• Research is sometimes far removed from bedside nurses
• Research is COOL!
• Research is about PATIENTS and not fame/fortune of researcher
• Research is critical to practice and there are big gaps that nurses need to fill
• Bedside nurses may be the most crucial link in research ideas, translation, and practice.

My Thoughts

Creating nurse scientists has been somewhat difficult for the profession of nursing.  I can only guess as to why this has been, but unlike other fields of biology, chemistry, and the like, where employment is often found in seeking answers, solving mysteries, and in effect being ‘scientists’, nursing has traditionally and rightfully been a ‘hands on’ profession of action for patients to produce desired outcomes. (Forgive the brevity of the definition of nursing, it is quite complex, but one gets the idea.)

Often nurses are too busy keeping patients alive, preventing complications, and working over time to consider solving the larger problems of their patients or their profession.  However, nothing could be more critical.  I believe that the hard-working, nose to the grindstone, mentality has kept nurses from exploring the science of their practice and answering important patient/practice questions.  Likewise, many nurses may not be empowered enough at the bedside, another post entirely, to solve problems, lacking support from administration.  There is also some distant mystery in the idea of being a nurse scientist.  Personally, I used to believe that I could never be a nurse scientist.  They were the rock-star like icons I only read about, but were not present in my health care institution, my local universities, and certainly, I believed, not pushing medications with me at the bedside.  (I still would love to get several autographs – so nurse scientists out there, send them in with your photos. Linda Aiken, Robin Newhouse, Bernadette Melnyk , etc.)

The Need for More Evidence:

Evidenced Based Practice (EBP) is more than the latest buzzword for the vernacular of health care facilities and nursing schools.  It IS health care, and yet it is still emerging.  For nurses, there are so many practice areas where we have not verified with research what we do.  I recently worked with a group of RN-BSN students on identifying a problem within their working units that they would like to change and I am always encouraged by their resounding frustration at not being able to find any ‘research’ on the area they want to change. Topics like decreasing cost of medical care waste, pain medication dosage/timing in post-operative patients, non-pharmacological practices for comfort measures at the bedside, nurse managed out-patient protocols for stomatitis in oncology patients, direct admission of septic oncology patients from out-patient/office triage, music as an anxiety reliever in pediatric emergency room waiting,  use of certain products as bedside cleansers in ICU patients, and so forth … pepper their projects but baffle their attempts to find printed, peer-reviewed, research.  The students are thinking and ready, but it is important for them to find nothing on their topics.  They must be aware that THEY must be the catalyst for evidence and change, and that interdisciplinary evidence, and pilot projects are needed to test their theories.  Science is a mystery that continues to change and nurses are the critical detectives, the Perry Masons of health care and patients, with their outcomes at the center of the mystery.

Research is Personal

As much as science provides statistics and evidence, it also has unseen faces, lives, and effects.  Numerous unidentifiable persons participate in research in hopes of improving their own lives or to help improve the lives of others.  They believe in health care scientists and our ability to move health forward.  Beyond the research awards, publications, funding, and all of the rest, they are central.  They are the purpose, the catalyst, and the mechanism through which we will discover answers.  This was never more clear to me than when I completed a recent study and saw first hand the hope and desire for improved health of participants.  For the researcher, who remains professionally detached,  we learn that research is about people.  Who better than nurses, who know people/patients well, to seek answers to the most pressing questions our patients face?  Often, nurses see the bigger gravity in what are considered ‘minor’ issues by others in health care and how they affect patients.  Patients need evidence and nurses can help them get it.

Now Where?

Nurse researchers really were at the bedside with me, guiding theory, practice, and nursing.  They were the ones who pushed for things like Primary Care nursing, improving patient relationships through listening and communication, and the like.  The need for evidence is no less pressing and is indeed growing.  Pulling in nurses at all levels of health care to help discover and translate evidence is needed.  Building consortiums of nurse researchers to bring nursing out to smaller health centers and hospitals as the ANA is doing, or building hospitals that function with bringing nurses into evidenced based practice at every level, and actually empowering them to act/translate/search/implement as Johns Hopkins is doing are models that should be echoed throughout health care agencies.

