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Pushing the Envelope

Judith Effken

The American Academy of Colleges of Nursing (AACN) recently made several recommendations, including encouraging “Fast Track” BS to PhD programs, creating a new practice doctorate and creating a new role, that of clinical leader.  Why the changes and why now?

The fast track BS to PhD program may be the easiest to understand, for it aims at more quickly filling our critical need for nurse scientists and nurse educators.  Traditionally, nursing has thought it necessary for nurses to move in lock step through baccalaureate, masters, and doctoral education.  However, many are now questioning that logic, arguing that clinical practice can be obtained at any point in the nurse’s career, in conjunction with the advanced education.  Further, why not help students who are clearly focused on an academic or research career to move into that career while they are young, enthusiastic and have many years of productive time ahead of them?

The papers in this issue of JUNS provide excellent support for this argument, I think.  These authors represent the best and brightest of our nursing students and demonstrate that undergraduates can indeed conduct meaningful research.  These are precisely the kinds of students that should be encouraged to pursue doctoral education early in their careers, rather than later.

The new practice doctorate has been proposed to increase the expertise of nurse practitioners, putting them on a more even footing with physicians and other health care professionals.  It is difficult for nurses to collaborate with colleagues when there are disparities in their education.  This new degree will serve to even the playing field.

The new clinical leader role also serves to even the playing field for nurses, but at the same time provides them with additional education so that they can act as case managers for groups of patients, facilitating their care across the continuum.  The additional year of education that is proposed is clearly needed in the current health care climate in which managing patient’s trajectories is so needed.  I recently learned of a doctoral student at the University of Washington who is studying the “work of patients” who are undergoing chemotherapy for breast cancer.  I await the results of his study eagerly and applaud the insight he has shown in exploring the topic.  Any of us who have had to work our way through the health care system lately will attest to the work of patients as they navigate the system—and we are in the field!  The clinical leader role is one that can specifically assist patients to navigate the healthcare system more efficiently and safely and perhaps reduce the burden of work they currently must assume.

One might ask, why now?  Why should we initiate new roles when we have an acute nursing shortage?   Certainly, nursing education will be challenged to prepare nurses to take on these roles.  But what better time can there be, when the shortage of nurses makes the need so acute?   In crises, there are opportunities—and this shortage is of crisis proportions.  But the result is that nursing, because of its absence, has become much more visible—and therefore fundable.   Increasingly we are seeing new collaborations emerge between schools and community agencies to support new educational programs because both stand to gain.

If you are in a nursing program now, this is the time to think big!  If you have a question that you really want to answer through research, consider getting a research doctorate (PhD)!   If you anticipate working as a nurse practitioner, consider a practice doctorate.  Not only do these degrees provide you with an incredible amount of additional knowledge and experience, but they provide career opportunities that can only be imagined.

So, if advanced nursing education might be in your future, think about the many new educational opportunities that are unfolding.  One of them might be just right for you!   

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