范式的转变是困难的 | Nursing Outlook

“Don't underestimate the power of your vision to change the world. Whether that world is your office, your community, an industry, or a global movement, you need to have a core belief that what you contribute can fundamentally change the paradigm or way of thinking about problems.” Leroy Hoodmottos.

Our profession, and its’ associated discipline, have faced their fair share of challenging times over the last 50 years. For many years we tried desperately to “prove” nursing was a profession, and then a discipline (i.e., science) worthy of others” respect. We argued among ourselves whether theories written by nurses were really theories and discouraged, yes even disallowed, our PhD students from testing those frameworks.

Some still, even today, fight hard to be recognized for their practice expertise while sometimes discounting nurses “lived experiences” as rooted in servitude and domination. And we even took sides over whether the mission of nursing was to “care” at one point 35 years ago. Interestingly, the dialogue and debate that took place over these many years served to develop and sharpen the thinking of nurse leaders who now lead us through troubled times. One had to certainly learn to think for oneself while listening/reading all the very heated discussions at conferences and in journals. But for the last 20 years or so we have been relatively stable in our “thinking and doing” as nurses working across a variety of settings. Things have gotten better as partnerships between academe and practice strengthened, accelerated undergraduate programs produced knowledgeable and skillful nurses in less time, and we integrated many innovations into our research, practice, and education settings.

So here we are- two full years living through a pandemic that seems to have left us with many lessons to learn. And we have threats to our traditional ways of thinking and doing for the past 40+ years in education, research, and practice. Truth be told, the threats and challenges have been with us for the past decade but only came into stark reality during the harsh journeys of the pandemic and racial justice. We are now in the middle of paradigm shifts in several important areas of our profession and discipline.

The word paradigm means group of ideas about how something should be done, made, or thought about. Paradigm shift refers to a change in approach or underlying assumptions of a discipline. When that change occurs something new and different replaces previous ways (Merriam-Webster Dictionary, 2022). Importantly, in a paradigm shift these changes in thinking and doing occur because the old traditional approaches are just not allowing the individuals in the discipline and the profession to solve the complex challenges facing them.

One major threat to our doing what has always traditionally worked (or so we assumed) is how we must respond differently to the overwhelming amount of information, innovations and complex sets of skills needed by nurses in practice. In a very important paper published last year Kavanaugh & Sharpnack (2021) present data from studies conducted over the past decade with newly graduated registered nurses that clearly outlines the urgency of addressing the continual declines in readiness for practice. In the latest round of data (this past year), in a sample of over 1,0000 new graduates, only 9% were measured in the acceptable range of competency for a novice nurse. Stunning statistic. And makes me thankful for the emphasis on academic-practice partnerships the past decade- this is going to take the best thinkers in both “worlds” to think of new ways to prepare and support new nurses.

Another major threat driving this paradigm shift is how we educate our students. After several years of hard work a large task force of representative deans at The Association of Colleges of Nursing (2021) wrote “The Essentials: Core Competences for Professional Nurses” report that will shift in a major way how we teach, mentor and measure both prelicensure and graduate students using a competency-based framework. This focus on competencies is a distinct shift from the obsession we have always had on “hours” of exposure to patients and preceptors. Competencies go way beyond just a number of credit hours sitting in a course theoretically absorbing the content. The construct transcends a “magic” number of hours in a clinical setting with a preceptor who may or may not have time to impart or model practice behaviors that are helpful to the student. Other health just health professions moved to competencies over the last several years- hopefully we can learn from them and their experiences as well.

A third major shift is related to our science and how federally funded programs of research must evolve. Over the past 35+ years nurse scientists have built knowledge for nurses and other health professionals that have addressed so many critically important issues such as pain, symptom management, palliative care, research ethics, neurodevelopmental support for high-risk infants, etc. They have built a science that has served as the solid foundation on which evidence-based nursing practice with patients has been built. But times have changed, and societal priorities and health indices are not improving at all in our most vulnerable communities of color. It is then time that our federally funded programs of research focus on developing and testing knowledge that will address racism and health inequities, develop interventions to address social determinants of health and to advance precision health and health care across the lifespan. (NINR, 2021).

For each of these challenges we can, and do, launch a myriad of arguments about lack of resources, time, past investments, long held beliefs about how things must be done. Yet, these complex, wicked problems are not able to be addressed using our traditional approaches and strategies. What we need is a new approach of looking at the problem…fresh eyes and thoughts…willingness to risk…and a strong commitment to the good of the whole profession/discipline.

Yes, paradigm shifts are hard. Since we judge ourselves most often on how well what we know works and how much we've contributed to the profession a paradigm shift can leave one with increasing feelings of inadequacy and lack of confidence. New ways of thinking about these challenges is hard work andtakes much energy. It even means connecting with and listening to others we usually don't think of as having enough experience or wisdom to solve these complex problems. This is not a comfortable place to be for those who have been so successful and wise during their careers. Brene Brown (2018), in her book Dare to Lead talks about having courage as a leader to create cultures in which brave work, tough conversations and whole hearts are the expectations. These are the cultures that will support the paradigm shift and help us all to grow together. We are not just one of the most trusted professions but the noblest (IMHO). For hundreds of year nursing as a profession and a discipline has not only survived but thrived in so many ways.

Just sit with it. Bring your strengths and possibilities to this new….build on what you have done already…….open your mind and heart…..stay curious about new possibilities and ways of looking at things so we can together thrive in the future.