I always loved taking care of patients. It was fun, exciting, intellectually stimulating, and rewarding. To this day, I remember special patients and keep in touch with the daughter of a patient who died following emergency surgery just days after he retired. Few experiences compare to the thrill of saving a life, the triumph of solving a complex problem, or sharing the somber moments of death. As a new nurse graduate, I remember being awed by the responsibility entrusted to me on a daily basis. As a seasoned administrator, I marvel at the resilience and hard work of nurses who dedicate decades to their careers as staff nurses. Their secret? Realizing the unparalleled satisfaction that comes from the caring experience.
This summer, a colleague reminded me about a conversation we had more than a decade ago, when we talked about being “a staff nurse by design.” Like most nurses, I started my career as a hospital staff nurse. As a new graduate, I was tapped to participate in a special advisory committee to the director of nursing—a shared governance structure ahead of its time. As a staff nurse, I had opportunities to shape the direction of organizations through collective action and help design new models of customized care to achieve better outcomes. Throughout my career, I have been passionate about patient care, and look back fondly on my journey from taking care of patients to advocating and caring for nurses and other caregivers. At each progression of my education, I preserved every opportunity to be involved at the bedside. As a clinical nurse specialist and a manager, I treasured the times I took on a patient assignment, feeling the unmistakable sense of accomplishment as a staff nurse.
I hope I never again hear the words, “I’m just a staff nurse.” Over the last decade, research has illuminated nurses’ critical contributions to patient outcomes. The growing body of evidence highlights the relationship between more nursing hours and reductions in serious adverse outcomes, hospital mortality, failure to rescue, and length of stay. In large part, staff nurses are responsible for these results. Thirty years ago when nurses advanced their education, they commonly moved to a job further from the bedside. Some criticized these nurses, many of whom wore white coats and carried clipboards, for earning degrees and then abandoning patient care. Whether or not their perceived reluctance to engage in bedside care was accurate, this was a period of progress when nurses entered discussions about quality, resources, professional development, education, interdisciplinary care, and advocacy. Perhaps they needed to look different to be treated differently.
Progress is no accident; it’s motivated by change. Nurses who have advanced their education are staying at the bedside, or “patient side” in nonhospital settings. Rewarded by more robust compensation and recognition through clinical advancement systems, they are some of the strongest leaders in the clinical ranks. They are staff nurses by design, contributing knowledge, critical thinking, analytical skills, coaching, mentoring, and leadership on a regular basis. As purveyors of expert care, they support and teach newer nurses, enhancing positive patient outcomes. The amalgamation of colleagues with varying experience, education, and outlooks is creating a synergy that’s helping to shrink the chasm among nurses who differ vastly in age and degrees.
The consensus statement on educational advancement for registered nurses issued by the Tri-Council organizations (American Nurses Association, American Association of Colleges of Nursing, National League for Nursing, and American Organization of Nurse Executives) in May of this year calls on all nurses to advance their education to improve quality and safety across healthcare settings. The statement acknowledges the need for a more highly educated workforce to meet the imperatives of a complex healthcare system. This means progression across the entire continuum of nursing education to align our workforce with healthcare delivery for the future.
Change will bring more progress with new opportunities in primary care, managing chronic conditions, enabling transitions in care, and expanding services into the home. Nurses on the front lines in all settings—in partnership with nurse colleagues in administration, academic practice, and other clinical roles—are the key. I find myself envying the highly skilled and facile staff nurse. I watch advanced practice colleagues escape back into patient care to stay grounded and get revitalized as a respite from bureaucratic debates and endless meetings. Overall, I’m encouraged by our progress. Meeting the challenges that lay ahead will require us to build on our strengths, abandon old battles about our differences, and value the voices of staff nurses and others alike.
Pamela F. Cipriano, PhD, RN, FAAN, NEA-BC