From the Editorial Co-Directors

Letter from the Editor-in-Chief

Every nursing-related meeting I have attended recently has focused on the Institute of Medicine’s report on The Future of Nursing: Leading Change, Advancing Health, the NP role in healthcare reform, or both. If you have not read the IOM report, take a look. Log on to http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx to download the entire report. In the report, the IOM states that APRNs should be able to practice to the full extent of their education and training. In addition, healthcare reform legislation has placed a new emphasis on the role of nurse practitioners.

Needless to say, this attention on APRN practice has caused some controversy, if not hives, among some physician groups. In fact, several physician groups have asked the Robert Wood Johnson Foundation to convene a meeting of physician and nursing groups to gain an understanding of what the intent of the IOM report (which they funded) really is.

Several concepts and words—including NPs functioning to their full scope of practice; use of the word independent when referring to practice for APRNs; and the different interpretations of what team health care means—seem to generate the most controversy. For the physician groups, team care is fine as long as an MD is the captain. Go team go.

First of all, let’s clarify what independent practice means. Not all APRNs are going to hang up their own shingles, although many may do so. Independence simply means that APRNs hold an independent license regulated by the profession of nursing. It does not mean that NPs or other APRNs will be able to work outside of or independent of the rest of the healthcare system! NPs should be able to function to the full extent of their scope of practice. Why waste education and skills when what this country needs is as many healthcare practitioners as we can get? Healthcare reform will bring many more people into the healthcare system. We need healthcare practitioners to care for them. As far as the team goes, what matters is how the team functions to care for patients, not who heads the team.

At the most recent meeting of the APRN Roundtable hosted by the National Council of State Boards of Nursing, my lunch mates and I began talking about a colleague’s son who was participating in team competitions creating robotics as part of FIRST (For Inspiration and Recognition of Science and Technology). The concept of how these teams functioned really resonated for me and for others at the table. Check out www.usfirst.org for more information about the organization.

We would all be winners if we applied FIRST’s concepts about teamwork to the healthcare arena. First of all, the organization encourages high-quality work, the value of others, and respect for individuals and communities. Members do not see fierce competition and mutual gains as separate notions. For example, in creating a robotic, points are given for sharing best ideas, even with the competitor. If Team A finds a solution to Team B’s problem, both teams can reach the finals if they are collaborating!

Members have coined the term Coopertition™ to describe innovations that come about as the result of unqualified kindness and respect in the face of fierce competition. Coopertition involves learning from others, teaching others, and assisting and enabling others to win. They use the term Gracious Professionalism™ to describe the process of helping others achieve what one team might not be able to achieve on its own. What a concept!

This concept certainly applies to what we should be doing to best meet patients’ needs, although each of us at the lunch table had different ideas about how this concept could be implemented in the healthcare arena. I focused on how, even within nursing, we could be more supportive of each other. As members of the healthcare team, we all could take a lesson from the FIRST robotics teams. If our goal is delivering the best patient care, it doesn’t matter who has the best idea as long as patients receive the best care. It doesn’t matter who heads the team. Sometimes it may be the MD, and sometimes it may be the APRN. Gracious Professionalism is about uniting science and technology and team members to solve complex problems.

Last, let’s take a lesson from FIRST. By that, I mean that we do best by serving our patients. No single profession or healthcare practitioner has the ultimate right to captain the team. And let’s be kind and supportive of each other in our attempts to reach our goal.

Susan Wysocki, WHNP-BC, FAANP President and CEO, NPWH