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Sharing the Lessons From the Past
Editorial
www.jpedhc.org
Sharing the Lessons From the Past Bobbie Crew Nelms, PhD, RN, CPNP At this past spring’s NAPNAP conference in Washington, DC, I had the wonderful opportunity to hear Barbara Safriet, JD, LLM, speak on “Advanced Practice Nursing: Lessons Learned and a Look to the Future.” If you were at that luncheon I’m sure you too went away feeling inspired (and entertained), reflecting on how far the nurse practitioner movement has come, yet aware of the continuing challenges ahead. During that same conference and since returning home, I have had the opportunity to speak with a number of PNP students and new practitioners facing the challenges of their new preceptorships and jobs. It has become clear to me that those of us who have been nurse practitioners for a long time have not done a very good job sharing the history of the role evolution with these new practitioners . . . and that’s a problem, because knowledge of the past can better prepare them to understand the present professional challenges and to prepare for the future. For example, one new graduate was describing how she used prescriptions presigned by a physician. She didn’t see this as an issue at all; it was “no big deal.” I shuddered thinking of
all those nurse practitioners over the years who have fought for full prescriptive privileges. All their hard work and this new graduate didn’t even seem to know or care about it! Ms. Safriet’s presentation touched on several of these critical challenges of the past, important issues that we need to share with both the nurse practitioner students of today and the new graduates. For example, she reminded us of the history of the struggles with medicine’s versus nursing’s scope of practice issues, emphasizing that it should be one’s ability, knowledge, and skills that determine one’s scope of practice. Such a view could minimize turf fights over who is infringing on the other’s scope of practice. These are the lessons we need to share with those new practitioners. Unfortunately, some courses on role development in graduate nursing programs only focus on the roles of today and do not include the important lesson of the past, with discussions of how the role got to where it is today—the battles, the defeats, and the victories. I think it’s time we start bringing some of the challenges of the past into today’s discussions. I think it
J Pediatr Health Care. (2006). 20, 291-292. 0891-5245/$32.00 Copyright © 2006 by the National Association of Pediatric Nurse Practitioners. doi:10.1016/j.pedhc.2006.05.009
Journal of Pediatric Health Care
would be a good idea for NAPNAP chapters to have “Remember When” discussions where a “seasoned” nurse practitioner (one who has been in practice since early in the development of the role) can share a specific example of a struggle they faced. I don’t mean a boring history lesson, I’m proposing a case study—a specific example of what early practice was like. Another approach might be to do “Pearls From the Past” in newsletters, in which someone can describe the struggles/challenges of practice during the early years of the nurse practitioner role. Hopefully such approaches can help new graduates and students avoid taking the role for granted. There hasn’t always been such a role, and it has taken lots of hard work to promote its development. I was thrilled to see the large number of new nurse practitioners at the recent NAPNAP conference, now I just want to be sure they have the knowledge of the role’s history so they can be ready to take on those challenges in the future and develop the role even further! I would suggest that these history lessons cover a variety of important topics. There have been major developments and changes in the role and all these should be explored. For example, it is important to share the challenges we have faced regarding prescriptive authority. It certainly wasn’t a given for the early pioneers in the role, and today some states still lack full prescriptive authority for nurse practitioners; a discussion of the struggles of the past may help inspire those in states with work yet to do. Hopefully, it will also help the new graduate see that having physician pre-signed prescriptions is not only not OK but that it takes us backward not forward in the quest to achieve full prescriptive authority. September/October 2006
291
Scope of practice issues also can be investigated, looking at what the state’s current scope of practice is and how it got that way. If possible, it would be interesting to have a discussion with those nurses who lobbied for the changes and get their ideas about what yet needs to be done—and how to get there. Another aspect that could be included in such discussions is the issue of collaborative practice versus supervised practice; these are very different concepts and have important implications for practice and professional autonomy. Changes in the level of education required to practice could also lead to an interesting discussion, especially in terms of today’s movement toward the clinical doctorate. It would be interesting to hear about some of the early continuing education programs, what was included and what wasn’t, including the internships that were common. Or it could be inspiring to hear the struggles of those early practitioners who took on the challenge of going back for their master’s degrees while practicing in the role. How were they treated? What were their challenges? What did they think of the education they received? These will be important discussions, as we look to
