The image of nursing has changed since the days of its founder, Florence Nightingale; however, the devotion is the same. Nursing as a profession, coupled with the men and women who make up its numbers, function as the first line of defense for their patients. Therefore, stewardship, governance, and advocacy for the profession must be employed by nursing leaders for its protection and progression.
Importance of Stewardship
The nursing profession is a vital component in functioning society, and nurses fill the roles of an educator, facilitator of care, administrator, counselor, and advocate. Nursing leaders have a pivotal role in the process of progress and change for the profession. They are the representatives and the face of their departments. They must exercise stewardship at the point of service while working to advocate for respectful interactions with patients and promote a just culture (Murphy, 2009). Stewardship is a concept that includes the philosophy of practical analysis and practice of serving others in such a way as to provide leadership while observing the shared values of the staff for which they are in charge. The staff is the intrinsic force in a department; therefore, its steward’s goal is to serve, protect, and perpetuate its growth and function (Murphy, 2009).
The steward at the point of service must be aware of challenges and differences while cultivating these aspects into objective and impartial practices. Nurse leaders and staff members can promote their practice while creating change by the effective communication of ideas and observations made on patient care. Further, the transformation of current practice into a more efficient delivery of care can be facilitated by open collaboration with nursing leaders and physicians. A realization that we are all in this together would serve to impact nursing in such a positive way.
Improving Nursing Through Shared Governance
Shared governance is a term that was introduced over twenty years ago and was used to provide actionable strategies to provide nurses with power over their practice. Shared governance is a collaborative strategy used by organizations to encourage nursing staff to manage their practice with a high level of commitment to practice (Green & Jordan, 2004). Further, the process of shared governance works to stimulate workplace advocacy, which operates at the local, state, and national levels of government. Without nurse leaders, staff participation, and the use of collective knowledge of patient care implications related to poor staffing ratios, policies will not change. Simply put, shared governance provides nursing with a vehicle to promote their collective voice.
The Leader and Advocacy
Nurses and nursing leaders are already aware that health care reform is needed. They are the first to see a breakdown in the efficiency and efficacy of patient care; therefore, it is the nursing profession’s collective responsibility to promote change (Abood, 2007). Further, to be an effective advocate for change, one must possess the desire, will, time, and energy required to engage in reform at the legislative level. There are a growing number of uninsured patients, a rise in the costs associated with providing quality care, and a continual decrease in the healthcare workforce. These problems impose a great strain on the nurses currently in practice. The strain further imposes the numbers of those who choose to be involved in reform. The current workforce is under excessive stress, which directly corresponds to a lack of interest in representing themselves or sharing their collective voice. Work stress aside, Abood asserts that nurses find it difficult to leave the comfort of their practice to engage in the battle to be heard by their legislators (Abood, 2007). However, without representation from the nursing leadership in practice, policies cannot be changed. It is the combined knowledge and field experience held by the nursing profession that is needed to influence those who make policies for change to occur.
Nursing leadership will encounter greater challenges in the near future. The management of human capital, digital technology advancement, and cost control are three of the major challenges and opportunities that nursing leaders will face in the 21st Century (Lee, Daugherty, and Hamelin, 2017). Nursing leaders will play a critical role in transforming healthcare through active participation on the nursing units and in executive boardrooms. Critical issues, such as an aging population and the nursing shortage, continue to be prevalent in the United States and globally. Therefore, nursing leaders will need to address issues that affect retention and create new ways to promote the profession.
Nursing leaders need to expand upon the foundation created by nursing pioneers such as Florence Nightingale. The integration of shared governance into the workplace begins with the nursing leader. There also needs to be a collective effort to revise and reform policies at all levels of administration within an institution and our state and national governing bodies. There is a legacy to uphold. By joining state nursing associations and showing solidarity, the profession can serve the public in a much larger capacity. The nurse leader has many challenges ahead. In taking pride at the bedside, the nurse has the power to impact not just those that he or she serves, but to the families, administrators, and peers alike. Our presence can be our voice, as well.
Our first Nurse of the Week in 2021 is a nursing icon. On December 27—the day before her 100th birthday—AAN Living Legend Loretta C. Ford, EdD, RN, PNP, NP-C, CRNP, FAAN, FAANP was awarded the Surgeon General’s Medallion for exceptional achievement in the cause of public health and medicine.
