BASIC PART of our culture is hope and believing in something beyond ourselves. Each fall, we nursing educators welcome a new group of students, full of hope and ideals. They see injustices that require correction; neglected people who deserve attention; illness that can be turned to health. They are determined to do something significant to make a difference in the lives of others. Csikszentmihaly (1990) describes seeking such ideals as a basis for optimal life experience-stretching mind and body to accomplish something difficult and worthwhile. He went a step beyond the individual (p. 9), as did J. S. Mill: “No great improvements in the lot of mankind are possible until a great change takes place in the fundamental constitution of their modes of thought.” Over the years, it has appeared to me that nursing education and the world of practice tend to treat hope and idealism with amusement-“they will learn.” Thoughts of improving the current status quo belong to Don Quixote and others who spend their lives charging windmills. As a result, we have a population of nurses who are worn down and worn out by disillusionment. Many of those same dreamers of yesterday now resist ideals, convinced that today’s reality is tomorrow’s necessity. Aiken (1990) observed both the change and the lack of it in hospitals, and pleaded that nurses “not give up on hospital nursing.” Many already have. Yet displaced dreams and beliefs have not exactly thrived outside hospitals. Are we giving up on caring, coopted by daily operations? Or because our ideals are beyond our current grasp? Or because we never really pushed the opportunity to test them on a wide scale? Or because we collectively are stuck in antiquated modes of thought? Or because we as a profession simply haven’t equipped ourselves to bring them to life? Some recent experiences leave me to believe all of the above, but particularly that we cannot change health care in a positive direction without some fundamental changes in our modes of thought. The University of Washington School of Nursing is taking on a new challenge to design and manage health services in a retirement community and nursing home facility. The purpose is not just to operate a nursing home, but to build on the best thinking of our colleagues in the field to bring knowledge to life in long-term care. Idealistic? You bet. Yet another in a series of academic projects to integrate practice, education, and research? So some say.
SUE T. HEGYVARY,
This project continues to have many exhilarating moments. But two observations have been very disappointing. First, a large number of nurses, administrators, and others either never had or have given up hope for long-term care. Their work consists of complying with volumes of rules and regulations-some sense, some nonsense. Most candidates we have interviewed for administrative positions have voiced or implied that professional nursing practice is for another world-it’s not part of “the regs.” The second big disappointment is that the “other world” is defined as academia. To many practicing nurses and administrators, research and education are like champagne and caviar on a no-frills ticket-incongruous and unrealistic. Perhaps research and education are the ticket, and not the frills. None of us claims to have the answer, for longterm care or any of the crisis areas of health and illness. But we can’t make improvements by licking our wounds at the station when the train is already moving. Now is when we most need innovation, not standardization. This is the time to back off from emotional responses to the “shortage” and give cognitive attention co our options in all parts of health care. In our lifetimes, we have seen dramatic changes in business, economics, demographics, and technology in almost every aspect of our lives. Knowledge and technology for health care have changed dramatically, but the organization and delivery of health care have not. Education has risen significantly for all health care providers except those in the most central and continuous roles in institutional care, ie, nurses. Assessment of our options requires careful consideration of the roles and preparation of the cadre of nurses that number more now than at any time in our history. Having something to believe in doesn’t mean naively recycling the noble ideals of yesterday. Planning for the future requires us to define our hopes and dreams, weigh them against the current facts, and take the necessary calculated risks to see if ideals and goals can be made real. Last week two nurses called to apply for yetto-be-created positions for a nursing group practice that will focus on independence and adaptation of clients. Two other nurses toured the developing facility in hard hats to see about transferring their elderly and sick mothers there. A hospital administrator sought an affiliation between our institutions. And a group of students asked if they would “get to do a practicum” in our new nursing center for care of older adults. We not only have an important challenge; we still have plenty to believe in.
Profasor and Dean School of Nursing
University of Washington T-138 Health Sciences Center, SC-72 Seattle. WA 98195
Copyright 0 1991 by W.B. Saunders Company 8755-7223/91/0702-0006$03.00/O 76
Aiken, L. H. (1990). Chatting the future of hospital nursing. Image, 22, 72-78. Csikszentmihaly, M. (1990). Flow: The psychology of optimal experience. New York: Harper and Row.
Journal of p~offi~siod Ntirsing,
Vol 7, No 2 (March-April),
199 1: p 76