An open mind, discussion, debate and the testing of new ideas: The way of the future
Article Outline
Globally social and health systems are rallying to address the tsunami of chronic disease and the burden of population ageing (Partridge, Mayer-Davis, Sacco, & Balch, 2011). Although technology and innovation have rampaged ahead in scientific advances, our health and education systems have been slower to adapt to changing times. In the scholarly literature and popular press we are continually reminded of the frailties and inadequacies of our health care system and nurses are often the target of criticism (Jackson & Daly, 2008). In particular the method and standards of educational preparation of nurses has been a focus of discussion and debate (Shields, Purcell, & Watson, 2011). Current methods of nursing education in universities, have been accused of failing to prepare nurses for the challenges of contemporary health care systems. These censures can be readily challenged as they commonly fail to address the broader social, political and economic contexts that shape the role and scope of health care and specifically nursing and midwifery practice. Albeit important, nursing and midwifery education is only but one dimension of the complex mosaic of contemporary health care systems. Therefore considering methods of nursing and midwifery education in isolation from other factors influencing health care systems is futile and a disservice to the communities we serve.
Recently there have been several reports providing a vision for reform for nursing education. An independent, multidisciplinary Lancet Commission, led by Drs Frenk and Chen, have identified that curricula for all health professionals require reform at both the instructional and institutional level. In particular this report argues for a “new professionalism” that uses competencies as the criterion for classifying health professionals (Frenk et al., 2010). Promotion of interprofessional and transprofessional education that breaks down professional silos and promotes team work and collaboration is seen as the way of the future. The Lancet report also argues an organisational shift from academic centres to academic systems, particularly those that embrace the primary care sector. This infers a more system-based, person-focussed approach to care, rather than our current approach organised to meet the needs of professions and institutions that are commonly engaged in protective behaviours (Frenk et al., 2010).
This report also challenges traditional hierarchical structures and systems of power (Frenk et al., 2010). This report paints a positive future for nursing and midwifery. Within this system likely our roles will flourish, particularly if we focus on the needs of patients, their families and communities and ensure that we operate in a competency based, credentialed framework. An increasing body of research demonstrates that nursing and midwives have been responsive to the needs of modern society, through developing, evolving and striving for competency based frameworks and challenging traditional professional boundaries (Allen and Dennison, 2010, Homer et al., 2002). In order to undertake research of this scope it is critical that nurses and midwives are prepared to undertake rigorous science.
In 2008, The Robert Wood Johnson Foundation and the Institute of Medicine in the United States launched a two-year initiative to respond to the need to assess and transform the nursing profession. The Future of Nursing: Leading Change and Advancing Health (IOM (Institute of Medicine), 2011) explored how nurses’ roles, responsibilities, and education are required to adapt in order to meet the increased demand for health care and the increasing complexity of the health care system. This report recommends that nurses should achieve higher levels of education and partner with physicians and health professionals in reconfiguring health care systems to meet the needs of consumers. An important recommendation is that nurses should practice to the full extent of their education and training.
In England, there has also been a report by the Prime Minister's Commission on the Future of Nursing and Midwifery in England (2010). This report developed a value-based vision of the future that sees nurses and midwives in the mainstream of service planning and development. This report provided 20 high-level recommendations including the need for high quality care and innovation.
In Australia, a healthier future for all Australians (National Health and Hospitals Reform Commission, 2009), the final report of the National Health and Hospital Reform Commission documented a system under increasing pressure and as one of the goals for reform called for a modern, learning and supported workforce to support an agile and self-improving health system. As part of reforms Council of Australian Governments (COAG) has established Health Workforce Australia to meet the future challenges of providing a health workforce that is responsive to contemporary needs.
Many of these aforementioned reports have noted the legacy views of health and also the professional domains of education and professional practice. They have also demonstrated that health care reform requires innovation and collaborative solutions not merely in the education sphere but in policy and practice as well. As part of developing and testing solutions to these problems we need scholarly debate and empirical testing of new ideas. This is an important part of achieving health care reform.
Although we have a complex documentation of the challenges faced by our health care system, solutions are less well articulated. It is increasingly apparent that nurses and midwives will play a critical role in the interprofessional and transprofessional health care teams of the future. But to credibly achieve leadership roles in these new models we will require open minds and be prepared to discard some of our previous traditions. We will also need to ensure that the evidence informing our practice is rigorous and sound and that we maintain the respect and regard of the communities we serve.
In Australia, the Royal College of Nursing Australia and Collegian, provide a voice for discussion and debate of issues facing contemporary health care. Having a forum for this professional debate and discussion is crucial in advancing our roles in health care systems, not merely in Australia but also on the global stage. In this edition, there are papers that address the challenge of doing things in a better way and of striving to address the needs of individuals and communities. Wilkinson (2011) provides an important overview of issues facing nurse prescribing in New Zealand and the need to consider past lessons.
Moving beyond documenting failures and developing and testing viable solutions are important issues for nurses and midwives working in policy, practice, education and research. These strategies are important for ensuring the health and well being of the global community. In order to achieve this we have to respectfully acknowledge the past, be open to criticism and debate and be prepared to change the way we do things and evaluate whether these need approaches are efficacious and effective.
In spite the challenges outlined in recent reports (Frenk et al., 2010, IOM (Institute of Medicine), 2011, Prime Minister's Commission on the Future of Nursing and Midwifery in England, 2010), we live in exciting times. Nurses and midwives have traditionally practiced in person-centred models and in teams, so we are well placed to advance the recommended health care reforms. We also need to reach beyond our work place to ensure that we help our colleagues in developing nations as in our globalised world the health and welfare of EVERY INDIVIDUAL is inextricably linked. Nurses and midwives need to position ourselves in policy, practice, research and education to ensure that in this agenda of health care reform, we retain our professional, goals and values and ensure that the health and well-being of individuals, families, and communities is the focus of our activities.
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PII: S1322-7696(11)00054-0
doi:10.1016/j.colegn.2011.09.007
© 2011 Royal College of Nursing, Australia. Published by Elsevier Inc. All rights reserved.
