Maintaining Optimism Despite a Challenging Social Context

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THE STOCK MARKET is plunging, political scandals are rocking the nation, the health care system is failing, terrorist attacks continue. Coupled with these headlines are the dire facts we face in nursing education: 767 faculty vacancies in 2007; 42,866 qualified students turned away from baccalaureate and master's degree nursing programs due to lack of capacity (www.aacn.nche.edu/IDS); and the prediction that by 2020, our nation will be in need of 340,000 more nurses.

Such headlines coupled with these difficult work situations contribute to the conditions under which we ardently work to try and instill in our students a sense of optimism and a dedication to become successful nurses who can and will make a difference in our society. We teach our students to practice nursing in a safe and ethical manner and to care for and tend to those who cannot care for themselves. We teach our students to develop social responsibility. Our new president-elect is a symbol of hope and change and optimism, and students may be very responsive to this new message. Paradoxically, however, there is a sense of doom and gloom on the nightly news and in predictions about the nursing shortage.

So how do we, as educators, serve as role models for our students and instill a sense of optimism?

I believe that we must integrate an understanding of the social context, of the societal dilemmas, into our teaching of nursing content. I believe that it is our responsibility to convey to students that part of being able to think critically as a nurse and in patient care situations also means being able to think critically as a socially responsible citizen. When we teach our students how to become advocates for their patients, we also teach them about social advocacy. But to be sure that our students develop social responsibility and become advocates for patients and for an improved health care system, they also need to have positive self-esteem. In my recent experience teaching undergraduate students in Nursing Frameworks, I have had many questions from students about how we can improve the image of nursing. These are exceptional students who are often questioned by their friends and relatives as to why they did not go to medical school. Such questions, coupled with the fiscal and social crises in our nation, present a prime opportunity for all of us to think clearly and articulate strongly the reasons that we, bright and motivated members of society, have freely chosen nursing as a profession.

We practice nursing within a social context; we do not care for patients in a vacuum. Our nursing curricula certainly reflect this emphasis on understanding the larger social world. We have courses on leadership and management as well as on policy issues affecting nursing and health care. And I know there are several other courses, both required and electives, that address the social context. I think we need to extend this emphasis beyond these courses. We need to encourage our students to become active in various nursing organizations and to consider roles in policy and leadership. Currently, for example, we have some nurses who are in strong positions in both of the major political parties. We have lobby days in our state capitols as well as in Washington, DC. We need to build on all of these important aspects of our nursing curricula. I believe that we need to include in our curricula some time for students and faculty to have open discussions about nursing issues. In addition to learning the history of nursing, the theoretical frameworks for the profession, and the foundations for nursing practice, we must encourage open communication with our students about the issues that they encounter as students and as future nurses. Our current nursing students are the future nursing leaders of tomorrow. They will be responsible for tackling many of the complicated societal issues that directly affect nursing. We, as their teachers and mentors, can work with them to develop a sense of responsibility and commitment.

As I write this editorial, I am struggling with what seems to be a “stream of consciousness” that focuses on several disparate topics. However, in reflecting on these seemingly disparate topics, I realize that they are all very much related. These topics include the dire social and economic circumstances that we face, the challenges related to the critical shortage of nurses and nursing faculty, and the curricular changes we need to make to be more responsive to both the societal issues and the nursing professional issues.

The message, then, out of what may have begun as a stream of consciousness, has jelled into a simple notion. We, as nursing faculty, need to work closely with our students by developing open lines of communication in which we listen to them and encourage them, our future nursing leaders, to take on, along with us, the challenges of our profession. To take on these challenges, they will need our consistent support and guidance. When they are confronted with questions such as why they chose nursing instead of medicine, we need to help them be proud and passionate about nursing. At the same time, we need to help them be realistic about the difficult circumstances in which we practice nursing while we continue to instill in them a confidence and a commitment to overcome these obstacles.