Nursing Research Matters to Everyone

With the increase in age of patients, nurses, nursing faculty, the pending large influx of patients into the U.S. health care system, and the push to a preventive-team approach to health instead of acute care-reactionary medicine, the time is now to create more nurse scientists.  Below are some links of importance to nursing science and highlights of nursing research being done.
Nursing science and EBP matter, for our patients.

• The NINR
• Nurse Researcher Hall of Fame at STTI
• Massage for blood pressure control (recent nursing research in the news)
• In home therapy improves disabled elder’s health outcomes (recent nursing research in the news)
• Vitamin C helps heart failure patients (recent nursing research in the news)

Thanks!

Dr. Carole Eldredge DNP, RN, NEA-BC – “Administrator’s Dream or Nightmare?: Effective Use of Social Media in Clinical Settings”

Dr. Eldridge’s Handouts are as follows: Guide to formatting a social media policy, NCSB social media policy statement, ANA social media toolkit.

Dr. Terri Schmitt Ph.D., RN, FNP-BC – “Professionalism, Communication, and Collaboration: Use of Social Media in Nursing Curriculum for Student Self-Enhancement.”

Dr. Schmitt’s handouts are as follows:  Social media integration for learning tip sheet, PDF of presentation

Rob Fraser MSN, RN – “From Theory to Pracice: understanding and Applying Concepts of Social Media” – His great handouts are on his blog at Nursing Ideas.

Teresa Heithaus MSN, RN-BC.  Teresa spoke on Sunday and also with us.  You should check out her blog, Nursing Staff Development Behind the Fire Wall.

*Prior to reading this post please be aware that I am not providing medical advice to anyone nor encouraging any lifestyle change or activity without consulting your primary health care provider.  In fact… I am really preaching to health care providers themselves (me included)

My most recent interest?…Reading and learning about nutrition and exercise.  As a nurse I have had some training in nutrition, which was required for my basic diploma degree, but no training in exercise physiology.  The world of nutrition, exercise, and alternative medicine have grown substantially since my white cap days.  I am by no means an expert, only scratching the surface of knowledge, but I thought I would share some opinions I have formed from my recent research.

My new found push to be ‘healthier’ (whatever that means) has evolved from several factors.  (1 ) I am aging and my mother had open heart surgery for complete blockage of a major artery in her early 40′s (you can’t change genetics).  (2) I have been doing some crossfit (yes, I am apparently into self punishment… but I have more than doubled the weight I can lift and both increased my speed and endurance in the last 2 years… crossfit is COOL!).  (3) Most importantly, I am finding my patient population in primary rural health to be sicker, more obese, and needing more medications, but let me be frank… medications are NOT fixing their health.

All of this has lead me to seek out what can really benefit my patients and not surprisingly the answer is EXERCISE AND DIET!  Exercise appears to be the proverbial ‘magic bullet’ for numerous diseases including heart disease, Type 2 diabetes, depression, anxiety, osteoarthritis, fibromyalgia and reduces the risk of a host of other diseases including cancer.

Further, the implications of nutrition in the treatments of such illnesses, while not as widely studied as pharmaceuticals, is impressive.  The implications for a vegetable and fruit based diet in preventing and altering heart disease risk is impressive.  Good nutrition in itself benefits diseases like diabetes and decreases obesity.   The use of nutrition to improve memory, anemia, prevent migraines, improve mood and sleep, and a host of other uses for fruits and vegetables and vitamins, has shown promise and needs more research.  So far, this discussion does not even include current problematic treatment of chronic pain in this country and the alternative therapies, diet, and exercise that could benefit such patients (another post perhaps?).

Let’s be honest, medications are dangerous.  With current adverse drug reactions and drug overdoses claiming more than 100,000 American lives alone per year, clinicians need to find a safer and more permanent way to improve chronic health in this nation.  There has got to be a more adventitious way, a safer way, to improve the health and quality of life of a nation (and to reduce skyrocketing health care costs)!  There is…. nutrition and exercise.

