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The Maternity Clinical Specialist: An Academic Viewpoint
nursing roles The Maternity Clinical Specialist: An Academic Viewpoint CAROL S M I T H , R N , B S , M S
Educating graduate nursing students and medical residents together is, in practice, a rather new idea. The following is a report of the principles, philosophy, and implementation of such a progrum, the goal of which is to enhance the autonomy and eficacy of a Master‘s-level maternity nurse.
The clinical nurse specialist is the newest and least-documented role in modern nursing. The educational approaches and methods being used are uncertain and largely empirical in formulation. This, in turn, affects the operational definition of the clinical nurse specialist and, ultimately, the professional practice. Precise understanding of the clinical nurse specialist’s capabilities and responsibilities is presently in the critical process of evolvement, which calls for sound direction and scientific investigation in order to successfully develop the role. Hochheiser stated that the nurse in this expanded role could help provide less expensive care to a greater economic cross section of the population.’ These are two important stimuli to developing the role and should b e recognized as such. However, health care delivery personnel are realizing that the combination of the expertise of physicians and nurses is most effectively performed in a collaborative and collegial environment. It is to this end that the Boston College School of Nursing a n d H a r v a r d Medical School have joined in creating the Maternity/Pediatric ClinicaI Specialist Program. It is a committed effort to improve the quality of care that is being provided by promoting and encouraging this environment in graduate nursing and medical education. March/April 1977 JOGN Nursing
The uniqueness of this clinical nurse specialist program lies in the fact that graduate nursing students and medical residents are educated together. Didactic seminars, grand rounds, and clinical conferences are designed to promote the constant interchange of nursing and medical viewpoints to ensure a true integration of learning and health care delivery approaches. The development of physical assessment skills needed in providing primary care services is combined with in-depth examination of outstanding nursing theories. The purpose of this methodology is to provide the graduate student with the proper perspective in assimilating this advanced knowledge into a nursing framework that will become a basis for the functioning clinical nurse specialist. The program’s operation relies on the psychosocial-oriented nursing background rather than the disease-focused medical approach to learning, which we believe influences how the clinical nurse specialist will utilize this knowledge. The differences between nursing and medicine teaching methodologies have been frequently discussed, and it is the integration of both styles that the Boston College-Harvard Medical School program is constantly refining. W e accept the educational premise that there is a direct positive correlation between educational input
57
and level of decision-making3 To that end, the joint faculties have specifically designed this three-semester program to assist the nursing student in thc gradual development of the increased clinical decision-making proccss involvcd in the autonomous functioning of the clinical nurse specialist. This is a major factor in the successful acceptance of this expandcd role which is not always recognized and specifically dealt with.4 The Children’s Hospital Medical Center and the Boston Hospital for Women are co-sponsors of our clinical nurse specialist program and provide the bulk of the primary care clinical experiences. Realizing the individual needs and aspirations of students, the program offers additional cxperiences in community agencies, school systems, and Harvard-based maternity research projects, and a number of Harvard preceptors coopcrate by providing experiences within their individual practices. Students progress gradually from closely supervised patient encounters to independent care assessments requiring only faculty support and minimal guidance. The Boston College-Harvard Medical School program is aware of its rcsponsibility to promote the development of a scientific base for the clinical nurse specialist role. Research techniques and proper application to approved hypotheses furthering the study of the clinical nurse specialist is a required component of the core curriculum. Both Gortner and Schlotfeldt agree that the lack of clarity regarding nurs-
