What is happening to Florence Nightingale?

These thoughts about nursing and health care today have been bouncing around in my head for a couple weeks. I've talked to others about it--some nurses, some not. I've read some words of wisdom in professional journals and news magazines. As often happens, when one is mulling over a topic, related items tend to pop up. I've tried to remain objective, but probably failed a time or two. I don't even pretend to have the answers, and I'm just starting to formulate the questions. Just shy of 2 weeks ago, my hubby had surgery to remove a kidney stone. A relatively simple procedure for the most part, we were told, but he has certainly shouldered his share of complications since then. Nothing life threatening, for which I am very grateful, but frustrating, painful, and limiting. My experiences have led me to wonder at how much nursing, and nursing education, have changed. As nurses, we serve as caregivers, resources, advocates. We take on the responsibility of interviewing, assessing, intervening, preventing, teaching and encouraging. In the past 2 weeks, I have seen many nurses in a variety of settings. There were nurses who rose to the challenges and deserve high accolades, one who dodged every responsibility and blamed it all on being too busy, and many who just floundered somewhere in the middle--doing the best they could and trying to smile. I've observed nurses who can do all the right things, but seem to have no ides WHY they do them. It is difficult to promote a successful recovery if one cannot recognize the abnormal. We can educate our nurses to handle all the technical machinery now available in medicine, and teach them the procedures and protocols they may encounter with a specific diagnosis or illness, but that illness is not the patient. The PERSON experiencing the medical challenge needs to be visualized as a whole, or the entire plan of care is compromised. Are we educating our nurses to fully examine the big picture? It would seem, in many ways, we may not be. Are we offering adequate hands-on clinical experience to our learners, or cramming too much into a short course of study in the hopes that they will "pick it up" on the job? For years we have heard about short staffing, increasing patient acuity, higher patient loads, and cost-cutting at every corner. That has never been truer than today. New nurses are set adrift in a sea of confusion, often with inadequate clinical experience to even recognize their own learning needs. Good preceptors, when they can be found, are overworked, overscheduled, often caring for their own full patient load. Senior nurses are being passed over or forced out in favor of newer, less experienced, CHEAPER alternatives, in the hopes that these fresh young caregivers will somehow catch on before they burn out. Many nurses who have been in the trenches for years have a wealth of knowledge to share, but are no longer willing to tolerate the conditions in which they find themselves. In frustration, they retire, go to less acute care settings, or to other professions. The best resources our profession has to offer are fleeing the field, and leaving a gaping wound behind them. The American Nurses Association is pushing for mandatory Bachelors Degree preparation for entry-level nurses. At the same time, many for-profit colleges have flourished across the country, offering lower admission standards and available loan financing for their high cost, shorter programs. One has to wonder if the quality of education can rival their more selective counterparts. It's a topic which draws heated debate, both pro and con. People point to the national nursing shortage and fear we are setting ourselves up for even more dangerous care levels if we demand expanded programs. In addition, we are on the upswing of a physician shortage, and many believe the new national health care mandates will do nothing but worsen an already tenuous situation. We can look to other professions, such as teaching, and ask if the mandatory graduate level education demand has had a positive impact on the vocation. Will demanding a higher level of education result in a higher level of nursing care? In this time of national upheaval in health care, can we afford to demand more years of preparation in order for a nurse to join the already stretched-thin ranks on the front line? A better question might be, can we afford not to?