From the Editor-in-Chief
The world was recently captivated by the nuptials of the young royals William and Kate, and while the ceremony was replete with traditional pomp, the nature of their relationship and public personae indicate a society that has changed from that of their forbears. Throughout the broadcast, we saw live video feeds of royal-watchers from around the world.
Within days of this historic event, Canadians also experienced elements of historical déjà vu when the electorate sealed the fate of certain political parties. Most significant was the resulting dramatic shift in dominance and roles, not to mention the unprecedented youthful representation in some jurisdictions. Not only did technology support the rapid tabulation of results, but posed a potential threat to the integrity of the process. The Internet and, in particular, the use of social networking tools such as Twitter, threatened to expose early results from closed polls prematurely. This possibility prompted immediate censure and threats of punitive action. The response of those would-be tweeters to the promise of reprisal were even more telling of a changed society.
The story of what the election results will mean for Canada over the next five years remains to be told, but suffice to say the country will likely look very different. Among the most important determinations will be the future of healthcare after 2014. In anticipation of the certain debate and discourse on this topic, the editors at Longwoods will be looking to spark discussion and will be inviting your points of view in the near future.
Whether the global fixation on the royal wedding, the civil revolution in Egypt, unrest in other parts of world or the rapidity with which national election outcomes became irrefutable, these events are manifestations of how society and roles are in constant evolution.
Marshall McLuhan's (1968) concept of the "global village" has steadfastly taken hold. Citizen engagement may or may not be directly correlated to the ubiquity of technology, but people worldwide are assuming their rights, demanding democracy and transparency, and in Canada, are becoming vocal about the disbursement of public funds for healthcare and other social services. We need to consider how such debate will change the work of nurses, our leadership responsibilities and the landscape of healthcare delivery in this country.
Our recent special issue on advanced practice nurses (APNs) in Canada (Pringle 2010) provided a robust chronicle of the evolution of these roles that has occurred over more than four decades. This rich compilation of research and perspectives on APN roles gives testament to our profession's responsiveness to the changing needs of healthcare delivery in Canada. Nursing has experienced a remarkable transformation of practice roles over the last 50 years, yet the breadth and depth of our collective influence still has room to expand.
Shamian (2010: 27) raised the increasing importance of having clinicians in senior executive positions to lead the way in the transformation of healthcare:
… clinician executives will be well placed to lead the major transformations that the system will demand. Their intimate knowledge of clinical realities, coupled with the proper management skills, will give them the edge in marrying productivity gains with quality improvements that keep the patient at the heart of the healthcare equation.
However, at the same time, concerns are being raised by nurse leaders as to whether we are doing enough to ensure that nurses are being appropriately mentored and groomed for these senior roles. In the current issue, Donner and Waddell invite you to engage in a conversation about how to ensure that we are meeting the needs of healthcare organizations and master's-prepared graduates transitioning to the workplace. In addition, our authors address other key issues related to nursing roles, including the work experiences of new graduates, the need to give attention to succession planning and the integration of nurse practitioners in primary care.
With the dialogue about the future of healthcare inevitably about to escalate, it is time to elevate the discussion about the role of nurses and nursing in that future. As some role boundaries are beginning to blur, there is a need to collectively determine what existing and possible future roles might constitute our professional identity and ensure the ongoing development and sustainability of same.
New technology disturbs the image, both private and corporate in any society, so much that fear and anxiety ensue and a new quest for identity has to begin. (McLuhan 1968: 126)
There is no doubt that technological and societal changes, as well as economic pressures, are driving healthcare transformation and directly affect the roles that nurses will assume in the future. In the context of these issues and anticipated skill shortages, the scope of practice of nurses and other healthcare professionals is increasingly under scrutiny to ensure optimal use of health human resources in various sectors of care. A case in point is the pending change to the scope of practice of nurse practitioners, which will sanction their ability to discharge patients from acute care settings in Ontario. This change has been largely tied to the recognition that discharges are often unnecessarily delayed, resulting in ER backlogs and unnecessary extensions of hospital stays. Creating new roles such as physician assistants and nurse anaesthetists, and expediting licensure for internationally trained health professionals, are other efforts to address skills shortages and improve timely access to care. As has already been demonstrated, controversy will be certain within and between professional groups in the face of new roles and responsibilities ("A Helping Hand for Doctors" 2011).
As McLuhan suggested, perhaps it is time to embark on a quest for a new or redefined identity. Whether or not you believe nursing needs a rejuvenation, let's get the exchange going as to how we might most effectively contribute to the path of healthcare transformation and be purposeful in influencing our own destiny.
Lynn M. Nagle, RN, PhD
About the Author
Lynn M. Nagle, RN, PhD, Editor-in-Chief
"A Helping Hand for Doctors." 2011 (April 21). Editorial. Ottawa Citizen. Retrieved May 29, 2011. <http://www.ottawacitizen.com/story_print.html?id=4658156&sponsor=>.
Pringle, D. (Ed.). 2010. Canadian Journal of Nursing Leadership. 23 (Special Issue).
McLuhan, M. with Q. Flore. 1968. War and Peace in the Global Village. New York: Bantam Books.
Shamian, J. 2010. "Clinician Executives: A New Breed of Leader." Canadian Journal of Nursing Leadership 23(4): 22–27.
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