Dr. Ford, who helped to create the first NP program at the University of Colorado in 1965, is regarded as a co-founder of the Nurse Practitioner (NP) profession. As a public health nurse in the 1940s and 1950s, she became concerned about Colorado’s underserved rural communities, and came to believe that with specialized training, nurses could help to fill the gap. Ultimately, Ford and pediatrician Henry Silver joined forces to found the University of Colorado pediatric NP program and the NP profession itself. Ford’s pathblazing role has led to numerous honors. She was the inaugural member of the Fellows of the AANP (FAANP), a special title reserved for providers that have made a lasting impact on the NP profession, and in 2003, she received a Lifetime Achievement Award from the journal Nurse Practitioner. In 2011, she was inducted into the National Women’s Hall of Fame, which acclaimed her for having “transformed the profession of nursing and made health care more accessible to the general public.”
Ford’s latest award, the Surgeon General’s Medallion, is the highest honor granted to a civilian by the Public Health Service and the U.S. Public Health Service Commissioned Corps. AANP President, Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP commented, “Dr. Ford has received this recognition for her vision and commitment to the health of our nation. Thanks to her trailblazing efforts, millions of patients have access to high-quality health care from NPs, the provider of their choice, and the profession has grown to more than 290,000 strong.”
David Hebert, JD, Chief Executive Officer of AANP, added, “As we celebrate Dr. Ford’s 100th birthday, I can’t think of a more fitting tribute to this titan of American health care. From co-creating the NP profession to advocating for patient access to NP care, she has played a profound role in strengthening health care access and choice for America’s patients.”
Online education has become a fact of life during the pandemic, and on-campus nursing schools have been looking to online institutions for guidance. What should on-campus nursing programs know about the challenges of remote instruction, and what lies ahead for online teaching? DailyNurse asked Dr. Camille Wendekier, Program Director and associate professor for the Online Masters of Science in Nursing at Saint Francis Universityand Dr. Tom Kannon, Program Director of the Online Psychiatric Nurse Practitioner Program at Regis College to share their perspectives on distance education in the COVID era.
What are the greatest challenges that nursing instructors face when teaching in a virtual environment? What measures can they take to overcome these challenges?
Dr. Tom Kannon, Regis College: When teaching in the online learning environment, you have to remember that, for the majority of the time, the students don’t have that tangible face-to-face interaction with the instructor. Most courses are asynchronous, and it can create a bit more anxiety for the student than a regular class as they cannot simply raise their hand to get clarification for something on the spot.
As an instructor, you have to be mindful that students are in and out of the course at all hours of the day and night, and will email with questions at all hours. It is best to try to keep to a schedule for replying, such as all emails will be responded to within 24 hrs. It is also necessary to still have scheduled virtual office hours that provided a more tangible connection to the instructor if help is needed. Another necessity is to have a contact list for technology support.
Above all else, clear communication is vital. Things happen, it’s inevitable, but communicating with the students that an issue is known and is being worked on, and providing updates, does a tremendous amount to quell uncertainty and anxiety. One major adaptation has been the need to provide greater flexibility in the clinical arena. Regis implemented use of various simulation experiences to meet some of the requirement, and implemented expanded use of telehealth for precepting to try to enhance the ability for students to achieve meaningful clinical hours towards meeting competencies.
Dr. Camille Wendekier, St. Francis University: The biggest challenge in a virtual environment is maintaining the personal student connection. Nursing faculty can offer small group and individual tutoring via video conference applications such as Google Meet or Zoom. The ability of the course instructor to mentor reasoning and knowledge construction can move students beyond using rote memory associated with passive learning activities such as reading or watching recorded lectures.
Video sessions also offer students an opportunity to introduce themselves on a personal level… Such activities help the course instructor and students better understand the uniqueness of each person in the class and the unique contributions each student can make to the learning experience. Knowing each other on a more personal level can help add excitement to learning, which could improve the metacognition associated with learning.
The other challenge is providing for testing security during stay-at-home orders. There are many companies that offer remote testing services, but several of these companies were unable to offer their services during the pandemic, so schools needed to investigate alternative options. It is important to adopt a secure testing application that has a good workflow for both the faculty and students. In addition to workflow, it is also important to consider the Internet requirements of each application in relation to Internet resources that students have at home… [so students] can take the test without losing connectivity.
