How nurses can use the past to transform their future

"Those who cannot remember the past are condemned to repeat it."

Those words, by philosopher George Santayana, can apply to many aspects of healthcare, but a new book shows just how much they relate to the future of nursing.

Despite dramatic scientific and technological advances since the nursing profession began in the 19th century, nurses today confront many of the same challenges as those who pioneered the profession, including excessive patient loads, staffing shortages, long shifts and workplace bullying.

I recently spoke with Leslie Neal-Boylan, a Ph.D. and registered rehab nurse, (pictured left) associate dean and professor at Quinnipiac University School of Nursing in Hamden, Connecticut, during an exclusive interview about her book, "The Nurse's Reality Shift: Using history to transform the future." It aims to provide nurses with practical solutions to common problems and a roadmap to move forward.

The first part of her book examines significant events in nursing's history from 1900 to 1970 and the root of some of the profession's ongoing concerns. The second third analyzes 608 survey responses from practicing nurses. The final section of the book looks at what the profession could become if nurses learn from the past.

One of the biggest problems in the industry, she says, is that the profession contradicts itself. "We say we need to do x and then do x; and then say if we didn't do x, then things would be better. Having one unified voice is a big crux of the issue. We need to get everyone to think in the same way to have a more powerful voice."

Neal-Boylan says nurses must recognize the divide between those who work at the bedside and those who don't directly provide patient care and serve in academic, research or leadership roles. It was clear based on the survey results, she says, that full-time clinical nurses don't understand what nurse leaders are trying to accomplish with policy and vice versa.

 "We are not valuing each other," she says. "I don't think as a group either one really understands the other and we need to recognize that there is that gap and see what we can do to unify nurses. Part of that issue is cost and part of it is [that] new graduates and students often think that they should move away from the bedside once they graduate ... But the crux of [nursing] is the care of the patient."

Her research found that since 1911 there has been disagreement among nurses as to how much clinical experience is necessary for students before they graduate to work in hospitals. It's a problem that continues today as many graduates can't find work because hospitals want to hire nurses with experience or more advanced degrees.

The issue, she writes in her book, may never be resolved unless nursing schools change the entire way in which they educate students. "Professional nurses must know theory: the whys and wherefores behind the care we provide. But they also need actual hands-on experience, only some of which can be gained using high-fidelity mannequins," she writes. "Should baccalaureate education be a five-year program with the last year being a supervised residency? Is a one-semester capstone sufficient to acclimate the graduating student to the reality of nursing?"

Her research also found that the profession tends to create another educational program or model instead of examining the past to determine why the prior model or program didn't work. "We need to learn from history and the tendency of the profession that instead of fixing problems of the past, we create another thing. We don't take what we had and figure out why it didn't work, what was good about it, and how to retain what was good and make it better," she says.

It's time for the profession to collectively decide the appropriate nursing education for entry into the workforce, according to Neal-Boylan. She writes in her book that options are to make a bachelor's in nursing a requirement or restructure the doctorate program as the entry-level degree for all nurses.

"Let's eliminate the [licensed practical nurse] associate degree and diploma so that we can say that all novice [registered nurses] are prepared at the same level," she writes.

Neal-Boylan hopes her book will generate discussion to help pave the way to resolve these ongoing issues once and for all. "The first step is recognition," she says. And in her book, she concludes: "In short, we must get our act together if we are to move forward. We do not want to be left behind, competing with each other over issues that should have been resolved years ago."  --Ilene (@FierceHealth)

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