During my nearly 35 years in nursing, I noticed that history was repeating itself. The nursing profession just kept revisiting many of the same issues. By writing the book, I hoped to provide an in-depth analysis of nursing's history with regard to specific issues that I thought kept recurring. I want to share this with other nurses and would-be nurses because we should really try to learn from our history.
RNL: Your book looks both backward and forward. What are three areas you consider top priorities for nursing as the profession looks to the future?
Neal-Boylan: We need to unify by eliminating the very palpable gap that exists between nurses who care full time for patients and those who teach or conduct research. Often, one hand doesn’t seem to know what the other is doing, why it is doing it, or how each can contribute knowledge to the other and thereby strengthen the profession.
We should accept that not everyone can be a nurse and stop sacrificing quality by allowing everyone who wants to be a nurse to become one. We must enforce high standards for entrance into the profession and require a professional demeanor and appearance. Nurses should be well-rounded, intellectual people who read widely, write well, and are articulate about a broad range of topics.
As a profession, we should stop creating new degrees until we finally eliminate the multiple entry-level degrees we currently have. Our inability to eliminate these degrees embarrasses us among other professions, as do the multiple letters after our names, many of which the public is unable to decipher or understand.
RNL: You observe in your book that, in many ways, the nursing profession has not advanced as far as your nurse forebears intended. Is there an inherent “personality” shortcoming in the profession that hinders its progress?
Neal-Boylan: Yes, its inability to harness the power of more than 3 million nurses. This relates to my earlier comment about the need for unification. Nurses have been calling for unification since the early 20th century, when self-proclaimed leaders made decisions for the profession. The “working” nurses perceived that those who were making the decisions were not actually caring for patients and, therefore, were unaware of the real issues. This gap has continued to widen.
The average working nurse can rarely affordto attend the very expensive professional conferences—particularly research conferences—or join nursing’s multiple national organizations. Academic nurses and researchers frequently disengage from direct patient care and consequently conduct research that has very little perceptible value in improving quality of patient care or the work life of nurses. When the results of that research are disseminated, nurses who could most use the information rarely access the journals in which the findings are published. I could giveother examples, but theremust be more effort to make everyone feel valued and avoid conveying to students and new graduates the idea that, as soon as possible, one must leave the bedside for graduate school.
RNL: You state in the book that not all nursing students are well-suited for nursing. Identify two characteristics you consider essential for those who aspire to become a nurse and why those traits are important.
Neal-Boylan: Prospective students should understand what is expected of nurses before applying for a program. Our programs are rigorous, and nursing is very demanding. I think we lose a lot of new nurses because they had no idea of what they were getting into and did not pursue nursing because they loved its art and science. The same holds true for people who apply to nurse practitioner programs. I have seen so many students who say they want to be NPs but, beyond writing prescriptions, have no idea of what an NP does.
RNL: In Chapter 4 of The Nurse’s Reality Shift, you identify what nursing is doing right. What’s one of the best things nursing is doing right? Why do you think so?
Neal-Boylan: We are still the most trusted of professions and rightly so. We are fortunate to have accrediting bodies that have strict standards but also allow some latitude in nursing programs. While we may be too flexible with regard to bending over backward to allow people to enter school who may not belong there, we do an excellent job of enforcing the culture of nursing and what it means to be a good nurse.
I love watching a new nursing studentbecome someone who understands what the nurse brings to the patient and family and why that is so valuable to society. Nurses speak the same language, and, ultimately, all nurses want what is best for the patient, regardless of the sacrifice to themselves. That’s pretty amazing.
RNL: You are an academician who has simultaneously maintained a clinical practice as a family nurse practitioner. What do you consider the greatest current need in nursing education?
Neal-Boylan: To give students very realistic clinical experiences. Unfortunately, it is becoming increasingly difficult to find clinical placements for students. This is partly due to a trend among health care agencies to ask for remuneration if they provide preceptors and the cost to the agency to allow experienced nurses time to work with students. Some agencies hire few RNs, so the number of staff members qualified to serve as preceptors is low.
Difficulty in finding clinical placements for students is also due to increased competition from multiple entry-level programs and from for-profit schools and online programs whose students are seeking clinical experiences. This is a multifaceted problem. Simulation is very helpful but can only go so far. Students need to care for more than two patients at a time and experience the typical day that a nurse in real life experiences. Nursing students also need more exposure to settings outside the hospital. RNL
Leslie J. Neal-Boylan, PhD, CRRN, APRN-BC, FNP, FAAN, is dean, University of Wisconsin Oshkosh College of Nursing. In addition to The Nurse’s Reality Shift, recently published by STTI, Neal-Boylan is the author of The Nurse’s Reality Gap, Nurses with Disabilities and Clinical Case Studies for the Family Nurse Practitioner.
ISBN-13:9781938835629. Published by STTI, 2014
Price: US $34.95. Soft cover, 240 pages. Trim size: 6 X 9