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Having attended the National Council
State Board of Nursing annual convention this month, I was once
again reminded of the divisiveness of the nursing profession and
the importance for us, at all levels of practice, to come together
with a united voice. I know that it seems an impossible
task, but I am a true believer that impossible tasks are the ones
we have chosen not to make a priority for solution.
As I sat in on meetings I heard another group advocate that a
BSN should be the minimum requirement for "professional"
nursing (RNs). I heard another group say LPNs should not
be allowed to expand their scope of practice. A committee
report to the council suggested how CNAs should be delegated to
in nursing practice. Finally, the worst of this divisiveness
I saw was when one state announced they had just opened a new
diploma school of nursing and the outbreak of emotional responses
was quite unprofessional to say the best. As I looked at
all the happenings, it occurred to me that we risk yet another
"turf battle" in the near future as advanced practice
nurses expand in numbers. Will the next battle we see be
these APRNs fighting to keep RNs from expanding their roles unless
they obtain advanced degrees? Well if our history continues
unchecked, I'd be willing to guarantee it will happen.
As noted above, at one of the breakout
sessions, a relatively new association joined with the ANA and
stated that the minimum education level for a registered nurse
must be a BSN. I spoke with that organization's president
after the session ended, making a simple point. When organizations
make these blanket statements, without forwarding a plan that
addresses the concerns of the majority of RNs who do not
have a BSN, such agendas can only be damaging to the
profession. What is your plan for ADNs, diploma nurses,
LPNs, and nursing assistants? Are they just to be swept
under the rug, or will they be given grants to continue their
education? More importantly, can any group attain "professional"
status, recognition and pay without having a group or group that
helps them deliver service to their clients. All the "professions"
have individuals, not as well-trained but capable and competent,
who help deliver their professional service to their clients.
For example, attorneys depend on para-legals, business executives
depend on executive assistants, and physicians depend on physician
assistants and nurse practitioners, and the list goes on.
Some will tell you that it's important
to have laundry lists of what certain levels of nurse can and
cannot do within their "scope of practice". In
my opinion, this can do nothing but hurt us as a profession.
First of all, we do it more to protect our "turf" than
to protect the public. Little if any research backs the
creation, validity, or necessarily of these laundry lists.
LPNs doing IV therapy! Who would have ever thought.
Well, if nursing didn't progress, RNs would still not be taking
blood pressures, let alone doing IV therapy. We must realize
that we are in a dynamic and rapidly growing industry. As
knowledge and capabilities expand, so too must the knowledge and
capabilities of all practitioners of nursing, regardless of their
educational level. Don't buy in to any group that tells
you a certain level of training is necessary to provide a skilled
service to patients in any setting. Nursing schools at all
levels train and educate their graduates to meet minimum competency
to begin practice. It is with years of experience, ongoing
education, and dedication that we become experts in any facet
of our profession.
Yes, regulators must provide nurses
with a "scope of practice", but these legal documents
must be written to allow for our profession's ever-expanding roles.
Many states use broad statements that meet these criteria and
these scopes of practice documents should be adopted by the NCBSN
as model regulations for all states. Let's not set ourselves
up to fail just when the need for nurses will be its greatest
since World War II.
Let me address briefly the who, what,
where, when, why and how of all this.
Who should be involved
in finding solutions to this problem? All nurses, RNs, LPNs, and CNAs should be invited
to become involved in addressing the issues and creating a direction
for the nursing profession. I'm sure most would agree that
registered nurse should lead the way, but answers that are derived
by exclusive groups rather than inclusive groups will only continue
to divide our numbers and whittle down our ability to determine
our own fate.
What do we need to do to
effectively address these issues?
The answer, in my opinion is both obvious and simple. A
new council needs to be created, comprised of representatives
from all the major nursing associations and groups. It would
have members at all levels of the nursing practice. Its
members would serve as "ambassadors" for their organization.
Collectively they should create recommendations and position papers
that can be taken back to their respective organizations with
strong recommendations for adoption.
Where do you go to help
make such positive and effective change begin?
It is important for you to begin a dialogue with your professional
association and insist that nursing's future be in the hands of
front line nurses. Talk with your colleagues and get a nursing
running nursing.
When do we need to get
started? As you might well imagine, the present is the very
best opportunity for nurses and nursing to achieve every dream
any of has ever had for our profession. The good news is
we have a window of several years to get it all accomplished;
however, we cannot wait for the impending nursing crisis to worsen
to a point where lawmakers will take our professional destiny
out of our hands and put it in the hands of the reactionary!
Why is this important? Because regulation of nursing practice is first
and foremost a legislative matter, it is important for nurses
to end divisiveness and speak with one voice so that we can be
an effective lobby. Currently we have too many associations,
representing too many sub-interests, often in total disagreement
with one another. The foundation for most of this are "turf
battles" I addressed earlier. In order to be effective
in lobbying both legislatures and regulators, nursing must speak
with a united voice.
How do you get involved
and make it all happen? First and foremost, you must get involved with at
least one of the major nursing associations. The broader
the representation of the association the better and more likely
that such initiatives can be advance within the group. These
initiatives must be inclusive, not exclusive and they must create
a model of nursing practice that can be advanced on a national
basis. It must be an initiative endorsed and embraced by
the majority of nurses at all levels of training and experience.
I know you may be thinking that I believe
in perfection (I would have used the word utopia, but there is
no need for nurses in utopia). Well, maybe I dream that
such a place could and should exist; after all, I am a nurse.
However; I also understand reality. One reality that we
must all be aware of is a simple fact: a very small percentage
of nurses, many of whom have little or no recent clinical nursing
experience are guiding our profession. They have supported
a divisive environment created in 1965, and they have failed to
deliver what is best for nurses, nursing, and the public at large.
We must all become more involved with our professional associations,
we must join our professional associations, we must hold them
accountable to our wishes. Associations are nothing but
micro-politics of democracy. As long as we let the minority
of nurses represent the whole, the majority will always feel and
be disenfranchised. Make the associations work for you and
your profession. Join in, encourage your colleagues to join.
Become involved and speak-up for a solidarity among all nurses,
of all levels. There will always be a need for nursing,
let's make it one mighty and powerful voice.
This is the first in a series of articles that
I will be publishing on this subject. If you'd like to
send me feedback, input, or your own op-ed, please feel free
to so. To e-mail me
.
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