As a nurse executive and editor, I attend numerous conventions. At each meeting, I learn something new. At many of them, I am reminded of things I already know and sometimes these reminders are so powerful they elicit strong feelings. That was the case when I attended the 2018 American Association of Nurse Practitioners (AANP) Conference, where I was struck with something that left me filled with pride, awe, and joy. Although many advanced practice nurses face continued obstacles, which make it less than easy to perform the care they are educated to provide, the presenters didn't dwell on this issue. It did come up, of course, but the emphasis I heard from speaker after speaker was on the people who need care, not the care providers. The speakers and the conference attendees resonated with the need to improve the health and well-being of individuals and communities. I was reminded again about the magnificence of our profession.
I experienced the same emotions while reading the international submissions for this edition of Nursing Administration Quarterly. It registered that the challenges faced by nurses throughout the world are much the same. I was gratified to learn about the shared dedication we have to helping people live better and healthier lives. I was appreciative to be reminded that nurses everywhere continue to advocate for the human rights of vulnerable groups. I was proud that they continue to care for others against all odds and often with very few resources. And, I was sad to read that, in many places, nursing is not highly valued and has low professional status.
In this country, nurses are valued and trusted, as demonstrated by the last 16 years of Gallup polls naming our profession as the most trusted in the United States. However, being seen as trustworthy and ethical doesn't mean that the public really knows what nurses do. Even our non-nurse colleagues in health care, including leaders, don't seem to know how much more we could do to help transform our care, increase quality, and decrease costs if we were recognized for the full extent of our education, competency, and leadership skills.
I've been mystified, time and time again, at choices organizations make in their utilization, or lack of utilization, of available talent. I believe some of these are made out of a deficiency of knowledge about the abilities of nurses and other team members. Many, though, appear to be the result of institutionalized unconscious bias about gender and professional backgrounds. Unconscious bias is much more common than most people realize, and nursing, still perceived as a largely female profession, has not been immune to its effects. As we move into the next era of health care, I am hopeful that knowledge gaps about team member abilities will be bridged and that our future is not unduly influenced by historical power structures that could stop us from the health care transformation we so desperately need.
Authors on the following pages come from a variety of nations, but they all understand what nursing has to offer to the people of the world. They know that the medical model will not lead to a transformed health care system. I think they would agree with this definition: (the) medical model is "the traditional approach to the diagnosis and treatment of illness as practiced by physicians in the Western world since the time of Koch and Pasteur. The physician focuses on the defect, or dysfunction, with the patient, using a problem-solving approach. The medical history, physical examination, and diagnostic tests provide the basis for the identification and treatment of a specific illness. The medical model is thus focused on the physical and biological aspects of specific diseases and conditions. Nursing differs from the medical model in that the patient is perceived primarily as a person relating to the environment holistically; nursing care is formulated on the basis of a holistic, nursing assessment of all dimensions in the person (physical, emotional, mental and spiritual) that assumes multiple causes for the problems experienced by the patient. Nursing care focuses on all dimensions, not just the physical."1
That definition concisely explains how nurses have been educated to think and act. It clarifies why we so easily understand the need for addressing social determinants of health. We respect the great value of the medical model, and we join our physician colleagues in treating those who are sick or injured, with all that Medical and Nursing Sciences have to offer. However, it is in our professional genes to also do everything we can to prevent illness and improve health. Recognition of this is part of the underlying rationale for the current Nursing Now movement, described in this issue by Ireland's Elizabeth Adams. Please be sure to read her article, because all of us should know about this 3-year campaign to "raise the status and profile of nursing globally, in order to maximize the contribution of nurses to Universal Health coverage, women's empowerment, and economic development."
Thanks to our guest editors, Franklin Shaffer and Rhonda Anderson, you can learn more about Nursing Now and other international work being done by the men and women who practice our profession around the world ... and who are dedicated, with us, to pushing, pulling, prodding, and partnering for a healthier world.
Thank you for choosing to lead.
-Kathleen D. Sanford, DBA, RN, FACHE, FAAN
Editor-in-Chief
Nursing Administration Quarterly
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