A few weeks ago, I had the privilege of attending Commencement for the 2018 class of Bachelorette, Masters' and Doctor of Nursing Practice (DNP) graduates. Sitting on stage behind the first row of dignitaries gave me the opportunity to look out over the sea of the graduates' excited faces. Their families were avidly watching from the stadium seats, lining the sides of the large auditorium, holding balloons, flowers, and young children. The President of the University and the Dean of Nursing both gave heartfelt speeches regarding the graduates' rigorous training and how they were more than competent to meet the challenges the nursing profession would present to them. Smiles from the graduates and applause from the families and faculty greeted the accolades.
The Commencement speaker discussed building a School of Nursing from scratch beginning with a faculty of one-herself! Over the course of 7 years, she raised $24 million, and currently has sufficient faculty and a laudable amount of students in undergraduate and Masters' programs. She discussed the challenges and successes along the way and provided examples of the accomplishments of her graduates that she was obviously very proud of. In a few months, she and her faculty will begin teaching in their new DNP program. She was very excited about the outstanding first class of applicants that had been accepted to the School and looking forward to seeing their faces from the podium at their Commencement.
After the Commencement guest speech, the Dean of Nursing present the Bachelorette graduates to the President and certified that the students had met the requirements of the degree. The President then proclaimed they were graduates with all the rights, privileges, and responsibilities of the degree. The undergraduates then proceeded to come to walk across the stage to receive their parchment and have their picture taken with the Dean and President. The families cheered when their loved one entered the stage and flashes from cameras were everywhere. After about the first 20 minutes, I started to "zone" out since none of the faces was recognizable to me. I began to focus on the shoes to pass the time. Some were spectacular-how did she manage to stay upright in them? And others I thought should have stayed in the store window.
As my mind drifted, I came back to the thoughts from the Commencement speaker who highlighted the many opportunities available to graduates of nursing programs. I watched the thrilled students with their smiling faces cross the stage as their families cheered exuberantly. My thoughts changed from the challenges of school work to that of the work environment. Are these nurses really prepared for overloaded patient-nurse ratios? How long would those faces be smiling when they were on shift? How long would these graduates stay working as nurses? It is known that dissatisfaction in the work environment is a main factor involved in nursing turnover.1 How many of these nurses will find employment in a Magnet hospital? Magnet hospitals encourage empowerment of nurses, which is linked to job satisfaction and retention.1 How will these new graduates, who have been nurtured in a caring environment, handle bullying and incivility? The graduate nurse is extremely vulnerable to incivility and will often leave employment within the first 2 years.2 Will all the studying and practicing of clinical skills be wasted?
And what about the nurses graduating with their Masters' degree? They are anticipating autonomy working in an advanced practice role and the ability to practice with a holistic approach to take care of their patient's individual needs. Taking care of the patient involves spending quality time discussing their concerns and teaching them about medications, necessary modifications to lifestyle, and complications of acute/chronic disorders. How long will it take them to become frustrated because they have to see 70 patients in a day? Given a 10-hour day, that is approximately 8.6 minutes per patient! Or will they gain employment in a private practice that allows time for a productive patient-provider relationship? Will physician oversight infringe on the advance practice nurses' (APNs) ability to be autonomous? Regardless of whether physician oversight is perceived to be restrictive or facilitative, APNs discussed that the oversight led to increased empowerment.3 Will the APN be the only provider in a rural area feel unsupported or professionally challenged to grow? I asked different questions to myself, as these graduates walked across the stage to receive their degrees and have their pictures taken.
At long last, the DNP graduates were coming forth. My student was the second one and I was so excited to be the one to "hood" her. I am certain that she can overcome any challenge given to her because of her resourcefulness and resiliency. But what of the others? Will they enter academia excited to teach other graduate students, and then leave because of demanding hours along with an income that is far below what they could command in practice? Because these graduates are "older," will they be happy being out of a busy clinical environment and more satisfied with teaching and writing? Working within an academic-clinical partnership between the university and hospital/clinic may satisfy their need to practice so that they have the best of both worlds. Given that the nursing workforce is aging, and DNP graduates are "older," how long will they remain in the workforce? What will it take to keep these providers satisfied and happy to increase retention rates and the nursing workforce?
As Commencement proceedings concluded, the dignitaries and faculty left the stage to create an honor guard that all the graduates passed by. They were all smiles, some said thank you, and others stopped to give a quick brief hug to the faculty members who supported them along the way. I remember that I had doubts about wanting to stay in nursing after I graduated from my undergraduate program, and actually began studying engineering. But then I found the world of neonatal nursing and within that first year, I knew I had found the place that was right for me. With that thought, I relaxed with the belief that each of these professionals will find the niche they feel is their home.
-M. Terese Verklan, PhD, CCNS, RNC, FAAN
Professor and Neonatal Clinical Nurse Specialist
University of Texas Medical Branch
School of Nursing Galveston
Graduate School of Biological Sciences
Galveston, Texas
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