292 Volume 20 • Number 5
the challenge of future changes in educational requirements for practice. Another lesson that would be important to share would be the expansion of the role: from the days of only being able to provide well-child care to today’s choice of acute and subspecialty care options, in addition to providing full primary care (well- and ill-child care). Learning about how this role expansion occurred and what factors supported it can help us look to the role changes in the future. Certainly these changes in role have been accompanied by changes in education preparation, certification, and continuing education requirements. An understanding of the interrelationships of all these aspects is critical to full understanding of how the role has evolved. Even the development and expansion of NAPNAP could be an interesting area to explore, including the founding of the certification board (now the National Certification Board for Pediatric Nurses), as well as the NAPNAP Foundation. Even today I often see on resumes that a person is certified by NAPNAP! NAPNAP has never been a certifying body and I find it sad that practitioners may
not know which organization has certified their clinical competence. This is certainly not an exhaustive list of important areas to address from a historical perspective. Topics such as costs of malpractice insurance and debates about licensing versus certification (especially today in terms of the National Council of State Boards of Nursing’s vision paper, “The Future Regulations of Advanced Practice Nursing”) should be explored. By understanding the historic issues, the implications of the challenges today are clearer. So, as fall activities begin for NAPNAP chapters and other professional groups, I encourage you to consider how to highlight some of these issues from the history of the role development. I think such discussions can be informative and interesting, and they can better prepare the newer practitioners to consider the past as they take on today’s professional challenges. Once again, the “seasoned” nurse practitioners can serve as important mentors for the new clinicians. I have certainly learned from those early pioneers and hope to share their challenges, frustrations, and accomplishments with these new practitioners. I think this sharing of history will be fun.
Journal of Pediatric Health Care
www.jpedhc.org
Sharing the Lessons From the Past Bobbie Crew Nelms, PhD, RN, CPNP At this past spring’s NAPNAP conference in Washington, DC, I had the wonderful opportunity to hear Barbara Safriet, JD, LLM, speak on “Advanced Practice Nursing: Lessons Learned and a Look to the Future.” If you were at that luncheon I’m sure you too went away feeling inspired (and entertained), reflecting on how far the nurse practitioner movement has come, yet aware of the continuing challenges ahead. During that same conference and since returning home, I have had the opportunity to speak with a number of PNP students and new practitioners facing the challenges of their new preceptorships and jobs. It has become clear to me that those of us who have been nurse practitioners for a long time have not done a very good job sharing the history of the role evolution with these new practitioners . . . and that’s a problem, because knowledge of the past can better prepare them to understand the present professional challenges and to prepare for the future. For example, one new graduate was describing how she used prescriptions presigned by a physician. She didn’t see this as an issue at all; it was “no big deal.” I shuddered thinking of
all those nurse practitioners over the years who have fought for full prescriptive privileges. All their hard work and this new graduate didn’t even seem to know or care about it! Ms. Safriet’s presentation touched on several of these critical challenges of the past, important issues that we need to share with both the nurse practitioner students of today and the new graduates. For example, she reminded us of the history of the struggles with medicine’s versus nursing’s scope of practice issues, emphasizing that it should be one’s ability, knowledge, and skills that determine one’s scope of practice. Such a view could minimize turf fights over who is infringing on the other’s scope of practice. These are the lessons we need to share with those new practitioners. Unfortunately, some courses on role development in graduate nursing programs only focus on the roles of today and do not include the important lesson of the past, with discussions of how the role got to where it is today—the battles, the defeats, and the victories. I think it’s time we start bringing some of the challenges of the past into today’s discussions. I think it
J Pediatr Health Care. (2006). 20, 291-292. 0891-5245/$32.00 Copyright © 2006 by the National Association of Pediatric Nurse Practitioners. doi:10.1016/j.pedhc.2006.05.009
Journal of Pediatric Health Care
