Indiana
Karen Luther Wikoff, RN, PhD
Assistant Professor
California State University, Stanislaus
Turlock, California
Preface
Nurses are committed to safe, high‐quality, patient‐centered care. Nurses demonstrate leadership and management skills in the provision of patient care, both interdependently with physicians and other members of the interprofessional team, and independently as nursing professionals. Various theories about Leadership and Management have been developed, as discussed in Chapter 1 of this book. These Leadership and Management theories are utilized by nurses in their personal life and from Day 1 of their clinical nursing practice. Millions of Americans turn to nurses for delivery of primary health care services, health care education. and health advice and counseling. The Gallup Poll (Brenan, 2018) has consistently found the nursing profession to be ranked as the Number One trusted profession in its annual polls of Americans. Suzanne Gordon is a journalist who has been writing about nursing issues since 1986. She writes,
“Nurses are regarded as honest and ethical but their breadth of skill is not known. When I was at the Beth Israel hospital, I was on the oncology clinic and followed these nurses for two years. Doctor comes in one day. Had a patient with breast cancer and the patient died. The husband gives him a trip around the world. What does he give the two nurses who cared for her? A scarf. The woman died, so it didn't work. The people who cared for her were the nurses. I happen to know the doctor, he was a, you're dying, I'm disappearing, kind of guy. The people who took care of her were her nurses. He gets the trip around the world, they get scarves. I think that says it all” (Maggi, 2001, p. 2).
Typically, professions are distinguished by certain specific characteristics. These include, but are not limited to:
Formal educational requirements,
Autonomy of practice,
Adherence to an established code of ethics,
Expansion of the level of knowledge, and
A common culture and values present among members (Joel & Kelly, 2002).
Professions progress through an expected evolutionary process. This consists of:
Expanding the scientific base,
Creating technical workers to share in the essential mission of the field,
Standardizing and up‐grading education for entry into practice, and
Moving forward with specialization.
Nursing's progression has been spotty and incomplete, largely because of the influence of external communities of interest, and the fact that nurses have resisted and personalized decisions that are necessary for future generations (Joel & Kelly, 2002). A profession must have a clear educational pathway into the practice and a constantly growing body of knowledge within institutions of higher learning (Blais & Hayes, 2011). Currently, there are many pathways for nursing education, ranging from 2‐year degree programs to Bachelor to direct‐entry Masters and Doctorate programs. For around 100 years, nurses have debated entry into practice. The result has been a myriad of programs with graduates used interchangeably in the real world. This absence of consensus within the discipline of nursing causes consumer confusion and seriously compromises our ability to serve the public (Joel & Kelly, 2002). Despite the variety of nursing programs and the range of advanced degrees they offer, all students have their basic professional nursing skills assessed by The National Council of State Boards of Nursing Licensure Exam (NCLEX). Successful completion of the NCLEX exam permits any RN to practice under the nursing practice act of an individual state, regardless of the level of education attained, though more and more health care institutions are choosing to give RNs with a Bachelor degree priority in the hiring process.
In 1999, a National Academy of Sciences, Institute of Medicine (IOM) Report, To Err Is Human: Building a Safer Health Care System (Kohn, Corrigan, & Donaldson, 1999), shocked the nation and called attention to the adverse events that occur in many acute care hospitalizations. The IOM Report stated that the annual estimated cost of medical errors was between $17 billion and $29 billion at hospitals across the country, with between 44,000 and 98,000 deaths yearly, more than die from motor vehicle accidents, breast cancer, or AIDS.
In 2004, another IOM Report, Keeping Patients Safe: Transforming the Work Environment of Nurses (Institute of Medicine, 2004), found that, “how we are cared for by nurses affects our health, and sometimes can be a matter of life and death … nurses are indispensable to our safety.” Nurses play a crucial role in protecting patient safety and providing quality health care. This finding has since been confirmed by several research studies (Aiken et al., 2017; Aiken et al., 2014; Cho, et al., 2016; Cho, Kim, Yeon, You, & Lee, 2015; Harrison et al., 2019; Kim & Bae, 2018; McHugh et al., 2016; You et al., 2013). The 2004 IOM Report concluded that education for the health professions was in need of a major overhaul.
In 2005, the Robert Wood Johnson Foundation funded a national project to educate nurses about patient safety and quality. The project developed Quality and Safety Education for Nurses (QSEN) Competencies, which identify the knowledge, skills, and attitudes needed for safety, quality, patient‐centered care, informatics, teamwork and collaboration, and evidence‐based practice to provide safe and effective quality nursing care. Today, QSEN Competencies are being integrated into nursing curricula, research, accreditation, and licensing to address the gap between nursing education and nursing practice.
In 2010, the Report, Unmet Needs: Teaching Physicians to Provide Safe Patient Care by the Lucian Leape Institute (2010) at the National Patient Safety Foundation highlighted the need for medical schools to integrate systems analysis, quality improvement, and patient‐centered care into their curricula. The Report emphasized the importance of a culture of safety in teaching hospitals, stressing that unprofessional behavior and authority gradients prevent physician trainees from reporting and learning from errors (Ranji, 2014).
In 2016, Henry reported that improving quality and safety has been a focal point in medical education for more than a decade, but improvements have not been dramatic. Some medical schools are changing their curriculum—and cultures—to make greater strides through their work with the American Medical Association's Accelerating Change in Medical Education Consortium (Henry, 2016).
Makary & Daniels (2016) found that more than 250,000 people in the United States die every year because of medical mistakes, making medical mistakes the third leading cause of death after heart disease and cancer. Makary & Daniels (2016), define a death due to medical error as a death that is caused by inadequately skilled staff, an error in judgment or care, a system defect, or a preventable adverse effect. These deaths include deaths from mix‐ups with the dose or type of medications administered to patients, surgical complications that go undiagnosed, and computer breakdowns. Makary & Daniels (2016), also noted that death certificates in the U.S., used to compile national statistics, have no way to identify medical error and that the reporting system should be revised to facilitate better understanding of deaths due to medical error. In 2019, the Institute for Healthcare Improvement (IHI) noted that health care delivery continues to be unsafe and that substantive improvements in patient safety will be difficult to achieve without major medical education reform at the medical school and residency training program levels (Gandhi et al., 2018).
The Robert Wood Johnson Foundation (RWJF) partnered with the Institute of Medicine (IOM) in 2010 and released a Report on The Future of Nursing: Leading Change, Advancing Health (National Academy of Science, 2011). This Report offered a series of recommendations to advance nursing's contributions to the health care environment, as follows:
Nurses should achieve higher levels of education and training through an improved