In the wake of the accelerated changes brought on during the pandemic, what are the key developments in online education that you hope/expect to see over the next 5 years?
Dr. Tom Kannon, Regis College: I hope to see greater inclusion/implementation of telehealth/teleprecepting for students. The COVID pandemic has shown us how quickly providers can adapt to using telehealth and how successful it has been in maintaining provision of care to millions of people.
I expect that for an institution to stay successful and positively impact their students’ education, all courses will be interchangeable between live and online, with maybe more of a mix of synchronous and asynchronous courses. I also expect to see a growth in the creation of more robust clinical simulation experiences that colleges/universities can tap into to provide greater flexibility to their students.
Dr. Camille Wendekier, St Francis University: Key developments in online education over the next five years may include:
Requiring faculty to obtain Distance Education Certification—either offered by the University or by an outside entity.
Utilizing more Virtual Clinical Simulations as allowed by State Boards of Nursing and accrediting agencies. These simulations will improve over the years with the use of more avatars and more critical thinking virtual experiences.
Utilizing more Google Meets or Zoom sessions to provide for more personalized classes and office hours. These videoconference sessions allow the course instructor and students to interact in real-time and discuss the course information in relation to individual learning needs.
Peggy Compton, Ph.D., RN, FAAN has been selected as one of the US nurses to be inducted into the International Nurse Researcher Hall of Fame, which will recognize 19 new members at the Sigma Theta Tau International (STTI) 31st International Nursing Research Congress on July 25.
Compton’s research—grounded in her practice as a neuropsychiatric nurse in different public treatment settings—specializes in the study of pain and opioid addiction, with a particular focus on the effects of addiction on the functioning of human pain systems. Her award from STTI recognizes her valuable contributions in the field, including the development of key tools such as family/personal histories of addiction and the consideration of psychiatric disorders and opioid use patterns to assess the presence of and potential for substance use disorders, as well as her study of opioid-induced hyperalgesia in patients on chronic opioid therapy. According to Penn Nursing Dean Antonia Villarruel, “Dr. Compton is one of the few nurses working in the area of pain, opioids, and addiction and how they intersect. She has built a significant program of research that includes one of the most widely used tools available to physicians and nurse practitioners to evaluate risk for misuse of prescription opioids in chronic pain patients.”
Compton is currently on the faculty of the University of Pennsylvania School of Nursing Psychiatric Mental Health NP program. She received her BSN from the University of Rochester before earning an MS from Syracuse University, a PhD from New York University, and completing a post-doctoral fellowship in substance use disorders at the University of California at Los Angeles. Of her award, she says, “I am honored to receive this most prestigious award, which represents a pinnacle in the career of a nurse scientist. Not only does it reflect the importance of nursing research in addressing critical public health issues, but also the profession’s commitment to meeting the needs of vulnerable, underserved and sometimes stigmatized patient populations, such as those with addiction and pain.”
For a full listing of the 2020 inductees into the International Nurse Researchers Hall of Fame, see the announcement at the Sigma Nursing site.
Nurses receive some disaster training, but as one New York nurse recently remarked, “We learned about a pandemic in school maybe for one day. Like it was literally one slide in one class…” Remedying this problem is a key concern in the Johns Hopkins report, “Recommendations for Improving National Nurse Preparedness for Pandemic Response: Early Lessons from COVID-19” and educators are already taking steps to add pandemic coverage to disaster nursing curricula. DailyNurse spoke to one of these educators, a member of the reporting team, Dr. Tener Goodwin Veenema, PhD, MPH, MS, CPNP, FAAN, about her role in the effort to update disaster training and education for the COVID-19 era. Dr. Veenema is a contributing scholar to the Johns Hopkins Center for Health Security, Professor of Nursing and Public Health, and author of the textbook Disaster Nursing and Emergency Preparedness.
DN: What sort of changes are you proposing in terms of disaster education and training?
TGV: I’ve been writing disaster nursing courses since before 9/11. And of course the focus after 9/11 was much more on deliberate acts of terrorism, and there was concern over natural disasters as always—pretty much the way the book [Emergency Nursing and Disaster Preparedness] was laid out—chemical, biological, and radiation events that may be human-caused. But now, because of the pandemic, the shift has really become much more public health focused.