Pills, Pills, Pills… do they create more ills? I am begining to wonder if the toxic nature of long-term pharmaceuticals is an issue for my patients? Seriously, this is a legitimate question.  I am not trying to throw the baby out with the bath water.  Pharmaceuticals are good.  I am thankful for pharmaceuticals and for common life saving drugs, but for the long term treatment of chronic diseases that are all life style related… is our current practice of medical care in this country (acute care hospitalization and primary care medication pushing) working? Look, in a published report on vitamin adverse reactions and deaths in the U.S. in 2007 there were only 8 adverse reactions and 0 deaths.  Yet, I would honestly like to know the general health outcomes, quality of life improvements, improvements in mood/sleep/lifestyle, and what patients generally die from who are on long term pharmaceuticals for chronic problems? Longitudinal research anyone?

Further, I have many patients who would benefit from yoga, massage therapy, physical therapy, acupuncture, and the like as supplements to their chronic pain management.  The majority of these patients have no health insurance or money, and if they do have health insurance it does not include coverage for such therapies… however, it pays for medications… an issue for another post.

With all of the empirical evidence as to patient improvements in disease through diet and exercise, why don’t we/health care providers (me included) use them more?  Wouldn’t we like to wean all of our patients off of their metformin, lisinopril, and lipitor? I know I would!

Several Bottom Lines: Bottom line number one, time constraints within a primary care visit, what ever they may be, and a culture of going to get a prescription for our ailments has lead us here.  It is a poor and pitiful excuse and I am not proud to write that I have fallen into the trap of both time and a patient’s desire for a prescription to fix instead of the hard work of lifestyle change.  I am confident though that health care providers can lead the charge to change how we practice and how we promote health in the U.S. and around the world!  We can do it in conjunction with athletic trainers, dietitians, exercise physiologists, and the like in cooperation.

Bottom line number two, the most common prescription we need to write is for diet and exercise.  However, will that make anyone any money?  As much as all health care providers hate it, money drives our system.  Of course, a patient being sick generally does not bring me personally any more revenue.  I would love to see healthy patients all day, or do something else if my patients were so healthy they did not need me (how great would that be!).  To cut costs, someone has got to stop making money.  Honestly,  if I could prescribe only two things to help almost every patient I had  in my practice it would be increasing fruits and vegetables in their diets and getting daily exercise.  (FYI- I am also going stop encouraging whole grains, because patients interpret this as bread and cereal and then eat processed cereal/bread and think they are being healthy.)

Bottom line number three, we have to help our patients get well through modeling. We have to start with ourselves.  No more should we as health care providers say… “well, I am going to eat this candy bar because I take my lipitor for it and I have to die of something anyway.”  No more cop outs.  No more excuses.  We can model the health we want our patients to have.

Now, go crossfit or something…

I have done some self wallowing this week, because frankly the above question has been haunting me as I have been working on my dissertation. As you can tell, my writing on my not so great dissertation is creating a little doubt and mild dysthymia. After 5 years of pursuing an education that I have no doubt learned much from, including what is good nursing research and writing, I am wondering if I will find a good niche in which to apply this new knowledge.  After all this time pursing this degree it has become quite clear to me that I am not very good at nursing research (honesty and reality are also key things I have learned in my doctorate education).  I wish I were good at nursing research because I love it and firmly believe it is the foundation of improving health care.  Being good at nursing research is about being able to get funded and writing well… You all read my blog and can attest to my lack of grammar abilities and disorganization .

I won’t bore you with all of my hopes and dreams, but my passion for nursing, adolescent health, international nursing education, improved health care access, and passion for students have been somewhat bound up in completion of this phase of my education, but now I am wondering if I will even be able to complete this first step.  Further, once I am done, whether any will want my overly frequent opinions, flight of ideas, certain disregard for rules, and the like within their department, faculty, patients, or students is a legitimate concern.

So, I am not only wondering if I will ever get this degree done, a degree which should be the foundation of a career and not the pinnacle, but if I do complete it what will I be able to do with it?  Further, what happens to those nurses who do not finish this last hurdle for varied reasons even after very very difficult work?  Do they hide, are they fired (most certainly sometimes),  are they disgraced (most certainly as well)? Does anyone even hire such over-educated nurses for cool staff nurse positions? These are questions that nursing, nurse educators, and those of us pursuing such degrees need to be openly discussing.

Sigh… trying not to sound self-seeking here, just pondering these real and legitimate questions myself.  Nothing is certain.  Anyway… I am apparently in a dry spell for writing. Will post again soon. Thanks for reading!

