nightingale museum situated on the grounds of St Thomas's hospital, London, where Nightingale established her first nurse
training school was organised with pre-registration adult nursing
students. The Victorian nursing pioneer is celebrated in this
museum as a sanitary reformer, statistician, administrator,
researcher and educationalist. There is also celebration of the
evolution and contribution of other historical nursing leaders, most
notably Mary Seacole. The multimedia interactive facility lends itself to guided or self-guided tours with provision for a maximum of
30 visitors at any one time. A tutor accompanied tour was offered to
2nd year adult nursing students courtesy of the university but on an
elective basis. Train fare costs were borne by students. The visit was
field work associated with a 2nd year BSc adult nursing discipline
specific module entitled Maintaining professional healthcare standards. In line with Nursing and Midwifery Council (NMC) standards
for pre-registration nurse education (Nursing and Midwifery,
2010), the module aims to help students further acclimatise to
professional role expectations and standards in regard to care
planning, including ethical and legal decision making responsibilities. Students did not receive instruction on nursing history here or elsewhere in the pre-registration curriculum prior to
the visit. Students who attended the visit were asked to write a
reflection on their visit and discuss these reflections using an
admixture of peer groups and individually tutor discussions.
4. Reflections
Students were steered through their reflections of the visit using
Gibbs (1988) reflective theoretical model (Fig. 1). Several feelings
were evoked by the museum visit, notably self-confidence, unity,
pride, inspiration, enthusiasm and sense of belonging. As evidenced

Fig. 1. Summary of student reflections on museum visit (Adapted from Gibbs, 1988).

by student reflections, the visit was evaluated as a welcomed departure from classroom centric study. Many students expressed
satisfaction with the versatility of self-paced, interactive and multimedia instruction which the museum offered while others experienced the museum as small and difficult to navigate and some
would have preferred solely or an additional Curator led talk.
Interestingly, male nursing students were impressed with how well
male nurses were represented in the museum. On balance students

analysed the museum visit as an overall positive experience and
one which many believed ought to be a compulsory as opposed to
an elective student activity during the course of their studies.
Students found the visit a useful prompt to reflection on professional beliefs and values and where nursing is currently and what it
could be in the future. Many viewed the visit as a useful team
building exercise and reaffirming of career choice, with especially
the latter for male nursing students. As regards nursing student identity and developing nursing identity, many students concluded
from the visit that nursing identity was not bound up in institutions
or organisations or vocationalism and self-sacrifice but bound by
values and behaviours such as caring, compassion, courage and
commitment. Critical nursing identity was also bound up in
developing nurses' receptiveness to change and adaptability. Action
points for students following the museum visit were firstly to enact
values in practice settings and to redouble nursing students'
commitment to nursing. Further action points for students were
the importance of nursing students’ identity as independent
thinkers and change agents.
In common with other reports, the museum visit was most
valuable in motivating students to continue their studies, especially
at this point in time in their course where enthusiasm tends to
wane (Hogan and Lovesy’s, 2007; Worthington et al., 2013). This
study strengthens the evidence for using museum visits to reconfirm nursing students' commitment and to counter student attrition. The museum visit seemed to foster team building and
opportunities to develop a sense of comradery and belonging to a
community of equals with a common interest, purpose and understanding of their field. This exercise showed that a visit to the
museum constructed nursing student identity as grounded in a
profession that had come along way and achieved a lot, one that
continues to be highly adaptable and open to change. In contrast to
assertions mooted in other studies (Hamilton, 2005; Brennan and
Timmins, 2012), this study constructed nursing students as independent thinkers not relying on institution or organisations, but
instead more interested in embracing the values and attributes
they observed Florence Nightingale and other nursing leaders in
the museum to inhabit. These values of caring, courage, commitment and compassion, reflect a number of the values of the National Health Service (NHS, 2013). The study showed that the
identity of contemporary intending nurses was constructed as being keen to combine the best elements offered by both institutions
to develop skills to benefit the people they care for rather than
being concerned with cultivating institutional or organisational
loyalties.
5. Implications for practice
Preparatory adult nursing education should meet the needs of
those receiving healthcare in order for programmes of instruction
to be fit for purpose (NMC, 2010; Felstead, 2013). To this end, nurse
educationalist need to meet the needs of nursing students through
curriculum design and development, when endeavouring to support students to develop a worthy sense of professional self.
Notwithstanding the current drive towards compassionate care and
the need to support nursing student identity grounded in shareable
ideals and in values, specifically the 6Cs, Care, Compassion,
Commitment, Courage, Communication and Competency, through
activities such as the museum visit, curriculum design and development is best informed by research and by consultation with a
number of stake holders, including nursing students. This discussion paper might serve as a reference point for curriculum policy
relating to the inclusion of nursing history in core preregistration
nursing curriculum on the basis that its inclusion is conceptualized
as a visit to a nursing history museum. It is acknowledged that
practical implications exist to such curriculum policy in that difficulty may arise for nursing students not so favourably geographically located to the Florence Nightingale museum. The associated
travel and cost implications may be substantial to bear and render
this particular historical nursing museum visit prohibitive for some
schools. In this instance the Florence Nightingale museum might be
encouraged to develop a mobile arm to the museum in the same
way Body Work Exhibition to help understanding of bioscience is

provided.
6. Conclusion
Although, the transfer of nursing pre-registrations education
has been in place since the 1980s, little was known about how this
has affected developing nursing identity during preparatory education programmes. As old certainties fade, it is timely to report on
nursing students’ experience and value of studying the old masters
of nursing in a substantive nursing history museum in developing
and articulating developing nursing identity. While the museum
visit could only achieve a brisk course in the history of nursing, the
emergent identities discoverable from this exercise might serve as a
references for other nursing schools to illuminate developing
nursing identity and in turn enhance student retention and support
development of appropriate attitudes and values. Future research
could explore how nursing museum visits shortcomings could be
neutralised and whether indeed museum visits over other historical learning activities should be normalised in pre-registration
programmes more nationally.
Ethical approval statement
Ethical approval was granted from the local institutional ethics
committee (AC/DREP/14-001). Following distribution of an information sheet, informed consent was obtained through written and
verbal consent. Participants were advised they could withdraw
from the study at any point. Data was managed securely in accordance with the Data Protection Act (1998). Participant anonymity
was maintained in the dissemination of the findings.
Funding statement
This project was funded by Alumni Fund and Summer Research
Scholarship Fund, Anglia Ruskin University, Cambridge, UK.
Conflict of interest statement
No conflict of interest.
Acknowledgements
Kind appreciation is extended to pre-registration students for
their helpful contributions.
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