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There have been a number of articles in newspapers and lay magazines recently that have caught my attention and raised my anxiety about nursing and its future, such as the front page of The Boston Globe, South Section.1 What disturbed me most about this and other similar articles was how nursing is being represented and communicated to the public. In the Globe article, the nurse is described as an "assistant" to the physician in the medical management of care. There is no attention to the role of the nurse as a knowledge broker with a clear disciplinary focus, autonomous in the delivery of nursing care,2 and complimenting medicine by focusing on the person in the context of their human experience and their environment.


What has happened within our discipline that results in the representation of the professional nurse displayed as care technician on the front page of a major newspaper? What is contributing to nurses being portrayed as assistants to physicians or replacing physicians as primary providers in the delivery of medical services? Are the proposed "new roles" such as clinical nurse leader and doctor of nursing practice3,4 being created to advance nursing by celebrating our unique disciplinary contribution to care outcomes, or are these new roles contributing to an abandonment of nursing as a discipline? Are we losing our disciplinary identity to look more like other providers of care, particularly physicians, rather than being true to a nursing mission? These are challenging questions and as we move forward, as a nursing community the need is to achieve unity around the collective use of nursing knowledge to heal and reform healthcare for the good of all. It would appear that the further we move away from our disciplinary identity, the more we run the risk of losing it all together.


The essence of professional nursing is centered within the partnership between the patient (family and community) and the nurse.5,6 This focus on partnership has been nursing's history and is the hallmark of our existence. Patients require precisely that which nursing, by heritage and current practice, is uniquely qualified to offer "[horizontal ellipsis]concern for the person and assistance in living and coping with[horizontal ellipsis]circumstances and[horizontal ellipsis]environment in such a way that illnesses may be prevented or recovery may be facilitated."7(p375) Through this concern "[horizontal ellipsis]lie opportunities for discovery, awareness, choice, and transformation through a process dialogue between the patient (family and community) as well as with the nurse."8(p219)


Being part of a university setting, I am involved in nursing student recruitment activities at all levels of academic pursuit. I am often struck by a potential applicant's ability to articulate the values of nursing, the contributions of nursing to patient care, and the overall agenda of national health. I wonder what happens to this understanding and vision as these students pursue nursing as a career. Do our nursing curricula attend to the articulation and differentiation of nursing's contributions at all levels of education? Is there careful attention to isolating and transmitting nursing science into the core classes that form our nursing programs? Is nursing theory valued and used to guide practice and research?


If nursing's unique contributions to care lie within the relationship between and among patients, families, and groups, how will nursing's voice be heard within in our current healthcare system? Will the focus of professional nursing be on the acquisition of "other discipline" knowledge to the sacrifice of nursing knowledge? Will the content of professional nursing education be informed by other health science so that the unique contributions of nursing become blurred and professional nursing ceases to exist?


As a discipline, nurses would agree that research and knowledge development are essential to growth and advancement of a profession. Yet, the recent proposals by the American Association of Colleges of Nursing supporting the creation of new roles, such as the clinical nurse leader,3 the practice doctorate in nursing,4 and the DNP Essentials,9 all seem to challenge that assumption Although the goal appears to be disciplinary advancement, the danger is further blurring the unique contributions of nursing and diffusion of nursing into areas such as medicine, informatics, business, and administration with less emphasis on "theory and metatheory and research methodology content."4 Without this knowledge, "the discipline lacks definition as a legitimate science[horizontal ellipsis]"10


"If nursing is a science, then nursing has its own unique phenomenon[horizontal ellipsis]".11 Is there disciplinary consensus around nursing as a science with a disciplinary focus, or do we continually respond to how others define us? Do we believe that the contributions of the nurse change not only the outcome of a clinical episode but also, when embraced to its fullest potential, change lives forever? The growth and advancement of nursing as a discipline lie in the continued development and expansion of nursing knowledge, complimenting other providers in the delivery of safe and effective, quality patient care. A continued emphasis on using other discipline's knowledge decreases our visibility, increases our focus on tasks and skill sets, and threatens nursing's unique contribution to interdisciplinary care. At a time when nursing knowledge is needed by consumers more than ever, will we neglect our disciplinary mission in favor of extending into other disciplines? While other disciplines are working to firmly establish their identity as providers of care, will nursing give up its unique position in the care of others?