Clinical nurses actually have to be public health nurses as well.
[At present], nurses get infection prevention and control coverage in school, but it’s at an introductory level. It’s not to the degree of what we’re experiencing now, where clinical nurses actually have to be public health nurses as well. So, we need to give nurses a better understanding of advanced concepts in infection control and prevention, and how to implement what we call intervention and containment strategies—non-pharmaceutical interventions, which includes things like social distancing, the use of masks, and frequent handwashing; closure of schools and businesses, and parks where people congregate.
More than anything else, the pandemic reveals where nurses did not have experience with the proper selection and use of personal protective equipment. It goes beyond nursing. Some of these problems were outside of nursing, for instance, the hospitals had failed to make a real commitment to emergency preparedness—to procure adequate supplies of PPE, or ensure that they had a vendor supply chain that would allow them to ramp up if they needed to order more. So, what I am advocating—and I’m working on a course right now—is to address these issues and strengthen prelicensure and nursing schools, and also continuing education to ensure that nurses have the knowledge and skills that they need not only to participate and survive, and protect themselves in this pandemic, but in future infectious disease outbreaks as well.
DN: As you mentioned earlier, there are many different sorts of disasters. Is there some sort of tool-kit that can increase nurses’ readiness in whatever emergencies might arise?
TGV: I define a prepared nursing workforce as a workforce that has the knowledge, the skills, the abilities, and the willingness to respond to these types of events. FEMA advocates what is called an “all-hazards” approach to disaster planning, which means that communities are charged with coming up with disaster response plans to address each and every hazard that might occur in their geographical area. Now for nurses, I think that they need to have a minimum knowledge base and set of skills on how to respond in an emergency and on how to continue to provide healthcare services within an environment that may or may not be safe.
The thing about a pandemic… is that it’s characterized by uncertainty…. Also, it’s everywhere.
I think that the challenge for the pandemic is, when a tornado or a hurricane hits, the event happens, and then it’s over. We move through the phases of the disaster lifecycle in a pretty straightforward manner. So, even the most horrific hurricanes that we’ve experienced over the past three years, they end. There have been extended periods of recovery—you can make the case that Puerto Rico has not yet recovered from Hurricane Maria—but you can plan for what’s going to happen. The thing about a pandemic, though, is that it’s characterized by uncertainty. For instance, we were anticipating a second wave this fall, but what we’re seeing is, we haven’t finished the first wave, and things are spiking again.
Also, [unlike most disasters, with a pandemic] it’s everywhere; it’s not geographically isolated in one region of the country. And of course, given the total absence of leadership at the federal level, now you have [states that are] basically 50 countries that are forced to address 50 different pandemics. That’s not the way you do it, so we’re failing there.
DN: Nurses have historically been on the front lines of response to disasters. What can be done to adapt the curriculum to provide them with better training and support for nursing in emergency and disaster situations?
TGV: I’m working hand-in-hand with AACN to help write an emergency preparedness competency to go into the revised Essentials document, so that schools of nursing will have a competency to teach to. AACN does a wonderful job with the Essentials documents, which basically serve as guides for curricula for nursing schools. I’m so proud to be working with them to help revise the essentials, publish this report, and then work on developing a five-module course with a company called Unbound Medicine. I produced a disaster nursing app with them back in 2015, and now I’m working with them to produce course content that schools can use to add to their existing courses or add as a standalone certificate to help provide this important information for schools that may not have the resources or the faculty who know how to develop this content or teach it—we’re hoping to do a great service for some of these schools.
DN: You mentioned the uncertainty of nursing in a pandemic. Where are we now?
TGV: We’re not through this. You’ve got California, Texas, Florida, and Arizona on the brink of being completely overwhelmed, and the Carolinas are right behind them. So the next month is going to be very ugly in the United States.
DN: What can individual nurses do to increase their readiness for pandemics?
TGV: They can pursue ongoing education and training as it relates to pandemic preparedness and response. Some of the professional nursing organizations are now offering short courses. I developed one with the National Council of State Boards of Nursing (NCSBN), and we have more that will be coming out.