P.S. Current favorite quote – Know the rules well, so you can break them effectively.  — Dali Lama XI

The Day, The Patient, and The Girl

The day had not been an untypical clinic day for us, meaning we had seen over 100 patients with a team of two primary providers (myself and a physician) and nurses/students who completed history, vitals, intake, pharmacy, and discharge.  The afternoon had brought some profound images of poverty, many of the patients not even having running water let alone access to medical care.  My last patient of the day was particularly moving, suffering a very violent attack several years prior and miraculously surviving only to find that they had no way of continuing to support their family and sporting  several very significant chronic injury/pain related sequelae of the attack.  All I had to offer this patient was some education, NSAID pain medication, vitamins, and a hygiene pack.  I felt very inadequate indeed when financial support, job training, education, PTSD counseling, and chronic orthopedic and pain management was sorely needed but would be completely unavailable to this patient.

As my clinic day was done I chose to do what I often do even at  home to decompress, I took a walk. Immediately upon beginning my mind clearing pacing around the sanctuary, that was serving as makeshift clinic, a young girl of no more than 10 approached me. In her hand she carried a small lunch cooler that was visibly worn from years of use.  She spoke rapid yet quiet Spanish, and my Spanish not being the most fluent (not fluent at all) I turned to one of the local gentlemen who had been assisting us with translation.  He conveyed that she was a ‘girl of the street’ and was selling hand-made empanadas to support her family.  This was her life.

Standing there, staring at this young impoverished girl no older than my middle child, to whom I could offer nothing to but 6 months worth of chewable vitamins, a toothbrush, and a small tube of tooth paste, I began to sob. Suddenly, the overwhelming events of the 120 patients of the day, many without so much, my last patient, and this last girl crashed upon me with such force that I physically had to sit down.  Realization dawned on me that during this one simple week we would not begin to make a dent in the needs of the people and the best I could do to make real headway was to help support the local work and begin to work to build something permanent.

My wracking sobs came in bursts and I am disappointed to say that my reaction frightened the girl, the translator, and others in clinic.  I am sure she was thinking, “What is wrong with the enfermera gringa? She must be crazy.”

Although this was not my first trip working with these people and their health care needs, it was my first major breakdown.  The result was a personal commitment to help build something lasting, a commitment for greater gratitude and judicious use of what I have been given (both creature comforts and education), and greater commitment to improving preventative health care access and the education girls world wide. Perhaps in the end I will not end up like the famous and grace filled Oskar Schindler who at the end of the famed film desperately pronounced… “If I had only saved one more.”

The Nurse sat rocking, not thinking about her own obvious youth,  naivety,  or even the fact that it was not her night to be here in the ‘Unit’.  What she was contemplating were the events that had brought her knowingly or not, to this moment.  She tried to pinpoint it. Had it been that day, not so long ago, when the doctor she was shadowing for a high school project had thought he was dumping her on a nurse to baby sit her and instead had planted the idea that nursing might in fact be more exciting that medicine? Or perhaps it was the days she  spent next to her mother’s bedside after she had suffered a myocardial infarction and subsequent open heart surgery at the young age of 41? Perhaps still it was her drive for independence, picking a unit to work in straight out of nursing school where new graduates were not only shunned, but where lateral violence ran rampant against them. Then again maybe it had been the desire to communicate more clearly with and  connect to the patients and families she now found herself strangely in charge of.

Had she connected too well?  Had she pushed the envelope of patient-nurse relationship? How much was too much, she wondered as she sat here on her first night off in many, feeling the  disapproving looks of several senior nurses in the unit as she slowly rocked back and forth.  Sitting now, alone in a corner of the ICU she pondered all of this.

Only an hour before a phone call had awakened her at home.  A fellow nurse who was caring for an infant that they had both been unofficially deemed primary nurses for the past several weeks, because frankly the continued struggle and resuscitation of this dying infant had been too much for many of the others to watch.  The nurse on the phone had reported that the infant was now obviously dying and had asked her if she wanted to come and be here as the parents could not bring themselves, for whether physical or emotional reasons, to do so. Now, as she sat holding the small beautiful lifeless 2lb bundle of what had been only an hour ago a struggling, suffering human, trying multiple times and finally succeeding to exit his young life she contemplated all of it. She decided that in this moment, whatever it was that led her to become this nurse, for this one life… everything was all as it should be.  Every extended shift, every struggle, every feeling of inadequacy, every single step…. All of it worth being present in this most humbling human moment.