Professional nursing is entering a time of challenge, growth, transformation, and potential. As a discipline, we need clarity of purpose and an opportunity to use nursing knowledge to serve others and reduce global suffering. The new roles being explored by the American Association of Colleges of Nursing could offer promise to move us forward as a discipline but proposed developments that, to date, could detour us from developing our science and currently lack the needed evidence to support that the promise will become reality.


In my opinion, these proposed roles do little to advance nursing as a science; rather, they continue to move us toward a corporate mission of healthcare that focuses on capacity management, medical management of disease, and role titles that do little to promote our nursing identity and may even increase consumer confusion. Instead of continuing to create something new, maybe we should consider building upon already established and accepted nursing roles. The clinical nurse specialist, for example, provides a model for delivery of advanced nursing and has the potential for continued professional advancement.


The clinical nurse specialist is prepared at the graduate level and is well positioned to respond to medical and other knowledge, while promoting nursing contribution to enhance patient recovery, prevent complications, improve life style, and prevent or delay illness. In addition, the clinical nurse specialist has mastery knowledge of nursing and is able to use this knowledge to change practice, improve patient care, collaborate with other disciplines, communicate disciplinary contributions, and develop and mentor staff. A clinical nurse specialist who is doctorally prepared as a nurse scientist builds upon knowledge from the discipline, specialty knowledge, and role expertise to generate new knowledge and expand and refine theory through research. The doctorally prepared nurse works to use knowledge to improve practice and bring a nursing perspective to innovative interdisciplinary research efforts to enhance global health and healing.


Nursing's move toward increasing its educational base is critical to assure consumers safe, efficient, timely, cost-effective, quality patient care. However, nursing has worked many years to overcome practice barriers to integrate nursing knowledge into clinical care. "We have traveled a long road to achieve status and legitimacy within American universities and scientific communities."12 We must not abandon our professional heritage. We must carefully stay true to the things that distinguish nursing and its efforts to insure equitable, affordable, knowledge-driven care for all. To do less would deprive society of the rich resource that is nursing.




1. Johnson CY. Physician calls make a comeback in care of elders. The Boston Globe, South Section. July 3, 2005:1,5. [Context Link]


2. Lyons B. Getting back on track: nursling's autonomous scope of practice. Clin Nurse Spec. 2005;19(1):30. [Context Link]


3. American Association of Colleges of Nursing In: Working Paper on the Role of the Clinical Nurse Leader. Washington, DC: American Association of Colleges; 2003:1-23. [Context Link]


4. American Association of Colleges of Nursing In: Recommendations for Approval of the Draft Position Statement on the Practice Doctorate in Nursing. Washington, DC: American Association of Colleges; September 9, 2004:1-21. [Context Link]


5. Flanagan J. Nurse and patient perceptions of the pre-admission nursing practice model: linking theory to practice. Diss Abstr Int. 2002;56 (UM I no. 30-53657). [Context Link]


6. Newman M. Caring in the human health experience. Int J Human Caring. 2002:8-12. [Context Link]


7. Johnson D. Development of theory: a requisite for nursing as a primary health profession. Nurs Res. 1974;23(5):375. [Context Link]


8. Jones D. The impact of HEC: concluding thoughts and future directions. In: Picard C, Jones DA, eds. Giving Voice to What We Know: Margaret Newman's Theory of Health as Expanding Consciousness in Nursing Practice, Research and Education. Sudbury, Mass: Jones and Bartlett Publishers; 2005:219. [Context Link]


9. American Association of Colleges of Nursing. DNP Essentials: Revised Draft. Washington, DC: American Association of Colleges. August 18, 2005:1-19. [Context Link]


10. Milton C. Scholarship in nursing: ethics of a practice doctorate. Nurs Sci Q. 2005;18(2):114-115. [Context Link]


11. Rogers M. Nursing science evolves. In: Madrid M, Manhart Barett EA, eds. Rogers' Scientific Art of Nursing Practice. New York: National League for Nursing Press; 1994:5. [Context Link]


12. Dracup K, Cronewett L, Meleis A, et al. Reflections on the doctorate of nursing practice. Nurs Outl. July-August, 2005;53(6):181. [Context Link]