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Department: Christian Ethics

Called, But Cannot Come

Fowler, Marsha D.

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doi: 10.1097/CNJ.0000000000000695
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Florence Nightingale was a devout Christian in the Church of England tradition: She felt called by God to nursing. Indeed, she regarded nursing as a “high calling.” Theologically, however, a call resides within the individual, as God calls persons, not professions. So nursing is a praiseworthy occupation to which God calls individuals.

Early modern nursing, as it was coalescing into a profession, faced an uneasy tension. Nursing leaders at the turn of the century were attempting to create an educated, scientific, paid profession for women working outside domestic service. They embraced the values of a profession including a developing body of rigorous knowledge that would undergird practice, practice expertise, scientific knowledge, rigorous higher education, and more. At the same time, nursing leaders cherished the notion of nursing as a calling for which one has received a personal, divine call, or a vocation (from the Latin vocare, to call). Vocation in this period means an occupation to which one is called and should not be understood in today's sense of a manual trade. Vocation did, however, carry a sense of charitable, unpaid religious labor that was problematic for the new profession. Nightingale weighed in on the side of nursing as a calling, but there was no need to take an either/or binary position. Instead, nursing leaders maintained the tension and embraced a both/and position, one that retained the values of both profession and calling.

But how does one know that God has called her or him to nursing or to any particular occupation? The German Pietists inspired the 17th century revival movement that ultimately came to influence today's evangelicalism. One of these Pietists, Pastor August Hermann Francke (1663), had a deep concern for a community of vibrant, living faith that included biblical literacy, Bible study, and social justice. For Francke, a living faith went beyond a cognitive knowledge of God to a faith that actively reached out to all who were poor. His motto for that kind of faith was that it served “God's glory and neighbor's good” (Sattler, 1982). Expanding this formula, a test of one's calling requires another element, a personal one. I believe that the threefold test of one's personal calling is that it serves God's glory, my joy, and neighbor's good. Serving God's glory is a reflection of obedience to one's call, for obedience to God intrinsically glorifies God. Work that also serves my joy allows one to work with satisfaction even when work is difficult or conducted under difficult circumstances. Hard work can still be satisfying and joyful work, even when not happy work. Serving neighbor's good reflects the fact that Christians are called to a life of service to God and to others, not simply service to one's self.

There are, however, calls-within-a-call. If one is called to nursing, there may be a secondary call to pediatric, medical, transplant, or any other form of nursing. Yet, it is sometimes structurally difficult to follow one's call in that some systems have no upward mobility within the same kind of work. For example, one may be called to teach nursing or to practice clinically, but after a number of years, when one has topped-out of the teaching or clinical scale (perhaps to professor or clinical specialist), there is a tendency to “promote” into administration. However, teaching and administration are two different kinds of calls. Although you may be able to do administration, if you are not called to it, the “my joy” portion of the threefold test will likely fade. Obedience requires that one adhere to one's call and only therein does one find joy. Without it, work becomes toil.

A call does not confer knowledge or skill; it represents ability and predisposition that must then be tutored. One may be called to nursing, but it still necessitates specialized, lengthy educational preparation. Over the course of a career, God may prepare one through a range of experiences and relationships for a call to evolve and be renewed. Here the key is to be constantly attentive to God's leading. This means that Christians must live theonomously, that is, guided by God, not autonomously as guided by one's self. To live theonomously is not to give up autonomy, rather it is to exercise autonomy, for one actively and freely chooses to follow God's leading.

Most discussions of one's call to nursing generally end here, with the individual, but calling deserves further examination. There is a sense of freedom or privilege in being able to pursue one's calling. Some are prevented from pursuing their call through personal or social circumstances such as poverty, structural disadvantage, and other forces. I was humbled when a colleague who grew up in a family that was severely economically constrained reminded me that her father worked solely to put bread on the table and hated his job; he had not had the freedom to choose an education that was commensurate with his ability and had not had any alternative opportunities. Pursuing one's calling is a luxury not afforded to all. Freedom, opportunity, and choice undergird the ability to pursue one's calling. It raises the question: What can I do for those who are called to nursing but cannot come in response to that call?

Here, some might resort to the passage about being “my brother's keeper” (Genesis 4:9) as part of a responsibility to reach out on behalf of others or advocate for others. But that verse emphasizes the familial relationship between Cain and Abel and is Cain's impudent retort to God. The emphasis of the verse is on the familial relationship that requires care for one another within families. However, later in the passage there is a less obvious but even more forcefully important guide for us. It resides within the word “cry.” Wenham (1987) comments on this passage:

“Your brother's blood is crying to me.” ...Here Abel's blood is pictured “crying” to God for vengeance, “cry” is the desperate cry of [ones] without food (Genesis 41:55), expecting to die (Exodus 14:10), or oppressed by their enemies (Judges 4:3). It is the scream for help of a woman being raped (Deuteronomy 22:24, 27). It is the plea to God of the victims of injustice (Exodus 22:22[23], 26[27]). The law, the prophets (Isaiah 19:20; cf. 5:7), and the psalms (34:18[17]; 107:6, 28) unite with narratives like this (cf. 2 Samuel 23; 1 Kings 21) to assert that God does hear [the] people's desperate cries for help (p. 110).

There are many who live below the poverty line in American society, whose cries reach God. There are many who face gender or cultural limitations that prevent them from pursuing higher education, specifically nursing education. There are some places where nursing education is inaccessible or unavailable. Exercising one's calling in ways that serve neighbor's good means not only providing excellent patient care but looking beyond the immediate nursing context to society and envisioning ways to hear a neighbor's cry—for fostering the circumstances that would enable them to pursue their own calling.

There are many ways, small or great, that we can assist those who are called to nursing but cannot come. We can work to establish and build scholarships, we can offer lodging to a student, we can mentor or tutor pre-entry students with weaker academic backgrounds, we can provide childcare for the parent who needs time to study, we can work with legislators who fund nursing education and research, we can research the factors that keep potential nurses out of nursing. A call to nursing can bring great joy; a call to nursing is also a call to share the joy that is found in nursing.

Francke was not satisfied with only a cognitive understanding of Christ and his salvation but wanted a living faith that was demonstrated in good works. His motto of “God's Glory, Neighbor's Good” was practiced as he and members of his parish invested in the youth of the city and reached out to the poor and destitute—not unlike nursing today.


  • How did you experience God's call to nursing? What is your call-within-a-call?
  • In what ways do you hear a “neighbor's call” to practically help him or her pursue a nursing calling?


Sattler G. (1982). God's glory, neighbor's good: A brief introduction to the life and writings of August Hermann Francke. Chicago, IL: Covenant Press.
Wenham G. (1987). Word biblical commentary, Vol. 1: Genesis 1-15. Nashville, TN: Thomas Nelson, Inc.
InterVarsity Christian Fellowship