ing’s central focus is responsible for poor understanding of the nursing role and poor recognition and valuation of the consequences of “scientifically based, human nursing pract i c e ~ . ”It~is our interest to encourage true research and publication of findings as students and program graduates. The program is 5 years old and has graduated 39 nursing students to date. Resides the requirement of a baccalaureate degree in nursing, a minimum of 1 year‘s experience is advocated. Personal interviews with candidates by an admissions board of two Maternal-Child Health nursing faculty members and one Harvard physician explore the philosophy and aspirations of the applicants. It also permits the opportunity for the potential student to learn more about the program. A retrospective survey has recently been conducted on the past graduates; it not only focused on their assessment of the academic preparation they received for the positions they now hold, but also examined the range of positions, salaries and benefits, and physician-health care personnel relationships they are encountering. The results of the survey are yet to b e assessed. The Boston College Graduate Maternal-Child Health Nursing faculty and the Harvard Medical School Obstetric and Pediatric faculty are committed to the promotion of an improved health care delivery system, focused on the primary care of the mother and child through ” the expanded role of the nurse as a clinical
specialist. It is the aim and purpose of the program to prepare nurses at a Master’s level who will function with increased autonomy and with a higher level of decision-making ability. References 1. Hochht>iscr, Imuis: Proceedings of the N u r s r Practitioner Research Confcrence.” Farmington, Connecticut, Univcrsity of Connecticut Health Center. Nurs Outlook 23:177, 1975 2. Ratvs, Barbara: “Doctor and Nurse: Changing Roles and Relations.” N Engl.1 Med 283:130, 1970 3. Anderson, E. M., ef a/.:“Epigenesis of thtl Nurse Practitioner Role.” A m J Nurs 74:183, 1974 4. Williams, Carolyn A , : “Nurse Practitioner Research: Some Neglected Iss i l t s ’ ’ Nurs Outlook 23:173, 1975 5. Gortnt~, Susan R.: “Scientific Accountability in Nursing.” Nurs Outlook 22:764, 1974 “
Address reprint requests to Carol A. Smith, RN, Graduate, School of Arts and Scicwxs, Department of Nursing, Boston Cokge, Chestnut Hill, M A 02167.
Carol Smith is Coordinator of the Boston College School of Nursing-Harvard Medical School Clinical Nurse Specialist Program in Maternal-Child Health, and Chairman of the Graduate Department of Boston College School of Nursing, where she is also a candidate for a PhD in Higher Education. Her other professional activities include membershiv in NAACOG and ANA.
Intravenous Therapy The National IntravenousTherapy Association will hold its Fifth Annual Convention on June 5-9 at the Marriott Hotel in New Orleans, Louisiana. For further information contact Susan Y. Thomason, Publicity/ Public Relations, The National IntravenousTherapy Association, Inc., 2202 W. Nash Road, Apt. 8-8, Wilson, NC 27893.
58
March/April 1977 JOCN Nursing
Educating graduate nursing students and medical residents together is, in practice, a rather new idea. The following is a report of the principles, philosophy, and implementation of such a progrum, the goal of which is to enhance the autonomy and eficacy of a Master‘s-level maternity nurse.
The clinical nurse specialist is the newest and least-documented role in modern nursing. The educational approaches and methods being used are uncertain and largely empirical in formulation. This, in turn, affects the operational definition of the clinical nurse specialist and, ultimately, the professional practice. Precise understanding of the clinical nurse specialist’s capabilities and responsibilities is presently in the critical process of evolvement, which calls for sound direction and scientific investigation in order to successfully develop the role. Hochheiser stated that the nurse in this expanded role could help provide less expensive care to a greater economic cross section of the population.’ These are two important stimuli to developing the role and should b e recognized as such. However, health care delivery personnel are realizing that the combination of the expertise of physicians and nurses is most effectively performed in a collaborative and collegial environment. It is to this end that the Boston College School of Nursing a n d H a r v a r d Medical School have joined in creating the Maternity/Pediatric ClinicaI Specialist Program. It is a committed effort to improve the quality of care that is being provided by promoting and encouraging this environment in graduate nursing and medical education. March/April 1977 JOGN Nursing
The uniqueness of this clinical nurse specialist program lies in the fact that graduate nursing students and medical residents are educated together. Didactic seminars, grand rounds, and clinical conferences are designed to promote the constant interchange of nursing and medical viewpoints to ensure a true integration of learning and health care delivery approaches. The development of physical assessment skills needed in providing primary care services is combined with in-depth examination of outstanding nursing theories. The purpose of this methodology is to provide the graduate student with the proper perspective in assimilating this advanced knowledge into a nursing framework that will become a basis for the functioning clinical nurse specialist. The program’s operation relies on the psychosocial-oriented nursing background rather than the disease-focused medical approach to learning, which we believe influences how the clinical nurse specialist will utilize this knowledge. The differences between nursing and medicine teaching methodologies have been frequently discussed, and it is the integration of both styles that the Boston College-Harvard Medical School program is constantly refining. W e accept the educational premise that there is a direct positive correlation between educational input
