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Our “They” Problem

Fulton, Janet S. PhD, RN, ACNS-BC, ANEF, FCNS, FAAN

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doi: 10.1097/NUR.0000000000000521
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Another nursing conference, more of the same. Remember 1980? The bachelor's degree in nursing would be the entry into practice degree for nurses. Diploma programs would close, associate degree nurses would be, well, I forget. More recently, remember the proposal that by 2015, advanced practice nurses would hold a practice doctorate? The year has come and gone. The ghosts of these and other bold ideas haunted the meeting. Debates about entry into practice, the focus of master's preparation, the scope of the practice doctorate, and lament over the declining enrollment in PhD programs occupied presenters' comments and participant discussion forums. Despite the futility of some initiatives, the collective outcomes have been impressive, achieving more bachelor's degree programs and increased opportunities for graduate education. Much has been accomplished in a short time. Nursing science has progressed. Practice autonomy has expanded. Yet, as the lingering ghost of 1980 hangs heavy, the movement forward has not been universal, resulting in widening the spectrum instead of a unified full forward movement.

We have a “they” problem. Comments in the discussions contained expressions of frustration and irritation with others who failed to endorse a preferred vision dominate at this particular meeting. They failed to upgrade the curriculum, offer a different degree, change certification requirements, support legislative initiatives, or endorse position papers. They were holding nursing back. They were the cause for lack of unity. They were the luddites who failed to grasp the future. In a discussion, a participant shared that his school offered a robustly subscribed to master's degree in nursing education at the request of community partners for graduate-prepared staff development educators. Now those same partners are asking the school to create a doctor of nursing practice degree option for nursing education. Helpful suggestions followed from the audience, including encouraging potential students to pursue degrees in education. Sending bright nurses to study in another discipline seem like a poor alternative. Other participants explained the purpose of the practice doctorate, which did not include “them” who were interested in education.

We are not listening to each other. Each organization's meeting agenda expresses its own vision. Moving forward together requires respect for what each contributes to the whole. To the public, we are all nurses. The licensed practical nurse in a long-term care facility is nursing to a resident's family. The associate degree–prepared registered nurse in the delivery suite is nursing to new parents. The clinical nurse specialist is nursing when discussing palliative care with the daughter of a patient in the intensive care unit.

Let us step back and see nurses as the public sees us. Crafting a message highlighting nursing contributions to the public wellbeing might, just might, help stop the lateral violence that underpins the persuasive need to “otherize” nurses when “they” do not embrace “our” ideas. We are they.

Twenty years ago, the pharmacy profession decided to require a practice doctorate for entry into practice as a pharmacist. A recent New York Times exposé detailed how pharmacists are struggling with system demands that are eroding quality. Fatigue, distraction, burdensome regulations, productivity metrics, and multiple other system demands are leading to fatal mistakes ( America's healthcare is complicated and fragmented. Could the lesson be that more a more educated provider will not fix system-level problems?

We stand on the shoulders of forbearers who pioneered educational and regulatory opportunities, moving nursing forward and opening up opportunities. Not everyone is in a position to take advantage. For those who choose alternative paths in nursing education and practice, for whatever reason, let us embrace them as us. Think seamless progression that encourages everyone to go as far and contribute as much as ability and resources permit. There is much work to do and everyone can contribute. Bringing nurses together under common cause is a heavy lift requiring some very extraordinary leadership. Our present approach of siloed leadership for competing agendas is not working for the larger objective of meeting our profession's social mandate.

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