Nursing is a community service profession. It has been argued that it is more a trade than a profession, which is why there are so many education models to achieve the title of “RN.” For it to continue on a trajectory of ‘professional’ practice, the education standards, role of nurse, his/her contributions to both medicine and the art of nursing must also change. This is becoming a global push and education is emphasized in numerous publications. In the United States, the push has been making ripples since the 1980’s. However, politically, it really came into focus in 2010 with the ACA/Obamacare and healthcare reform. In 2008, the Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) launched an initiative to re-model the standards of, and change the practice and outlook for nursing.(www.nationalacademies.org)

Part of this reframing is an acknowledgement from the medical community that nurse work does matter. We are not just doctor’s secretaries. We don’t just ‘follow orders’ or are subservient to their role. Nurses are professionals in their own right. They have their own boards, set of ethics, and standards that are not just shadows of the hippocratic oath, but stand both independent on their own merits, and interdependent along with medicine as practiced by physicians.
Because nursing is being seen as a profession with concerns, needs, and patient focused care that are not addressed by the science of medicine but rather the social science that also encompasses our field, the way in which nurses are educated needs to change along with the way society, technology, and medicine is changing. To continue to gain respect and support from physicians, administration and the public, nurses need to have the education to back up their perceived ability to lead.

While nurses have always been on the frontline of care, we have not been included in policy, community boards, or the political realm in which physicians or other scientist have. We continue to fight the ‘mother’ role; we are vital to the health of our communities, but often overlooked.
Up until the past decade, nurses have not been actively sought or actively volunteered to be involved in the transformation of healthcare in this country. We are 3 million strong. We are the largest workforce in the world. Now, more than ever, our voices matter and can, indeed, change the world.

Nurses need to promote our craft and our education both individually and collectively. We need to volunteer on boards and community service organizations that promote health. We have an uphill battle to fight, including the nurse bullying and hierarchy that continues to plague our places of work and even educational institutions. Our education is already vigorous, even the ADN level nurses take more science courses than the general public, or many baccalaureate degrees not based in nursing or medicine. We spend hundreds of hours doing bedside training, hours studying, and must past difficult national licensure to ensure we are educated enough and safe enough to perform complex tasks that can be life altering to those we serve.

Why isnt this enough? It is, and it isn’t. Does having a masters degree increase my ability to care for other humans? I have found many that have BSNs or advanced degrees of any kind are less common sense people than those who have more hands on training. Common sense at the bedside saves lives as much as a knowledge set in theory or policy.  Perhaps the new model of nursing, needs to look at reframing the practice of actual nursing in addition to higher learning. Doctors go to medical school, become interns and then residents before being able to practice on their own. Nurses need to be at the bedside, or treating actual patients in the community before going into roles or continue education to enact policy that affects not just patients but the nurses who treat them. As we all know, theory and and reality are not the same. A controlled environment looks nothing like the real life chaos of saving lives. Being able to think on one’s feet, make immediate adjustments to one’s practice depending on patient status, only comes with experience. All nurses need to have done patient care.

Siloing is already a huge problem not just between hospital units, but between institutions, long term care, community health. There is so much defensiveness, inability to see past the “ but we need it on this form, even though you’ve filled it out on that one” and focus on the minuta because someone in an office who only know policy and theory says it must be done. Our roles have stayed task oriented and fragmented even as our place in the health care system has grown and legitimized as a profession of educated men and women, versus flunky doctors or handmaidens.
Not only do hospitals vie for Joint Commission’s accreditation, but also add  to the mix the magnet status that is also an added feather to an acute care institutions hat. The focus on magnet credentials became a hot topic, also in 2008, along with the focus on increased nurse education, although it credentialed its first hospital in Washington State in 1994. (nursecredentialing.org 2011.)
I doubt the focus on education and magnet requirements is incidental. As more agencies focus on long term outlooks, the more their requirements to achieve goals will become the same.
One goal is to transform nurses into leaders, implement empirical data and have nursing goals based on evidenced based practice (EBP.) The idea to help transform healthcare through nursing is based on the goals set forth by American Nurses Credentialing Center (ANCC). Part of this includes structural empowerment through professional engagement, commitment to teaching and education, commitment to community involvement, and the recognition of nursing in its own right. (nursecredentialing.org 2011.)
As medicine, nursing, community health, and patient engagement continue to evolve, so too, will the needs and roles of who nurses are and what they do  shall also. Nurses will have more power to empower as they gain a larger knowledge base. My only concern is that more people who see nursing as a form of academia versus public service, will become those whom focus in on how goals look in a nice formally written policy or dissertation, and not always the people who are affected by said implementation.

The bedside nurses focus on the people, not the process. As the two begin to merge as a seamless all encompassing profession, may they meet in the middle and understand the needs both in the trenches, and in the boardrooms.

 

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