Advanced practice nursing is an option?

In the Czech educational system, a public school student can choose to concentrate studies along a technical or professional path beginning at age 14, or what we in the United States consider high school. For instance, a student accepted to a health-career school would have a curriculum that follows a scientific and biological course, with clinical experiences in health care. After four years, the student can decide to pursue nursing, medical or allied health programs at the university level, go a completely different direction with university studies, or simply enter the workforce.

This past week, I was invited to speak at a health-career school in a neighboring community on the subject of health care in the United States. My audience was comprised of third- and fourth-year students, ages 17 to 18. The students submitted questions in advance, which gave me an idea of the type of information they were interested in.

They wanted to know a bit about me; where I went to school, where I had worked and in what section of the hospital. In fact, the assumption was that all my experience was in a hospital setting. In the Czech Republic, there are few nursing jobs outside hospitals, so, when I mentioned the many different roles nurses fill in the U.S. system, the students were quite surprised. I also identified and explained available levels of nursing education, including advanced practice possibilities, and this came as a downright shock to the students. They had never heard of an expanded nursing role, even though it exists in Europe with practitioners in the United Kingdom, the Netherlands, Sweden and Switzerland.

I had been warned that Czech students are not interactive, and I should not expect them to engage in dialog. However, the discussion about opportunities in nursing and advanced practice spurred many questions and interaction that surprised the class teacher. She admitted, once the discussion had ended, that she was amazed at the amount of interest the students had expressed and how engaged they were with questions. I hope I planted a seed of curiosity in my audience that may lead them to explore the many ways nurses can contribute to the health of their nation. The possibilities are exciting.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

We got something right!

One of my responsibilities, when moving to a new post, is to assess local medical resources. Most cultures are more formal than the American culture, so there are official introductions, sometimes the exchange of small gifts, often tea or coffee, and polite chatting before we get down to the business of me asking, “What can you do for the official Americans in your country?” Not in those words, of course, but that is the real purpose. I will visit the hospital or clinic and ask nosey questions to determine if the facility is acceptable to me, and those I serve.

I continue to be surprised by the hidden jewels I find in the most unexpected of places around the world. I remember the husband-wife MD team—Harvard residencies—working in a truly backwater clinic in Rwanda and, in Guinea, the tropical disease expert from Germany. I have never served anywhere that I couldn’t find at least a few excellent physicians.

Nursing is another matter. Frankly, most of the countries in which I have worked undervalue the nursing discipline, and a few—Guinea and Afghanistan come to mind—don’t recognize the discipline at all. Nursing in these places is an OJT technician job with little formal training and no respect. In more modern countries, nursing usually requires formal education but falls short of the critical thinking required in countries with the highest standards of nursing care.

I recently had dinner with a German nurse who was lamenting that nurses in her country, while highly educated, were underutilized as integral members of the health care team. She was intrigued by advanced practice nursing and commented on the ways in which the German system could benefit from such a program. Finally, she said, “You Americans have really got it right!” Now, there’s a comment I never hear. I usually have to listen to all the things we Americans have wrong.

For Reflections on Nursing Leadership, published by the Honor Society of Nursing, Sigma Theta Tau International.