Donna Frost

Introduction 23 1 My career in nursing spans 25 years and the health care systems of three different countries: New Zealand, the United Kingdom and the Netherlands. A story relevant for all three countries describes nursing practice as complex and dynamic, taking place in challenging contexts characterised by varying degrees of uncertainty and high expectations of the nurse as professional. Nurses are persistently confronted, for example, with bureaucracy, time pressure, staffing shortages, audit and control procedures, a steady streamof implementation projects and ongoing organisational change. A related story tells of nurses and other health professionals who do not work in life affirming person-centred ways, and the colleagues and managers who do not intervene. These stories are influential and disheartening, but they do not capture the whole picture. Despite the many pressures and challenges within the healthcare system some nurses do manage to practise with beauty and graceful skill. In their ways of doing and being such nurses maintain their focus on the person who is before them (Frost, 2008 ). They ground their actions in evidence ofwhat works, or is likely towork, in the particular situation in which they find themselves. These nurses demonstrate that effective, beautiful, perhaps even transformative practice is possible. Duringmy career I have been witness to countless of these moments, moments of excellence within nursing practice, demonstrated by nurses who make a real difference for the people they are nursing and who make their work seem effortless, despite the complexity. These stories and ‘beautiful moments’ (Frost, 2008 , p. 47 ), in which professionals manage to transcend the tensions, constraints and complexity of the practice context, give me hope. Such stories contain inspiration and the seeds of growth and transformation. What is going on in such situations, where the coming together of what nurses know, how they behave andwho they are leads to exemplary practice? Schön ( 1983 , 1987 , 2001 ) considers such instances of excellent practice to be demonstrations of professional artistry . He asserts that a purely rational, linear and technical view of practice and the practice world, a view which he calls technical rationality , leads to behaviourist conceptualisations of professionals and practice (Schön, 1983 ; Fish & de Cossart, 2006 , 2007 ). Within a technical rationality narrative the achievement of pre-determined and objective goals is valued as the purpose of professionalismand professional judgement. Structured, rational and even pre-determined processes for both decision making and professional intervention are therefore thought to ensure predictability, safety and effectiveness. Schön ( 1983 , 1987 ) argues the contrary, stating that a technical rational view is generally too simplistic to account for, explain or understand the complexity of many real practice situations and the