A post in another class reminded me of a student I taught in a health science technology program in South Texas - let's call her Astria. Having had some experience with nursing care as a cerebral palsy patient, she had decided that caring for others was what she wanted to do with her life. Of course, the nursing schools in the area (a wide area) roundly rejected her on the basis that she would not have been able to preform the clinical skills necessary to be a nurse. Bear in mind, this was not yet even 20 year ago, in the early 1990s.
Is there no room in our professional culture for someone who does not practice clinically, at the bedside? Our mandate, to promote health, is not limited to activities requiring fine motor skills. It never has, really, at least not since I began work as an RN (1991). We've been all about organizing and managing patient care, in my experience, a responsibility for which Astria was quite well suited. Of course, we still get our hands dirty, but even with the magnet emphasis on BSNs providing primary care there are plenty of nursing jobs that do not require any clinical patient contact whatsoever.
Yet somehow, to work in one of those non-clinical positions, nurses are typically required to demonstrate clinical experience. We're expected to have "paid our dues" in the trenches. I recall graduating and being strongly urged to head for med-surg to "get my skills." I refused. Why go learn something I don't want to learn? Instead, I headed straight for the NICU, and later went to home health, where even "lacking skills" I did a fine job. As we seek to evolve into the administrative, consulting, and educational roles that health care desperately needs from us, what is it in our culture that prevents us from stepping up and realizing those roles? Certainly, nobody is suggesting that nurses give up clinical roles, just that those of us with the vision to take our unique set of intellectual skills away from the bedside be allowed to do so - and still lay claim to the title of nurse.
This is why I wonder what your plans are as soon-to-be BS and MS prepared nurses. Many positions for which your new degrees are required will remove you from the clinical setting. Is that OK? Will you still consider yourself nurses? What do you think? Does nursing = direct, skilled patient care?
Graduation Time
15 years ago
Dr. Anderson,
ReplyDeleteI had the same feelings as you when I graduated nursing school. I had never had the desire to do med/surg and always said I would never do this. After nursing school, I went to PCU/telemetry. I then worked L&D, and later did some home health as well. I now have had experience in med/surg, but I do not feel that getting other experience first hurt me as a nurse. I never felt that I lacked any skills. I actually felt that I had a wide range of skills that has helped me grow as a nurse. The example of the student that you taught that was unable to get into school due to her cerebral palsy is very sad. It is hard to believe that someone with the desire to help others would be turned away just becuase she could not perform certain physical activities that go along with bedside nursing. I do not feel that it is fair to judge her this way because there are so many different areas of nursing that do not require the pysical duties that are common in nursing. I know that many places want you to have clinical experience, but in circumstances like this, it should be overlooked. Someone with the heart and compassion to do good for others should be given the same chance as everyone. When I finsih my BSN this semester I will be moving on to persue my FNP, so I will still be in a clinical setting when I graduate. But eventually I would love to teach, and then I would not be in a clinical setting unless I were teaching clinicals. I still feel at that time I will be a nurse. I do not feel that nursing only = direct, skilled patient care. If you are teaching, you are teaching future nurses to do this, if you are in a management position, you are still working on providing safe and effective care to patients through administrative duties. As nurses, we have the desire and heart to help others, whether or not it is direct or indirect care. I think that anyone with these qualities should be given the opportunity to be a nurse or whatever else they want to be regardless of physical limitations. I wonder what that student ended up doing, do you know by any chance?
She's actually helping to run the family business. She's very bright and is probably an important aspect of the business now. It may not be what she really wanted, but she's doing all right. That's comforting to know, for me. :)
ReplyDeleteI agree, it is comforting that she is doing well. It is still a shame, she could be an excellent nurse providing excellent care to patients.
ReplyDeleteI feel that I am a "seasoned" nurse. I will always feel that I am a nurse without providing care at the bedside. Today, healthcare roles have expanded so much that I am excited of the choices that I have and the directions that it will take me. It is so much I want to do such as a nurse, as many may know I am struggling even after 10 years to find my niche in nursing. I don't feel that I will be doing bedside care in the next five years and if I am it will be as a nurse practitioner. I enjoy autonomy when I'm working, it can be scary yet challenging at the same time. I want to consult as well. I feel that in order to do this, however, is to have experience with hands on training. As far as Astria I feel bad for her and wish there was a way to accommodate her with her goal of being a nurse.
ReplyDelete