These past few months have been quite the roller coaster ride—the ups and downs of politics and the economy, and the changes that have occurred in the health care arena. For the first time in my career, I have been more of an observer than an activist. Not apathetic, mind you, but more calm in my reaction to what has transpired.
My readers may not agree; I have raised the ire of some and caused others to stop and think about their roles and responsibilities not only as health care providers, but also as people. I too have had the opportunity to be challenged on several matters, and my editorial this month will address one specific topic on which I have frequently been asked to comment. My colleagues have already suffered through my pontification on this subject!
Before I continue, please know that this issue has been raised for decades, and there has never really been a firm decision made with regard to it. Yet we have embraced the concept and, in my opinion, have clumsily struggled forward. The topic is nursing education—more specifically, the educational routes to becoming a nurse practitioner.
When I was first deciding my future, I chose to pursue a career in nursing. I was guided away from the traditional hospital-based nursing school program toward the “up-and-coming” college program. My advisors were well-established, successful nursing professionals, all of whom were “diploma grads.” They convinced me that college-educated nurses were the wave of the future, and that there was much more to learn than the technical skills of nursing.
I decided on an associate’s degree program. Once in school, I wondered whether I would have the skills that were required of a “real nurse,” the ability to assess and quickly assist a patient who was in distress. I envied those students who had hours of experience on the floors, taking care of multiple patients, really getting to understand what it was to be a nurse. I quickly learned, just as I had been advised, that those skills would come, and problem-solving skills (we didn’t call it critical thinking then) would become the asset to serve me well throughout my career.
Six years after graduating from nursing school—picking up a bachelor’s degree along the way—I started my NP program. My classmates came from different educational backgrounds, yet we all had that underpinning and commonality of nursing. Despite our education, we had experienced years of what it was, and what it meant, to be a nurse. We had been, as a dear friend recently articulated, “socialized” into the profession. As I added new skills to my basic education and began my role as an NP, it was nursing that I continued to hold as the foundation of what defined my practice and my identity.
It is that socialization and identity that I fear we might lose as we make advances in education, suggesting that the preparation of the next generation of NPs should occur at the doctoral level. How will we hold onto our nursing roots? We have bridge programs that allow those with a bachelor’s degree in any discipline to learn basic and advanced nursing in three to four years. Is there a plan to develop bridge programs for people who have a master’s degree to progress toward the NP role in a similar fashion?
I have every confidence that the critical thinking and diagnostic skills needed to practice are acquired through the current educational programs. Nevertheless, I wonder whether students are learning about the heart and soul of nursing—the societal obligations, the fact that, as Sellew and Neusse eloquently wrote in 1929, we as nurses are a group “set apart to serve society.”1
Will the students in these programs understand that they are truly nurses first, and that the NP role is an extension of that? Have they learned that “society looks to nurses for community service and leadership”2? Have they embraced the responsibility of being “concerned with the larger society, and [taking] part in securing the conditions that put good health within reach of everyone”1? How do these graduates progress from novice to expert when their experience as a nurse is limited?
The question is whether the cost for advancing our profession educationally will be the loss of our nursing history. Do we maintain our robust and admirable foundation and include that in the curriculum? Do we share the stories of how and why we decided to become a nurse first, then a nurse practitioner? These are the questions I wonder aloud when I am asked about NP education.