The Future of Nursing

Lillian Wald’s public health nurse uniform

The future of nursing should begin with people and community/population health. And to do that we need to disrupt our tired, outdated approach to nurse education. Not by tweaking here and there. Not by investing tons of money in yet more high tech simulation labs and “dummies.” Not by asking ourselves and our students, “What would Florence do?” (as in the Florence Nightingale, important as she is). Rather, we should begin by asking, “What would Dorothea do?” (as in Dorothea Dix, US and international mental health reformer) and “What would Lillian do? (as in Lillian Wald, the “mother of public health nursing” and founder of the Henry Street Settlement House in New York City).

“Begin with people, not body parts,” is what one of our nursing students told us recently when she heard that we are disrupting our pre-licensure nursing program at the University of Washington. Starting this coming academic year (begins in September), we will begin with people—with community, public health nursing instead of the longstanding “traditional” acute care medical-surgical nursing. I am excited to be teaching this “new” community/public health nursing course. It will begin at the true beginning with the social determinants of health equity. Not just with the social determinants of health (SDH)—those factors that affect our health from where we live, work and play. The social determinants of health equity extends past the SDH to acknowledge and address the inequities inherent in our society that affect health, including structural racism, and all the other “isms” of longstanding discrimination against women, persons of color, LGBTQ people, disabled folks, and the aged. Dr. Camara Jones and her “Cliff of Good Health” is the best illustration of this.

The Future of Medicine 2030 Seattle Town Hall was held at the University of Washington this morning. This builds on and extends the work of the Institute of Medicine’s Future of Nursing report back in 2010. The theme of today’s town hall meeting was “High Tech, High Touch.” I was dismayed (okay, I was irritated) that the lead speaker at today’s event was a physician, Molly Coye, who is an executive-in residence with AVIA, a network of US health systems “solving problems with digital technologies.” It is the “The Future of Nursing” after all and not “The Future of Our Insanely Expensive and Ineffective US Healthcare System.” And it should be led by nurses!

The one truly inspirational speaker at today’s event was a nurse—Dean Kenya Beard from Nassau Community College in New York. She spoke of some of the drawbacks of health technology and how they can amplify health inequities and how most of the proprietary algorithms for high tech “solutions” lack transparency. She called out the pressing need for nurse educators to “rise above any level of discomfort” and address structural racism and interventions that work. As to structural racism in our country she stated, “humans created it and only humans can destroy it.” She ended her talk with, “We need daring ingenuity.”

My question/comment which I posted online during the town hall was this:

“Why aren’t we using the much more useful term “social determinants of health equity” versus the rather status quo term “social determinants of health”? Why aren’t we killing forever the outdated and unhelpful message to our nursing students that they “have to have at least two years of inpatient med-surg” work before they go on (yes, go on) to community, public/population health nursing? Why aren’t we stopping the practice of educating nursing students to be “agents of social control” and instead to be “agents of social change?” Also, thanks for the refreshingly honest and necessary presentation and perspective from Kenya—Brava!

In Praise of Curiosity

Photograph from inside the reconstructed room/installation piece  "Room No 2 1984" by Irina Nakhova. Tate Modern Museum, London
Inside “Room No 2 1984” by Irina Nakhova. Tate Modern Museum, London

It struck me this week that curiosity—the time and space necessary for nurturing curiosity—has little to no place in our institutions. Not in the university or in our classrooms or in the hallowed halls of government or in our health care system. Instead of open-minded curiosity that can lead to innovative solutions to big problems like homelessness, we rely on snap judgements and decisions based on our close-minded, biased, preconceived notions.

Curiosity did not kill the cat. Curiosity is necessary for growth and survival and resilience in the face of adversity. Curiosity is necessary for empathy, for perspective-taking and imagination and creativity. Babies and small children are naturally curious, but as they grow up, formal education largely forces them to suppress curiosity. Students, and especially university students, are typically afraid to ask questions for the fear of appearing incompetent and stupid. We grade students based on their answers and not on the quality of their questions. University professors, including nurse educators, do not model a healthy valuing and practicing of curiosity. We are forced to specialize in a “focused area of study,” to become (or at least to pretend to be) experts with answers and not wise educators with yet more questions. 

Tenelle Porter, Phd, a behavioral psychology scholar at the University of California, Davis describes intellectual humility as the ability to acknowledge (to ourselves and to others) that what we know is quite limited. She points out that university professors are not known for having high levels of intellectual humility, yet fostering intellectual humility (closely linked with higher levels of curiosity) in students leads to greater learning and later career success. In addition, intellectual humility is associated with a greater openness to hearing and considering different viewpoints—something that is sorely lacking in our society and in our classrooms. 

“Who Owns What?” by Barbara Kruger, 2012, Tate Modern Museum, London

Sources: 

Francesca Gino (2018) The Business Case for Curiosity, Harvard Business Review

Tenelle Porter & Karina Schumann (2018) Intellectual humility and openness to the opposing view, Self and Identity, 17:2, 139-162, DOI: 10.1080/15298868.2017.1361861

Tenelle Porter (2018) The Benefits of Admitting When You Don’t Know, Behavioral Scientist