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The Nurse's Reality Gap Chapter 6: The Chasm in Nursing

The Nurse's Reality Gap Chapter 6: The Chasm in Nursing

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Published by Brent Patrick
By Leslie Neal-Boylan, PhD, CRRN, APRN-BC, FNP
By Leslie Neal-Boylan, PhD, CRRN, APRN-BC, FNP

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Categories:Types, Research
Published by: Brent Patrick on Apr 01, 2013
Copyright:Attribution Non-commercial


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Chapter 6
The Chasm in Nursing
I once conducted a qualitative research study o elder nurses todiscover how they thought the proession had evolved and the kinds o changes they had seen or experienced. This sample o nurses rst helpedme realize that there was a denite gap between bedside nurses andacademic nurses. They described nursing in days long past, when
esprit decorps
(their words)—nurturing new nurses and taking pride in being anRN—was key to the proession. They were shocked to observe as oldernurses (and, later, as patients and spouses o patients) that this
esprit decorps
no longer seemed to exist. These nurses came rom a variety o educational backgrounds and experiences in nursing, but they all notedthat there was divisiveness in nursing that had not been there beore.In contrast to that earlier study, which ocused on nurses who hadlong been in the proession, this book presented the views and concernso people who had only recently become nurses or obtained a graduatedegree in nursing. As you learned, there were many similarities in theirperceptions and experiences—especially among associate degree-preparedand baccalaureate-prepared nurses. Indeed, it seemed some experienceso the brand-new nurse transcended level o education. One interestingdierence, however, was that although many associate-degree nurses sawthe value o continuing on or a baccalaureate degree, they did not seemto have the same distaste or bedside nursing as that expressed by severalo the baccalaureate-prepared nurses. Somehow, baccalaureate-preparednurses had gotten the idea that one must move away rom bedside nursingas soon as possible. Indeed, the proession seems to consider moving away
The Nurse’s Reality Gap
rom the beside to be a point o pride. (Note that or the purposes o thischapter, “bedside” reers to any direct patient care.)It appears that this attitude is contributing to a growing lack o unitywithin the nursing proession—the divisiveness those older nurses hadobserved. The act is, there is a widening chasm between nurses whoprovide direct patient care and those who have no contact with patients atall, even though both groups consider themselves to be nurses and wouldbe horried to be thought o as otherwise. Indeed, it would be dicult tond another proession in which there is such a large gap.Unortunately, in my experience, nurses who opt to remain in directpatient care rather than pursue graduate degrees seem to be looked downupon by nurses who
have graduate degrees. In addition, althoughmany nurses who have advanced degrees still provide direct patient care,nurses who do not interact with patients directly sometimes look downon the nurses who do. Indeed, they seem to espouse the view that allRNs should go beyond the baccalaureate degree to a graduate degreespecically to move away rom the bedside. At the same time, thosenurses in direct patient care appear to have little respect or nurses inacademe or research who do not also maintain clinical practice. Theyseem to think—perhaps justiably so—that nurses who do not maintainsome level o clinical practice cannot know what it means to take careo patients, and thereore may not be able to educate new nurses usingup-to-date inormation or conduct research that is directly applicable toclinical practice.
A Word on nursing reseArch
It is all well and good or nurses in academe to dictate howothers should think about nursing and provide theoriesregarding what nurses should do, but it is only air or nursesin the trenches to question how realistic and pragmatic someo these ideas really are in practice. As a researcher and ascholar, I believe that researchers who design studies that havedirect impact on patient care or the work lie o the nurse arecontributing to the proession. However, many studies are donethat have no obvious relationship to improving patient care ornursing work. Unortunately, i the researcher who proposes astudy hails rom a Research I institution, chances are high he or
chApter 6:
The Chasm in Nursing
she will receive unding or that study—regardless o whether it has obvious clinical value. And even with studies that do haveobvious clinical value, the people who most need to know theresults are unlikely to have access to the inormation becausethey will not read the journal in which the results are published or attend the conerence at which the work is presented. (Moreon these problems later in this chapter.) In the end, the study will simply join the long list o works that do not serve to improve the proession or the work we do in any way. Even so, academics,researchers, and theorists will pat themselves on the back and tell each other how much they have accomplished or nursing.
There seems to be a point in every nurse’s career when the nurse isexpected to go on or higher education or to move to a role that mayinvolve patient care but that is not directly at the bedside. It is dicultto pinpoint when this is, and it may vary or each nurse, but in myexperience, the expectation is there regardless.For nurses to be educated—intentionally or not—that bedside nursingis somehow beneath the proessional nurse is to completely devalue whatnursing
. It is unconscionable that people within our own proessionwould seek to devalue who we are, separating nurses into those who“get dirty” caring or patients rom those engaged in other activities that,theoretically, support them. Those who support nurses who provide directpatient care are typically in academe or research, but these categories arenot black and white. Many nurses who teach or conduct research continuetheir clinical work, and many nurses who provide direct care to patientsengage in teaching and/or research. However, as mentioned, there appearsto be a airly distinct line in the sand between those who provide directcare at the RN level and those who work primarily in academic settings.Aren’t we all nurses? Isn’t our rst responsibility the welare o patients and patient care? Why should nurses who remain in bedsidenursing, regardless o the venue, be made to eel they are not ambitiousor motivated to better themselves, or that they lack the intelligence to geta graduate degree and do something else? Aren’t all nurses prepared tomake important and lasting contributions, regardless o whether they stayin direct patient care or they leave it or “scholarly” activities? Shouldn’tnurses respect what each o them brings to the proession and not

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