would be a good idea for NAPNAP chapters to have “Remember When” discussions where a “seasoned” nurse practitioner (one who has been in practice since early in the development of the role) can share a specific example of a struggle they faced. I don’t mean a boring history lesson, I’m proposing a case study—a specific example of what early practice was like. Another approach might be to do “Pearls From the Past” in newsletters, in which someone can describe the struggles/challenges of practice during the early years of the nurse practitioner role. Hopefully such approaches can help new graduates and students avoid taking the role for granted. There hasn’t always been such a role, and it has taken lots of hard work to promote its development. I was thrilled to see the large number of new nurse practitioners at the recent NAPNAP conference, now I just want to be sure they have the knowledge of the role’s history so they can be ready to take on those challenges in the future and develop the role even further! I would suggest that these history lessons cover a variety of important topics. There have been major developments and changes in the role and all these should be explored. For example, it is important to share the challenges we have faced regarding prescriptive authority. It certainly wasn’t a given for the early pioneers in the role, and today some states still lack full prescriptive authority for nurse practitioners; a discussion of the struggles of the past may help inspire those in states with work yet to do. Hopefully, it will also help the new graduate see that having physician pre-signed prescriptions is not only not OK but that it takes us backward not forward in the quest to achieve full prescriptive authority. September/October 2006
291
Scope of practice issues also can be investigated, looking at what the state’s current scope of practice is and how it got that way. If possible, it would be interesting to have a discussion with those nurses who lobbied for the changes and get their ideas about what yet needs to be done—and how to get there. Another aspect that could be included in such discussions is the issue of collaborative practice versus supervised practice; these are very different concepts and have important implications for practice and professional autonomy. Changes in the level of education required to practice could also lead to an interesting discussion, especially in terms of today’s movement toward the clinical doctorate. It would be interesting to hear about some of the early continuing education programs, what was included and what wasn’t, including the internships that were common. Or it could be inspiring to hear the struggles of those early practitioners who took on the challenge of going back for their master’s degrees while practicing in the role. How were they treated? What were their challenges? What did they think of the education they received? These will be important discussions, as we look to
292 Volume 20 • Number 5
the challenge of future changes in educational requirements for practice. Another lesson that would be important to share would be the expansion of the role: from the days of only being able to provide well-child care to today’s choice of acute and subspecialty care options, in addition to providing full primary care (well- and ill-child care). Learning about how this role expansion occurred and what factors supported it can help us look to the role changes in the future. Certainly these changes in role have been accompanied by changes in education preparation, certification, and continuing education requirements. An understanding of the interrelationships of all these aspects is critical to full understanding of how the role has evolved. Even the development and expansion of NAPNAP could be an interesting area to explore, including the founding of the certification board (now the National Certification Board for Pediatric Nurses), as well as the NAPNAP Foundation. Even today I often see on resumes that a person is certified by NAPNAP! NAPNAP has never been a certifying body and I find it sad that practitioners may
not know which organization has certified their clinical competence. This is certainly not an exhaustive list of important areas to address from a historical perspective. Topics such as costs of malpractice insurance and debates about licensing versus certification (especially today in terms of the National Council of State Boards of Nursing’s vision paper, “The Future Regulations of Advanced Practice Nursing”) should be explored. By understanding the historic issues, the implications of the challenges today are clearer. So, as fall activities begin for NAPNAP chapters and other professional groups, I encourage you to consider how to highlight some of these issues from the history of the role development. I think such discussions can be informative and interesting, and they can better prepare the newer practitioners to consider the past as they take on today’s professional challenges. Once again, the “seasoned” nurse practitioners can serve as important mentors for the new clinicians. I have certainly learned from those early pioneers and hope to share their challenges, frustrations, and accomplishments with these new practitioners. I think this sharing of history will be fun.
Journal of Pediatric Health Care