Decades ago, I was enthralled by a film of the well-known health care futurist, Leland Kaiser. I had heard Leland speak many times, and each presentation he made gave me great hope for patients and those who care for them. However, the first time I heard him prognosticate the coming "Golden Age of Nursing" was while watching this short movie. He depicted a future in which professional nurses (supported by virtual technology that seemed like science fiction then) were able to lead change that truly improved health for individuals and communities. I have never been able to locate that particular video again, but I still remember it as inspiring.
I thought about Dr Kaiser and his predictions while editing this edition. I do believe we are entering the future he foretold. There are certainly great opportunities for nurses and nurse leaders in every area of the care continuum. The dawning realization that advanced practice nurses (APNs) provide exceptional value through their high-quality care is creating an environment where they, especially, are well into the beginning of what could be called a Golden Age. However, any new age faces challenges, including opposition from others who are afraid of change or prefer the current (or even a past) era. The articles collected by guest editors Michelle Edwards and Tim Porter-O'Grady address these issues, while sharing examples of how nurse leaders are moving forward to support advanced practice.
Supporting advanced practice is an accountability for nursing leaders. It is especially part of the role of chief nurse executives, because of their responsibility for the practice of nursing, wherever it occurs in their systems. We have an obligation to ensure APNs, like all other nurses, are competent practitioners who work within their scope of practice, at the top of their licensure. We also have a duty to help our advanced practice colleagues navigate the complexities of organizations that resist change.
A question we should all be asking, though, is to whom we owe that duty. An acquaintance and I once had a spirited conversation in which he claimed the primary duty of a professional is always to his profession. (He also reminded me that, until fairly recent decades, the only "recognized professions" were the Clergy, the Law, and Medicine.) My stance was (and is) that this conviction could (and has) lead to some members of a profession protecting their fellow professionals, even when this may be to the detriment of other people and society. My US Army Nursing professors taught that nursing is a profession, but they were very clear on this point: the professional nurse's first duty is to the individuals and communities to whom she or he provides care. I think that distinction might underlie the reason nursing is repeatedly recognized as the most trusted profession in this country.
Why am I bringing this up in an editorial on Advanced Practice? I mention it here to emphasize that support for APNs practicing at the top of their licensure is not because they are nurses. It is based on the quality of care they provide, the increased access to care they offer to individuals and communities, and the holistic viewpoint they bring to a fragmented health care system. In other words, advanced practice is needed, and must be supported, as a strategy for providing appropriate, quality, and affordable care, in a time where resources-both money and people-are limited. As nurse leaders, we owe this to our constituents, not with the goal of ushering in a Golden Age of Nursing but to bring on a Golden Age of Health. It should be increasingly clear that these two things go hand in hand.
Thanks for choosing to lead,
-Kathleen D. Sanford, DBA, RN, FACHE, FAAN
Editor-in-Chief
Nursing Administration Quarterly