The Nurse grew older, had more patient connections, healed others, made more mistakes, learned more professional and life lessons, and pursued new paths and adventures in nursing. However, she never forgot the night she came in on her night off to rock a lifeless baby in a corner of an ICU so many years ago, the night where she first realized that everything that it took to be a nurse was well worth the cost indeed.

Inspired by Teresa Heithaus and her SIUH journal club on facebook, and in the interest of networking, relationship, and the vast amount of nursing knowledge… (Drum roll please)… I have started a small journal club with nurses from varied backgrounds and employers.  There are only 5 of us, but that number was just right for discussion and connection.  It was great to get to meet with nurses who I admire, consider friends, and who are exceedingly intelligent to discuss nursing, research, and ideas without the constraints of political correctness or the over-hang of employer scrutiny.  Although not every article was strictly research, the manuscripts stimulated ideas, expanded discussion, and stimulated problem solving among the group.

Setting Up a Journal Club: I had no idea what I was doing so I just made up rules and they were…

1.  Bring 5 copies of a journal or research article.

2. Bring your favorite appetizer or beverage to share (no rules as to what).

3. Bring any current project you need help on (no limitations) for editing, feedback, etc.

4. Come to relax, nothing fancy.

It was a huge hit! People made new acquaintances, we laughed, we agreed, we disagreed… and we plan to meet again this summer sometime.  It was like water for the nursing soul! Below is a synopsis of the articles brought/presented with their citation.  They are ranked by interest in the group that night.

What I learned from Journal Club (Research)

1. Ethics, the ICU patient, and Nurses’ Personal Grief and Opinions: Most popular award of the night goes to a non-research article that provided excellent qualitative reflection from several nurses who cared for a pregnant vegetative patient.  The emotions in the article run deep and an interesting dialog ensues in both the lay-out of nurse responses within the manuscript, and internally within the reader! Take home message: Caring for patients is ethically messy and often family emotions and the rights of third parties affect the process of care.  I highly suggest you read it. Check it out:

Abazzia, C. et al. (2010). In the Name of Good Intentions: Nurses’ perspective on caring for pregnant patient in a persistent vegetative state. Critical Care Nurse 30(1), 40-46.

2. Making an Online Nursing Course Worth Taking – FEEDBACK: A few in the group are faculty members and teach online, so an article about improving feedback to students in online courses was also quite popular.  This article reviewed evidence-based strategies to help faculty provide ‘diverse’ feedback to students in an online course.  Suggestions included: providing multiple sources of feedback, give some assignments with automated/immediate responses,  allow for assignments that are sent in in smaller parts to allow for multiple feedback opportunities, provide clear course introductory materials and an orientation with strategies for learner directed learning, be active in discussion boards, use grading rubrics, and allow students to self-reflect on their learning.

Bonnel, W. (2008).  Improving Feedback to Students in Online Courses. Nursing Education Perspectives (29)5: 291-294.

3.  Online Academic Integrity… Don’t all online learners cheat? This was a great article that sparked some discussion on the idea of barriers to online learning from faculty and administration; namely in the form of ‘increased risk for academic integrity infractions’.  This article was a presentation of research from two different RN-BSN cohorts, one seated and one in an online program. Number of participants online 330, seated 44.  The results were not what one would expect.  The seated students reported higher levels of cheating compared with online students such as getting questions or answers from someone who has already taken the exam (47% traditional classroom reported YES in the 40 and younger crowd and 13 % in 40 and older, compared to a respective 2 and 0.8%).  In traditional seated students ages 40 and younger, 28.6% reported helping someone else cheat on an exam, 19% reported working on an assignment with others in person or via e-mail that was supposed to be individual work, compared to 0% of online students. Needless to say, online students, who may have different characteristics or learning motivations than seated students, cheat much less than traditional students.

Hart, L. & Morgan, L. (2010) Academic integrity in an online registered nurse to Baccalaureate in nursing program. Journal of Continuing Education in Nursing. 41(11); 498-505.

