Saturday, February 16, 2008

An interesting arrangement

A few years back, I diminished my employment by 30%, from full-time to 70%.  Instead of crying out, "What will we do without you?", my boss thanked me. More cutbacks in nursing education were occurring at Big Fat University (BFU) up on the hill; and she needed to find ways to save dollars. Yes, the nursing shortage is global and growing. Yes, the nursing faculty shortage is even worse.  Yes, the population is "graying" and the demand for nurses will only increase. Yes, the research shows that better-educated nurses save lives. But health care financing is tight and the schools are supported by hospital revenue to a good extent. Done deal. 

The irony is that I would have more free time (not working 6 days a week - what a treat!), make more money, and be more effective in my academic role.

How can this be?

Cutting out the fluff.Concentrating on what matters. Not volunteering. Attending fewer meetings. Leaving the policy-writing to others. Abandoning critical roles on crucial committees that claim to NEED my blessed presence.  I'm putting on my scrubs and athletic shoes. I'm tying back my hair, eschewing most jewelry, getting up at 5:30 and nearly killing myself for 12 1/2 hours on my feet before going home feeling completely satisfied. I'm using my pocket calculator and stethoscope in the intensive care unit and leaving my cell phone at home. I am bringing my best negotiation skills to bear when a glib, self-certain surgical resident tries to gloss over a real issue that he'd prefer to leave to the ICU resident. And I am making more money as a working ICU nurse than as a teacher and researcher while doing what I MUST to bring relevance to teaching. 

Nursing is a practice discipline. One of the implications of this is that we have to practice nursing to maintain skill. In a practice discipline, standing still = falling back. Historically, however, there have been no opportunities for faculty to practice nursing, so faculty have been forced to quit nursing in order to teach nursing. Nursing homes, home care agencies, hospitals and community organizations do not see the value of having an experienced and educated nurse on hand one-half, one or maybe even two days a week. It's full-time or nothing unless you give direct bedside RN care (as I do, although I'm an advanced practice nurse.)  Nursing faculty like me with graduate degrees, years of experience, advanced practice licensure and multiple certifications simply have nowhere to practice nursing.  We have a health care system that thinks there's no place for us. 

Universities do not pay nursing faculty to maintain their clinical practices. After all, they're not in the patient care business. I was an anomaly to negotiate 10% FTE in my first 3 years post-PhD for practice. Most nurse faculty like me simply assume that practice has to be given up.

What went wrong? Well, one thing I know for sure is that those in control have a vested interest in suppressing the power of nurses. Control over health care goes to those who make the big bucks. (I don't harbor fantasies about shadowy, sinister men convening secret meetings in poorly-lit backrooms to plot against female-dominated professions. They actually meet in spacious, tastefully-decorated conference rooms and their names are prominently featured in organizational charts.) This is not the place to explain, so I'll refer you to any of the many books and articles on the topics of paternalism, power, nursing, sexism, and health care.*  And this blog post. 

At BFU the "Executive Leadership Team," (ELT) comprised of MBAs and MDs, once opined that our university may not need a bachelor's of science in nursing program because (paraphrased) "nurses can be trained in community colleges." When one considers that the last word in the organization's name is university, it seems counter-intuitive that any of these people would suggest educating nurses in a university setting makes no difference. Are nurses the one exception to the rule that better education = better performance among professionals? Most organizations encourage their employees to advance their educations. Yet, a certain member of the august ELT at BFU  - that member happened to be the dean of the school of medicine - himself determined, all evidence aside, that nurses could be educated adequately in two years at a community college and a university degree is unnecessary.  This is redolent of my grandmother's being deprived of a desperately-desired high school education because, in rural Ohio, only boys were allowed to attend high school. So much has changed in 90-some years. 

The ELT really can't be blamed for this remark, I guess. The members are ignorant people exerting their right, as the big bosses, to act in their own self-interest. Perhaps if the ELT included at least one representative of the largest single group of employees in the organization (also the largest single group of health care providers in the country), these things would happen less often.

As a part-timer at the  School of Nursing, I would get to hear less of the ELT's antics, and that could only help me stay sane. Perpetual outrage is not good for a person.

* Such as:
Medicine as culture: illness, disease and the body in Western societies
 By Deborah Lupton

Perspectives on power, communication and the medical encounter: implications for nursing theory and practice. 1995. Nursing Inquiry, 2(3), 157--63. by Deborah 

Hospitals, Paternalism and the Role of the Nurse 
by Jo Ann Ashley

  • by Barbara Ehrenreich and Deirdre English