Sunday mornings are routinely my favorite time to peruse websites related to my profession of nursing. I grab a triple vente cappuccino at Starbucks and begin reading. Last Sunday I read an article from the Robert Wood Johnson Foundation website called A New Dawn in Nurse Education written by Mary Ellen Smith Glasgow, PhD, RN, ACNS-BC. The article discussed how she integrated strategies of Japanese car manufacturing systems into a university nursing curriculum. The tenets emphasize concepts creating a permanent culture in which an organization continuously improves its ability to deliver high-quality products and services to customers.
Time for a Change
Dr. Glasgow’s approach is intriguing to me because there has been a call to change the way we educate nurses for several years now. Her approach to nursing education is surprisingly unique, even though it incorporates the same strategy hospitals are using to reach quality benchmarks. This Japanese based strategy is known as Total Quality Management (TQM). It makes sense to me that nursing should apply an educational system that teaches and prepares RNs to meet the demands and practices of their future workplace. There are many areas of nursing education that need attention and this article helps explain the changes and pitfalls that lie ahead to accomplish this goal.
From a personal perspective, in the past four decades since I left school not much has changed in how we educate nurses. For example, in order for a nursing school to have national accreditation, all instructors who teach nursing courses must have a Masters or PhD in nursing. This means an intro level nursing pharmacology course is required to be taught by a nurse rather than a pharmacist, unless the pharmacist also holds an advanced nursing degree. This practice might seem strange to some as a pharmacist is and should be considered an expert in the field of pharmacy.
Importance of the Orchestra
In reflecting on my journey as a nurse and now nurse educator and the article on Dr. Glasgow, I’m further reminded of a book by Dr. Edward Deming, one of the fathers of TQM. This book was given to me by a CEO of a major health care system I worked for in the 1980s. Dr. Deming was a Wyoming businessman who was asked by the Japanese government to help rebuild their shattered economy. His original approach was more of a philosophy that compared the workings of an organization to an orchestra judged by how well it plays together and its listeners rather than by each individual musician.
While growing up on a poor farm in Wyoming, Dr. Deming became aware that cooperation helped to ease the hardships and there was great value in the shared benefits of farm life. Later, he obtained a degree in electrical engineering and graduate degrees in mathematics and physics. His earlier experiences and education influenced his appreciation of how parts of a system work together to create a whole. This helped generate his orchestra philosophy and TQM strategy.
This brings me back to nursing education…
Strings Taught Only by Strings
Nurses are simply one part of the health care system. We might think of nurses as the string section and the orchestra as the place of employment; in this case a hospital. The string section is generally the largest part of the orchestra. Nurse educators represent the violins, cellos and harps and they educate and create new strings of the same type (i.e. maternity, critical care, medical, surgical, mental health and geriatric nurses). They then send their new protégés out into the orchestra. Because the new strings have never heard the sounds of the percussionists, the woodwinds or the brass, the new nurses feel lost, disconnected, even unappreciated, despite creating ‘music’ with the rest of the hospital staff. The percussionists, woodwinds and brass are unaccustomed to combining with the sound of the string section and hence the orchestra’s sound becomes autonomous instead of a melody to both the orchestra and the listener.
We might think of the sound as the productivity and the quality of the health care experience. The orchestra creates music but the sound is not conducive to the orchestra or the listener (i.e. the patient). How can revamping education change this scenario? If nursing education would incorporate the percussion, woodwind, and brass sections into the education of the string section, a less fragmented orchestra might result. All members of the orchestra would remain autonomous within their respective musical ability but because they have ‘practiced’ together, (i.e. educated by each other) the music created would be more in harmony. In other words, productivity and quality in health care would improve, and the string section, the largest part of the orchestra, would not only retain their identity and their autonomy, but would become masterful in their purpose to provide service. Those in need (the listeners) would significantly benefit from this harmony and unity in purpose.
So, the question remains, who are the percussionists, the woodwinds, and the brass of the health care orchestra that are willing to practice with the strings and who is their conductor?