4.  Which is better manual or automated blood pressure readings? This article was a great systematic review of 10 solid studies comparing manual versus automated devices. Findings and conclusions were that automated devices were less accurate, but in most cases provided sufficient enough information for clinical use.  However, mercury auscultatory devices were found to be the gold standard and certain automated devices were better than others.  Many of the automated devices over-estimated blood pressure and in specific patients use of such devices was discouraged and included; hypertensive patients, patients with arrhythmias and trauma patients.

Skirton, H. et al. (2011).  A systematic review of variability and reliability of manual and automated blood pressure readings. Journal of clinical nursing; 20(5-6); 602-614.

Again, let me reinforce that this project should teach them how to evaluate sound websites (which is not Wikipedia but—what can I say they are learning), how to write for an audience (learning this to), and how to create and manage a blog.   Overall they did a very nice job on the project and showed a good depth of learning for such a short period of time. GO NURSES!  Check them out!

Webliographies:

Pulmonary Embolism

Respiratory Syncytial Virus

Cystic Fibrosis

Community Health Nursing

Peripheral Neuropathy in Diabetes

Hunington’s Disease

Polycystic Ovarian Syndrome

HIV/AIDs

Advanced Directives

MRSA

Nursing Leaders/Leadership

Hand-held Computers in the Workplace and one on PDAs

Obesity

Migraines

Glioblastoma Multiforme

Diabetes

Breast Cancer

Rhabdomysarcoma

Amyotrophic Lateral Sclerosis (ALS)

Congestive Heart Failure

Nursing Research Resources

Personal Emergency Response Systems

Strokes

Triage

In the meantime I have pondered some issues related to nursing lately that I wanted to share about.

Getting to close to patients?

Recently I had one of my favorite patients pass away.  Yes, nurses and health care providers do have favorites and with this particular patient the world will miss a great spirit.  Whether it is related to colorful personalities, life spark, historical experiences, personality traits, or people who are simply ‘the salt of the earth’ that draws me to certain patients I do not know.  I just know that I am inevitably drawn to some of them.

With all of my patients I feel such a loss when they pass, as we all will, from this life.  In reflecting on my own feeling of loss I wondered if this is the ‘too close to patients’ that I was warned about all of those years ago in nursing school?  Staying at a professional distance and relatively uninvolved in our patients’ lives is mandated.  However, I find that my humanity leads me inevitably to ‘feel’ something more for my patients.  This feeling often invests me in their care, increases my feelings of responsibility in their outcomes, and is one of the highlights of practicing in primary care where I learn more, develop professional trust, and share in patients lives as time passes.

Of course there are obvious boundaries for professional health care providers.  Not abusing the provider-patient relationship, not doing harm, not exploiting, not developing intimate relationships are all important in professional practice.  Patients have to be able to ‘trust’ us.  However, I wonder if I am sometimes too invested in my patients and how they do? Perhaps the fact that I am asking the question is clue enough. However,  in a rural community relationships become even more difficult to navigate as rural culture values knowing everyone and their business is part of the ‘trust’ factor in developing a good working health care provider-patient relationship. Likewise, social media is changing the paradigm of communication and relationship.

I am going to explore research on this topic and professional standards and get back with all of you on this topic.

Links

There have been some great blog posts, links, and organizations I have come across recently that I wanted to share.

Thanks to @EllenRichter on Twitter I now Know about the Center to Champion Nursing in America (CCNA). They are a great organization that is working to advance nursing through clear goals/objectives.  Read more about them at http://championnursing.org/

Find them on twitter @championnursing.

There is also a great ‘call for abstracts’ page at the Sigma Theta Tau International Nursing Honor Society.  If you have important knowledge, research, or evidence to disseminate to other nurses you may want to check them out here.

Nursingschools.net also have a great new blog post on 50 health care podcasts.

Also, thanks to the Aurthur L. Davis Publishing Company you can now access your state board of nursing’s publication here.

This past year there have been three monumental nursing activities that have pushed for increasing the education of nurses, revamping nursing education, and better preparation of nurse educators; the Tri-Council on nursing report, the printing of the Carnegie Foundation research on nursing education, and the I.O.M. report on the future of nursing.  While I agree with these I am seeing a nursing education movement that concerns me, for all nurses who teach in nursing education to hold a degree in nursing education.

