May 2013

Many Reasons for Optimism

By Bobbie Berkowitz, PhD, RN, FAAN

Dean, Columbia University School of Nursing

Maternal Health

Spring is a busy and exciting time for Columbia Nursing. Seasonal milestones this year included the annual reunion, followed by graduation ceremonies for the class of 2013, and then welcoming events for our new Entry into Practice (ETP) class. As I participate in these milestones in the life our school, I have taken note of how far nursing has come as a profession.

This year’s reunion was particularly joyous because of the outstanding nurses who were recognized with the Distinguished Alumni Award. The recipients epitomize the many important contributions and achievements of advanced practice nurses: Sarah Sheets Cook ’05, Professor Emerita,  for her exemplary teaching, scholarship, and service to CUSON; and Patricia L. Riley ’76, for her 37 years of service in health policy and contributions to evidence-based practice in the field of global health human resources. And in an emotional moment, June J. Siegfried ’39, who was beloved by all whose lives she touched and whose career was the very definition of a nurse humanitarian, was recognized in memoriam.

As fate would have it, the same Friday as our reunion, The Wall Street Journal published an article, “Midlevel Health Jobs Shrink,” which reported on what it called ”the gradual disappearance [in health care] of semiskilled occupations that don't require a college degree.” The article noted that positions such as licensed practical nurses and medical-records clerks are being phased out in many hospitals and registered nurses increasingly need at least a bachelor's degree in order to be hired. The Journal reported that “the trend is worrisome to economists” because these “middle-skill jobs” were once an entry point for good-paying positions.  Only near the very end of the article is the point made that the “increasing complexity of medicine, along with an increased focus on measuring and improving patient care, has raised the bar on educational requirements for some jobs.”  

Unfortunately the article does not properly explain that healthcare employers are demanding higher levels of education for nurses because healthcare itself is changing rapidly. 

Hospital-based care is already replete with sophisticated technology whose complexity will only accelerate in the years to come. This of course means that nurses need additional education and experience to respond to fast-paced additions to best practices. And because of medical science’s ability to better address acute illness with a modern pharmacopeia, patients are living longer with a wide variety of complicated chronic illnesses — which adds to the need for higher-skilled nurses. Finally, the fact that care is increasingly being administered outside of the hospital setting means that nurses need more skills and training to  design and manage multi-faceted care programs. 

As a profession, nursing is adopting dynamic new approaches to accommodate to this new reality. One solution that is spreading across the nation is that students with community college associate degrees are completing their baccalaureate degrees at a university.

What is so disappointing about the Journal article is its implicit perspective of nursing as simply a job-for-pay instead of embracing the notion that nursing is a profession requiring a special combination of commitment, skill, and education.

The article reminds us that for some people —at least some economists — nurses are still not fully recognized as highly skilled — and highly educated —problem-solvers.  Nurses have never simply cared for patients by-the-numbers, cleaning a dressing here, taking a temperature there. What is required of them now, and more than ever, is the ability to think critically, act resourcefully, and always keep the patient’s best interest at the center of the healthcare system’s attention.

As healthcare reform continues to roll out cost-saving solutions, if they are not well planned, there is the potential to substitute formulaic steps for decision-making by caregivers. Nurses must play an even more conspicuous role in ensuring that the human touch is not stripped out of the caring process. This will require nurses with finely-honed skills and a foundation of experience commensurate with the tasks of synthesizing an enormous amount of information, quickly making sense of it, and acting in the best interests of the patient — all the while remembering that each patient is an individual with unique needs and circumstances.

I see these qualities in great abundance in our students. These young people come to us because they have chosen nursing as their life’s work and approach it with the desire to make a real and sustaining difference to society. Each student has a compelling reason to seek additional knowledge. While some are brand-new nursing students, others have already worked as health care providers for disadvantaged populations and know that to do more, they need to know more.  We assist them by fine-tuning what they already know and adding extra science, additional technical skills, and more refined diagnostic reasoning so they can make the finest contributions possible to the welfare of patients and their families.

I am extremely encouraged when I consider the women and men who are our students. Looking at them, the conclusion I draw is straight and direct: the future of healthcare looks bright indeed.