To the editor:

Re: "Doctoral Education: Preparing Our Next Generation for Disruptive Innovation" by Diane J. Skiba, Nursing Education Perspectives, Vol. 39, No. 5.

In her column, Dr. Skiba asks relevant questions about the education of the next generation of doctoral nurses (PhD and DNP) including: "Are nurses fluent in data analytics and artificial intelligence?" "Do we provide opportunities for doctoral nurses to foster and become a part of a culture of innovation?" Although I agree with the importance of such questions and with the relevance of innovation in nursing and health care, I sometimes wonder if we are not overlooking a more urgent problem: the problem of accessibility to basic health care here and abroad.

Across the globe, the disparity in the level of health care systems is gigantic. While in some countries telehealth and electronic medical devices transmitting parameters in real time to on-call practitioners are available, other countries still struggle to have running water and electricity in hospitals. From 2016 to 2018, I collaborated on a project to support the development of a qualified health care workforce in the Republic of Congo by improving the education programs of nurses, midwifes, and laboratory technicians. With Congolese practitioners, we discussed the issues they were facing regarding the education of the next generation of practitioners as well as the reality of their health care system. Even though I expected that their resources would be different from what I was used to in Canada, I understood their reality when I tried to give a three-day workshop in a classroom without electricity.

In May 2018, I attended the 7th International Nurse Education Conference. Presentations concerning innovation and new technologies were very popular, whereas presentations of projects to improve quality and access to care in developing countries were left empty. It is important to raise awareness that, globally, health care access is still an issue in 2019.

We are not responsible for resource allocation for health care and health care education in different countries. But as we discuss the preparation of the next generation of doctoral nurses, it becomes crucial to remind ourselves that, still today, access to basic health care is an issue. While we might think issues of accessibility exist only in developing countries, they do not. Even in Canada and the United States, many people either do not have access to health care or cannot afford it. In 2017, more than 10 percent of the US population did not have basic coverage (Centers for Disease Control National Center for Health Statistics Prevention, 2017). In Canada, despite having a universal health care system, accessibility remains an issue, mainly due to wait times and difficulty to get an appointment (Clarke, 2016).

I am not advocating to stop innovation in nursing or in health care. Skiba asks if we provide the opportunity to nurture that culture of innovation in our doctoral nurses; it is definitely a question worth examining as programs are developed and reformed. We need to have more doctoral nurses who are comfortable with innovation and technology. Manis (2018) argues that innovation reflects the demands of today's health care customers who "expect much more than access, quality and affordability. They expect an exceptional, retail-like experience: ease of use and immediacy of service - how, when and where it is most convenient for them, not us." That represents the world in which we are living: a world of overconsumption where the individual experience is more important than anything else. But at what expense? If we prepare our doctoral nurses to be tomorrow's leaders, we should teach them to keep in mind that innovation should not be done at the expense of accessibility to health care. Rather, innovation should help improve it.

REFERENCES