What Shall We Become?
Imagine for a moment that decades ago we had built together a large ocean-going ship designed to transport thousands of helpers across the Atlantic from the U.S. to Europe. Europe was where the help was needed. The ship sailed effectively enough and it met everyone’s expectations because, more or less, it made it to Europe. You might dock in England, France or Spain, but you got there. Over time, we kept our heads down and improved the ship dozens of times. We gradually moved from a wooden ship to a steel and glass cruiseliner that sailed more efficiently and effectively than ever.
However, when the need for help began to shift to other continents, we had become so preoccupied with improving the ship, so comfortable with our route, and so impressed with our progress, that we didn’t even notice. Occasionally, there would be an irate group of passengers who made a fuss over the ship’s destination, but generally, they could be placated with small direction changes that still landed us in a familiar European port.
Then… our ship hit a pandemic-sized iceberg. The resulting disaster was so large and so overwhelming that it is unthinkable that we would not stop and ask serious questions… Or is it?
Recently, I had the opportunity to help a progressively-minded undergraduate nursing program crosswalk their curriculum to the NCLEX test plan. The curriculum is concept-based and heavily tilted toward population health and public health. Interestingly, it is not very intuitive to map this kind of curriculum to the test plan. Why? Because the NCLEX does not appear to test much of anything outside of what might be considered conventional acute care. That is not a new observation but reflect for a moment on this reality in light of our current crisis. If it is true that in disciplines heavily governed by regulation and accreditation, standards always have an outsized shaping influence on the educational product, how would we judge that impact on nursing’s readiness for the current public health crisis? Can we confidently say that the shaping influence of the NCLEX has aided us in producing the nurse that is needed for tomorrow? If not tomorrow, then what about today?
A large national “re-visioning” effort in nursing education is presently underway and promises to reshape, by way of accreditation, the shape of curricula all across the country. The basis of this large undertaking is outlined in AACN’s Vision for Academic Nursing. The vision is organized around several key areas: Accelerate diversity and inclusion; transition to competency-based education and assessment; increase collaboration between education and practice; increase emphasis on faculty development and career advancement; and explore and adopt opportunities for resource efficiencies. The pursuit of each of these elements will likely strengthen the quality of academic nursing. However, let’s ask the same question that we asked of the NCLEX test plan: Can we confidently say that this re-visioning effort will aid us in producing the nurse that is needed for tomorrow? If not tomorrow, then what about today?
Without doubt, stellar organizations like the NCBSN and AACN have brought incredible value to nursing. The initiatives each organization is currently leading will likely produce incremental improvements in the ship that is sailing to Europe. But is Europe still where we need to go? The pandemic is our iceberg no doubt. Will we embrace the opportunity to step back from some of our ship improvement projects and ask the riskier question about whether or not the ship is taking us to the right destination? This should be a soul-searching time for nursing education, the nursing workforce, and the healthcare system. Are we creating and deploying nurses for a world that existed yesterday?
The last several months have been, if nothing else, eye-opening. In some parts of the country, nurses protest the lack of PPE, beds, and ventilators in their clinical environments. In other parts of the country, there are nationwide calls for nurses to come from out of retirement, to come from out of state, and to come from out of their educational preparation early, to help offset shortages in acute and long-term settings. In yet other parts of the country, nurses are losing shifts and being furloughed as their agencies cease all non-essential activities. Potentially most striking is the lack of preparedness we are witnessing in our public health system. A factor that, perhaps, explains much of what has happened, and not happened, in our response to the pandemic.
There is an incredible opportunity and a daunting obligation before us. Who will step forward and lead the national conversation that questions our current vision for nursing? Who will show us the pathway to aligning our professional structures around that vision? As we now can see more clearly than ever, lives depend on the ability of the largest group of healthcare providers in the country to carve a path to a future that is better than the pres
Will we call all hands on deck to stop and ask the critical questions about our ship, its route, and its destination? The iceberg will eventually float away. If nothing is done, we’ll put our heads back down and return to our ship improvements… Until the next iceberg.
