The policy forum of this issue takes as its point of departure an April 2011 summit of North Carolina nurse leaders, who met to review and discuss recommendations from The Future of Nursing: Leading Change, Advancing Health, a report recently published by the Institute of Medicine of the National Academies. Commentaries from experts across the state affirm the importance of ensuring that an effective, educated nursing workforce is present; that nursing education involves a seamless process; that nurses can practice to the full extent of their education and training; that nurses are full partners in redesigning health care; and that an effective, comprehensive health care workforce planning system is in place. Also in this issue, original articles address the use Charlotte-area emergency departments for primary care services and the presence of defibrillators in North Carolina public schools.
Future of Nursing in North Carolina
Everything that rises must converge.
Pierre Teilhard de Chardin
The policy forum in this issue of the NCMJ centers on the profession of nursing and its place among the health professions in the United States. In the articles, there is a pervasive sense of both aspiration and frustration as nursing tries to take on the problems facing health care professionals of all types. Nurses seek to rise to the challenge society has given them to improve health care amidst the realities of the complex economics of health care. The aspirations of nurses and nursing have changed dramatically in the recent past and are beginning to converge with medicine. This convergence is due to the shared need to bring the best and most-efficient means to making a healthier society when many forces run counter to that goal. Nursing is rising to the challenge.
“Everything that rises must converge” is a quotation from Pierre Teilhard de Chardin and the title of a short story by Flannery O’Conner. Teilhard de Chardin was describing how humans evolved in a way that underlined the unity of all living things. In that sense, we are seeing both a rising in our ability and capacity to affect the health of people and cure disease, as well as a blurring of roles and responsibilities across health professions. O’Conner’s story is more about how we must recognize the need to come together in a moral sense but also how this change is hard for some to understand.
The rules have changed in health care, and the social structure of the health professions have changed under the pressure of economic factors and the convergence of missions. We have begun to see that there is a unity to what we wish to achieve in making a healthy society and caring for and curing those who become ill. That moral quest has compelled us to change our views about who we can and cannot keep apart. Nursing has for many years stayed apart from medicine and other healing professions, and the other professions have kept nursing at a distance as they built their own places in society and the economy. Nursing asks that this separation be dismantled. There are no more valid reasons (or “evidence,” as we now say) to maintain such separation. There are no good reasons why we cannot begin to share roles and responsibilities.
But nursing itself has its hierarchies and its separating forces. These are driven by the education and training structures that generate barriers within the profession. The same lessons of convergence should apply here. The articles in the policy forum provide us with examples of what has been achieved and what can become more normal as we see our structures of health care come together to do what they all profess: to make us healthier, safer, able to lead better lives.
For those who are interested, here is the quotation from Teilhard de Chardin, drawn from The Phenomenon of Man: “Remain true to yourself, but move ever upward toward greater consciousness and greater love! At the summit you will find yourselves united with all those who, from every direction, have made the same ascent. For everything that rises must converge.”
Thomas C. Ricketts III, PhD, MPH editor in chief, NCMJ.