The huge downturn in the U.S. economy, the Federal government's healthcare reform initiatives, the potential impact of the Centers for Medicare and Medicaid Systems' denial of payment for "never events," and the continued escalation of insurance costs (Jepsen, 2009) have resulted in a flurry of activity as hospitals, third-party payers, and patient care professionals try to reinvent themselves in an attempt to weather the storm. Even new drug development and research, a linear, trial-and-error process that has for decades required a lengthy time line, is now recognized as an unsustainable model as biopharmacists reshape their work. As each group of stakeholders tries to redefine its mission and the added value it puts into the bigger system, priorities are shifted, strategic goals re-evaluated, and the world reshaped. Professional nurses, and the organizations to which they belong, are a part of this changing healthcare landscape; once again, we try to reinvent ourselves.
Nursing (with a capital "N") has a long history of recasting its history in an effort to extend and develop its professional image and practice base. Over the course of the past 150 years, nursing has established formal university-based educational programs, legally regulated practice, and produced a growing body of research. However, we still have no standard entry to practice, and episodic shortages of practitioners have often led us down a path that distances us from our past. We have failed to depict ourselves as a profession that evolved and adapted over time to historical and scientific contingencies; instead, we frequently recast our skill and knowledge as discontinuous with our past.
As we find ourselves in the midst of the "reform" of healthcare in the United States, perhaps the time has finally come to clearly define our place, as individuals and a professional specialty association, in the new landscape. Historically, nursing practice mirrors the science and technology of the era in which it is practiced, basing the practice on current scientific theories. It has always been a discipline rooted in problem solving and the critical thinking that underpins it. Nurses have always been able to see the big picture, to think creatively, and to use skilled observation as they try to meet the needs of their patients. Perhaps most important, nurses have "always been confronted with patients who are complex and health care systems which are in flux" (Nelson & Gordon, 2004, p. 259).
How can we, or should we, use the past to shape our future? We can foster a deeper understanding of the importance of everyday nursing practice-monitoring patients, keeping them safe and comfortable, and preventing complications. We can demonstrate respect for the knowledge, skill, and ability of our colleagues in myriad healthcare settings.
We can also become visible, active, vocal stakeholders in our profession. Join a professional association; these associations look strategically at their own and the larger profession's future. They can help us drive (or at least steer) the direction and focus of its membership. A solid professional association thinks about the future of the profession and builds a specialty practitioner network on that foundation.
In addition, we can begin to think more clearly about nursing as a business. Huh? In a recent interview, Charles Jacobs (2009), author of a book that links "management science with brain science," tells us that all of business is about human interaction and that each of us understands the world differently during these interactions. He argues that we can never be certain that others see the world as we do or that we see the world as others do. To link these concepts with the business of nursing and the possible reinvention of our profession, we may need to make a paradigm shift that incorporates a willingness to change. Jacobs argues that new ideas physically change the chemistry in our brains. When our own professional beliefs and values are not in sync with external inputs-for example, the discussion of healthcare rationing in the context of nursing practice-our brains respond to patterns we're already aware of, we compare these to our memories of similar situations, and then we rethink the problem.
As a business, we can support our professional associations as we participate in the reinvention of nursing. Support can help us increase public recognition of the value we deliver to the larger society; it can help us increase public awareness of what today's nurses do. Membership in professional organizations increases the volume of our voice. As a group, we generate the new ideas that change our brain chemistry-as a neuroscience nurse, I find this a particularly appealing benefit. Rather than reinventing ourselves individually or in small groups, let's reinvent ourselves in a big way so we are an active partner in reform. Join, speak up, make your expertise public, and share your knowledge and wisdom!
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