Do not hear me wrong, I think nurses with graduate degrees in nursing education are critical to the education process.  However, I recently was made aware of one nursing program that openly told its faculty that they will not get promoted if they do not have a degree in nursing education. This proclamation was made after they had hired nurses with degrees in clinical areas like CNSs or NPs.  Those faculty members, some who are the most clinically competent that I have ever met, were basically told that they were second class citizens.  To me, and this is purely my observation, it had the feel of lateral violence.

To the evidence: Do we need to change how we are doing nursing education? Yes, change is good. However,  we do not need to throw the baby out with the bath water, but some good changes in education do need to be made.  Evidence so far provides that patient outcomes are better and nurses stay in practice longer with higher entry to practice degrees. The changes to nursing education need to happen to help support our students as they move forward into very challenging clinical areas.  Preparing our nursing faculty to better meet those challenges is always an excellent idea, but is the best faculty mix one that is only of one nursing degree? I am currently avidly and enthusiastically reading the recent publication of the Carnegie Foundation For the Advancement of Teaching, Educating Nurses: A call for Radical Transformation by Benner, Sutphen, Leonard, and Day.  The majority of the book speaks to issues and brings forth data that I can whole-heartedly support, like emphasis on good nurse educators who also have a clinical practice to draw upon in the classroom.  Yet, the developing air of superiority of the nurse educator graduate degree as the only one suited for nursing education is somewhat concerning to me.

I cannot find current evidence that nursing students who have instructors with graduate nursing degrees in areas other than nursing education do more poorly in job performance, school, and on state board licensure exams.  If some of you out there have evidence to support this I would be genuinely interested in it.   Further, some of the best faculty I have ever worked with have held nursing degrees with emphasis in family practice, public health, adult health, women’s health, pediatrics, and administration and leadership.  Likewise, I could argue that some of the poorest nurse educators have been ones with degrees in nursing education.  In fact, given the complexity of health care and the vast expansion of knowledge, one might argue that the best mix of nursing faculty would be a group that had diverse nursing degree backgrounds so that each person’s weaknesses could be supported with the strengths of the other.

I would go a step further and argue that disciplines like history, chemistry, and math do not require their faculty to have a degree in education to teach undergraduates…  What was that you said? Why,… no those professions are not ‘hands on’ like nursing… O.K. so let’s look at other ‘hands on’ professions.  Do physicians, respiratory therapists, physical therapists, pharmacists, and the like require their faculty to have degrees in education to teach? Rather, do they seek out a faculty set that are diverse in experience and background to provide thorough education in all aspects of their programs?

From what I have learned in nursing education I am concerned that either we are making this requirement for one or more of the following reasons (Some tongue and cheek, some honest): 1. We throw nursing faculty, like students, right in and then eat them alive or talk about them in the break room if they do not do well starting out instead of supporting them.  2.  Nursing education and curriculum design has truly become so complex that no one without a degree in nursing education can figure it out.  3.  The nurses we are hiring to educate our students, no matter their degree, really are not doing a very good job and the only way to remedy that is to require that they all hold the same graduate degree.  4. Educators really are too far removed from practice and need some way to feel good about the knowledge they do hold. OR, 5.  Students who come out of programs where the faculty all hold degrees in nursing education are much better nurses.

The way I see it we have a golden opportunity here with the push for change and advanced education to build some excellent places for nursing education.  Places where students are supported, encouraged to critically think, encouraged to have open/safe discussions that explore topics like bedside manner, ethics, communication, culture, spirituality, technology, and sciences.  We can create the best future clinicians the world has ever seen but to do this we must have competent and complementing teams of nursing faculty.  I am excited at the soon to be prospect of many new practitioners with doctorate of nursing practice degrees as NP’s move into this education mode.  I have thought all along that these nurses would also be a HUGE benefit to the basic nursing education programs, because advanced clinical degrees at the doctorate level would assist programs in their development and fostering of student use of evidenced based practice knowledge, clinical skills, and critical thinking.  With this push for change in education, which is wonderful to say the least, I was hoping to see more unity among nurses instead of greater divides.

It seems that I might be wrong and that the best nurse educators are ones who have a degree in nursing education.  Hmmmm…. looks like I and several others had better consider other options in nursing because I may not be qualified to teach.  It may be a good thing I can put my PhD to use in other areas.

Opinions or thoughts?