Dear Editor:

The Online Journal of Issues in Nursing is a wonderful and much needed addition to nursing resources. As a nurse, an educator, and a doctoral student, I am immersed in nursing's struggle for recognition and autonomy. I believe that the nurse practitioner movement, oppression, and basic educational preparation are inextricably linked.

We cannot separate from our problems the fact that we are an oppressed group. I suspect this condition partially accounts for the fact that we have jumped full tilt onto the practitioner bandwagon. The rapid expansion of this albeit valuable role flies in the face of the fact that a primary care physician glut is imminent, and that the system is still primarily controlled by medicine and payors. Frequently students will state the belief that practitioner status will bring them recognition and job security. Of that I am skeptical.

If we truly wish to meet the needs of society and to advance our professional recognition and power base, we will have to liberate ourselves from the effects of our oppression. And that can only happen internally. Imitation of an oppressor group such as medicine will only keep us oppressed. So, how do we promote our image of ourselves and equip the members of our profession to find their place at the table? I believe this could be accomplished with a higher base of education for all nurses.

I cannot be convinced that for the work that needs to be done in nursing today and in the future, that anything less than a five or six year professional degree is adequate for entry into professional nursing. Essential educational components should include a broad liberal arts base that will foster critical thinking and provide richness for our practice. A very strong theoretical and science base that prepares clinical nurse scientists, otherwise we will continue to struggle with practice based on tradition and bureaucratic influence. Skills that enable us to effectively manage ourselves and others in complex systems. And a heavy dose of ethics and health care policy. This level of education in combination with sufficient practice experience in a student role mandates a much higher level of educational preparation than we currently accept for entry level practice.

I have seen time and again the empowering, liberating effects of higher education in nursing. The "ahas" that come when nurses learn about professional standards and leadership strategies and the excitement of practice based research. Our inability to require adequate preparation of nurses who care for highly complex clients in a highly complex environment is akin to sending a child out to do an adult's work. Nurses are in the anchor position in health care, and as such we must prepare ourselves for that role. Otherwise we most assuredly will continue to feel unappreciated and powerless.

Nurses must replace infighting with pride and with understanding of the roots of our difficulties. Emancipatory leaders are needed to co-dialogue with nurses to encourage and facilitate. But true liberation can only come from within the ranks of everyday grassroots nurses. With liberation will come a sense of worthiness for who we are and an understanding of what action will truly change our condition.

The importance of nurse practitioners in indisputable. But choice should hinge upon a nurse's goals and capabilities, not upon a desire for increased visibility and recognition, or belief that the role will be valued more by others. Those needs can only be addressed through the process of liberation from within, and the profession's wholehearted decision to finally educate all, not just some, of its members at an appropriate level.

Kathryn A. Ballou, RNC, MSN, CNA
Clinical Instructor, University of Missouri — Kansas City
University of Missouri-Kansas City
2220 Holmes Street
Kansas City, Missouri 64108-2676

Ballouk@smtpgate.umkc.edu

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