57
and level of decision-making3 To that end, the joint faculties have specifically designed this three-semester program to assist the nursing student in thc gradual development of the increased clinical decision-making proccss involvcd in the autonomous functioning of the clinical nurse specialist. This is a major factor in the successful acceptance of this expandcd role which is not always recognized and specifically dealt with.4 The Children’s Hospital Medical Center and the Boston Hospital for Women are co-sponsors of our clinical nurse specialist program and provide the bulk of the primary care clinical experiences. Realizing the individual needs and aspirations of students, the program offers additional cxperiences in community agencies, school systems, and Harvard-based maternity research projects, and a number of Harvard preceptors coopcrate by providing experiences within their individual practices. Students progress gradually from closely supervised patient encounters to independent care assessments requiring only faculty support and minimal guidance. The Boston College-Harvard Medical School program is aware of its rcsponsibility to promote the development of a scientific base for the clinical nurse specialist role. Research techniques and proper application to approved hypotheses furthering the study of the clinical nurse specialist is a required component of the core curriculum. Both Gortner and Schlotfeldt agree that the lack of clarity regarding nurs-
ing’s central focus is responsible for poor understanding of the nursing role and poor recognition and valuation of the consequences of “scientifically based, human nursing pract i c e ~ . ”It~is our interest to encourage true research and publication of findings as students and program graduates. The program is 5 years old and has graduated 39 nursing students to date. Resides the requirement of a baccalaureate degree in nursing, a minimum of 1 year‘s experience is advocated. Personal interviews with candidates by an admissions board of two Maternal-Child Health nursing faculty members and one Harvard physician explore the philosophy and aspirations of the applicants. It also permits the opportunity for the potential student to learn more about the program. A retrospective survey has recently been conducted on the past graduates; it not only focused on their assessment of the academic preparation they received for the positions they now hold, but also examined the range of positions, salaries and benefits, and physician-health care personnel relationships they are encountering. The results of the survey are yet to b e assessed. The Boston College Graduate Maternal-Child Health Nursing faculty and the Harvard Medical School Obstetric and Pediatric faculty are committed to the promotion of an improved health care delivery system, focused on the primary care of the mother and child through ” the expanded role of the nurse as a clinical
specialist. It is the aim and purpose of the program to prepare nurses at a Master’s level who will function with increased autonomy and with a higher level of decision-making ability. References 1. Hochht>iscr, Imuis: Proceedings of the N u r s r Practitioner Research Confcrence.” Farmington, Connecticut, Univcrsity of Connecticut Health Center. Nurs Outlook 23:177, 1975 2. Ratvs, Barbara: “Doctor and Nurse: Changing Roles and Relations.” N Engl.1 Med 283:130, 1970 3. Anderson, E. M., ef a/.:“Epigenesis of thtl Nurse Practitioner Role.” A m J Nurs 74:183, 1974 4. Williams, Carolyn A , : “Nurse Practitioner Research: Some Neglected Iss i l t s ’ ’ Nurs Outlook 23:173, 1975 5. Gortnt~, Susan R.: “Scientific Accountability in Nursing.” Nurs Outlook 22:764, 1974 “
Address reprint requests to Carol A. Smith, RN, Graduate, School of Arts and Scicwxs, Department of Nursing, Boston Cokge, Chestnut Hill, M A 02167.
Carol Smith is Coordinator of the Boston College School of Nursing-Harvard Medical School Clinical Nurse Specialist Program in Maternal-Child Health, and Chairman of the Graduate Department of Boston College School of Nursing, where she is also a candidate for a PhD in Higher Education. Her other professional activities include membershiv in NAACOG and ANA.
Intravenous Therapy The National IntravenousTherapy Association will hold its Fifth Annual Convention on June 5-9 at the Marriott Hotel in New Orleans, Louisiana. For further information contact Susan Y. Thomason, Publicity/ Public Relations, The National IntravenousTherapy Association, Inc., 2202 W. Nash Road, Apt. 8-8, Wilson, NC 27893.
58
March/April 1977 JOCN Nursing