Editor's
Note
Tunnel
vision
Narrow
focus on tasks does not allow nurses to reach their potential
Carol Bradley, MSN,
RN, California Editor
April
23 , 2001
What
is the value of nursing in today’s health care system? What
are the most important contributions we make? Perhaps these
are questions that we first must answer before we tackle
the nursing shortage.
Is nursing
simply defined by the tasks that make up the daily work
of nurses, or is there a more important and higher function
that we should focus on? Using another profession to ask
the same question, is the value of an architect found just
within the building he or she designs, or is it found in
the innovative use of space, the artistic statement, the
impact on the community development, local economy or environment
of a people and the way they live?
The
"success" of an architect’s work is not the building
itself, but how it interacts, blends and contributes to
its environment in a positive way.
If you
believe as I do that it is not about the "building,"
but how it interacts and influences the environment and
society for which it exists, then nursing must create its
future with a consideration for the needs of society and
the health care system vs. a limited focus on task and roles.
One
of the most important strategic actions that nursing can
take to ensure its future is to turn away from the simplistic
approach to defining nursing as a list of tasks and functions.
Just
look to the past and you will see that as medicine has advanced
in its practice, nursing often has been the beneficiary
and we have eagerly embraced functions traditionally regarded
as the domain of medicine. In kind, it is now time for nursing
to reassess the importance of certain traditional nursing
activities and allow those to be reassigned to other qualified
and trained caregivers who are not registered nurses.
Unfortunately
in the ’90s, a combination of fear and an inability to envision
a better future caused many nurses to support regulation
that attempted to define and confine certain aspects of
nursing care to registered nurses vs. expanding the use
of unlicensed personnel.
Contrary
to the conventional argument at the time, it appears we
missed an opportunity to free nurses to explore increasingly
professional vs. technical realms of practice.
While
ensuring quality of care was the frequent rationale, in
reality, the data in many clinical settings proved that
unlicensed personnel could safely, if not expertly, perform
certain tasks when provided with the appropriate training,
guidance and supervision. In settings where poor implementation
resulted in problems, we blamed the idea and the people,
not the process.
Even
today, with the critical shortage of registered nurses,
we continue to waste the valuable time and productivity
of registered nurses in activities that do not deserve or
require their extensive education and license.
As a
result, we often shortchange the time that registered nurses
have to perform the most important activities of professional
nursing, such as analyzing and synthesizing clinical data,
planning, coordinating, evaluating care, educating and guiding
patients.
Even
though our plate is full, it is time to make a plan to revisit
those regulatory handcuffs that unfairly burden registered
nurses. The challenge is not what we can all throw into
the scope of nursing practice, but defining the most important
contribution for nurses to invest their time and talent
in for the best interests of patients.
Perhaps
then we would be able to reconsider the often unreasonable
expectations we have for new graduates in clinical/technical
proficiency.
Before
we travel down the path of solving our shortage, let’s make
sure that we make the best use of the talented registered
nurses we do have. Like the trapeze artist, it is often
necessary to let go before we can take hold of the next
bar.
