About One DNP

I earned my "terminal practice" degree in nursing from the University of Tennessee Health Sciences Center in a journey of excitement and challenge. It inspired me to advocate for an all encompassing clinical credential rather than continuing the hodgepodge of nonsensical initials. I hope these entries will provide entertainment and insight into the Doctor of Nursing Practice experience, which will soon be the entry standard for all advanced practice nurses.

Monday, August 16, 2010

"The More Things Change, The More They Stay The Same"

10 points if you can name the movie and character (hint: call me snake!)

After completing the assigned reading on interpersonal communication and attending an excellent presentation on lateral violence today, I am in a revolution kind of mood.

Nurses have been burying their mistakes since the first report on deficits in nursing education came out in the 1800's. Not only was nothing changed, but they refused to publish the reports! Fast-forward to present and we see every excuse in the book to maintain the status quo in professional conduct and portrayal in pop-culture. So here are my top three contributors to enduring stagnation within the nursing profession.*

"Nurses eat their young"
Ahh, the mantra for new grads since Flo hung up her cape. I heard it multiple times in undergrad and unfortunately experienced in my first nursing job. While everyone acknowledges this is a detrimental and pointless hazing culture, little is done to curtail the nastiness because "that is just the way it is and you need to adapt to the aggressor rather than make the aggressor change their attitude." People are allowed to perpetuate workplace hostility because as a whole, nurses would rather gossip then confront. We are also quick to judge and slow to forgive and, if ever, forget. Nearly half of all new nurses in my area quit nursing in the first year because of "mean girls." Sometimes they switch units and sometimes they leave the field entirely. Catty, punitive, and passive-aggressive behavior contribute to the barriers we encounter to being regarded as a professional and not a skilled laborer.

Over-theoried, Under-practiced
I have heard it, seen it, and believe it: Diploma nurses were the best nurses. They knew how to be nurses when they got out of nursing school - none of this "I can't wait to graduate so I can get out and learn to be a nurse." From stories I have heard them tell, they had their own set of issues, but they were competent in delivery of care and pioneered the way to advanced practice education. Ah, advanced PRACTICE, implies there should be some basic practice, right? Practice is based on knowledge and I am seeing a dangerous dumbing-down of nursing programs with reductions in overall clinical hours. Hard laboratory sciences need to stay in the nursing curriculums and not be replaced with so-called health care versions like statistics-lite or mini-microbiology or chemistry-concepts. Spending more time in the classroom talking about care, but not really in the trenches performing it does not breed confidence or competence. Great, you can pass the NCLEX, but now that you are a licensed public servant, all you have is a pocket full of skills and a hope that you will have a competent preceptor and supportive work environment.

The advanced practice nurses with DNPs throwing "I am a doctor" around does nothing to gain allies and just kicks up the dander of the AMA. Their argument that we do not have a residency or solid science grounding is pretty laughable when you look reports demonstrating increased patient satisfaction, decreased prescriptions for controlled-substance prescription, and equivocal outcomes. But when we start lowering academic expectations, decrease hands-on hours, and allow advanced practice nursing students to avoid clinical practice as an RN, we start supporting the contentions of the opposition.

If We Are So Trusted, How Come No One Knows What We Really Do?
Every year, nurses are consistently the #1 or #2 most trusted profession in the US, but the perception is still that we function as the arm of an MD or are little angles of mercy. Great nurses are often asked "why didn't you go to medical school?" as if being an ARNP is something less than an MD. I have seen it on numerous medical shows where the "sharp nurse" decides to go to medical school while the very notion of nurse practitioner school is not even addressed. I will not get into the various stereotypes or complete lack of nursing role in some of these shows, but we have all seen them and cringed.

The public does not understand that the focus of medicine is to treat diseases after it happens while the focus of nursing it to prevent disease by promoting healthy behaviors. In parent terms, we are the ones that say "I will give you until the count of 3" and the MDs are the ones who enact the discipline. We are not served by having collaborative or affiliation agreements with MDs instead of seasoned NPs who actually practice the same form of health care. Psychiatrists do not oversee psychologists or social workers, orthopedists do not oversee physical therapists or chiropractors, and pulmonologists do not supervise respiratory therapists, yet nursing is forced to perpetuate the handmaiden role.

And that's my Rant!

* Subject to change without notice

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