I recently experienced an “a-ha” moment at a meeting where Ed O'Neil, PhD, director of the Center for the Health Professions at the University of California-San Francisco, was addressing health care reform issues. He pointed out that above all, nursing in general needs to reform how it thinks about itself. He further noted that, for nurse practitioners (NPs), no regulatory changes will matter until there is a cultural change. “WOW!” was my initial thought, but as the next 24 hours passed, I started wondering what he meant; in what way is a “cultural” change needed? I did not see him again to ask, but really, this was an issue that I needed to think about for myself.
Nursing has a long history of martyrdom, of self sacrifice, and as NPs we have carried that baggage with us. We feel oppressed by the rules and regulations “they” have imposed upon us. We perceive, in general, an external locus of control. These feelings were reinforced culturally by the recent, inappropriate attempt of another profession to define our scope of practice.
So what did O'Neil mean by a culture change? Look inside yourself, dear colleagues! As I was, it occurred to me that this is why I am sitting here as your president today—that we can and should be in total control of our own profession, and until we all are on the same page with this, no regulatory changes will matter!
What can we do to change? I would like to suggest a few ways to start. First, examine the issue of who owns the title “doctor.” No one! Start referring to MDs and DOs as “physicians;” that is what they are. Use the title as appropriate for addressing them, yourself, and your colleagues with doctorates, and others in the clinical and professional arena who have earned the title.
Second, do not wait to be invited to the table for health care policy discussions. Assume your place, you are meant to be there. And if someone tries to deny that place, publically question how any discussion can be legitimate without you there! Know the facts and studies and dazzle the others at the table with your expertise!
Another area to focus on is our initials. Just look at the left-hand column on this page, at the list of board members. How many different credential variations do you see? Some variations are designated by state practice acts, others by various certifying bodies. MD and RN are standards that everyone recognizes. By lack of such a standard, the public will remain confused about what constitutes an NP.
I would love to hear from you on other “cultural” changes that we as a profession need to make and how we can go about it. Let's get the dialogue started now! ACNP is excited about emerging social networking opportunities, and we are investigating which model will best suit our needs as an organization. Until then, please feel free to email me at president@acnpweb.org.
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