Chapter 21: Promoting “Top of License” Nursing Practice; the Future of Nursing at MD Anderson
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Description
In this Chapter, Dr. Summers talks about the future of the Division of Nursing. She explains the importance of ensuring that nurses are practicing at the “top of license,” noting that in the future nurses will work as coordinators of care. She explains some of the resistance she anticipates from stakeholders and nurses as the role of nurses changes and they are not available to perform roles (that are not “top of license”) currently expected of them. She notes that this change in nurses’ roles will transform MD Anderson culture.
Identifier
SummersB_03_20140429_C21
Publication Date
4-29-2014
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Barbara Summers, PhD, Oral History Interview, April 29, 2014
Topics Covered
The Interview Subject's Story - The AdministratorThe Administrator The Leader Building/Transforming the Institution Contributions to MD Anderson MD Anderson in the Future Professional Practice The Professional at Work The History of Health Care, Patient Care
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey Ann Rosolowski, PhD:
What about other roles in the division or, say, your future view for the division as a whole?
Barbara Summers, PhD:
You know, I think that we as a division and as a community of professional nurses have a huge challenge ahead of us in redefining the practice of professional nursing and ensuring that we are able to evaluate our most significant contributions and then design the role around those contributions. It’s commonly referred to as ensuring nurses are practicing at top of license. Nurses and any professional actually can, but nurses are particularly vulnerable to falling in the trap of taking on responsibilities that don’t require the preparation of a baccalaureate-prepared professional nurse but—
Tacey Ann Rosolowski, PhD:
Yeah, I think last time we talked about how you—
Barbara Summers, PhD:
Yeah, because nurses are very flexible and very smart, they do take on roles that are not necessary for them to take on. So we—I mean, this is going to be a huge, huge undertaking. We’ve already launched some of that in the inpatient area, and we’re starting to have conversations in Ambulatory Care, but it’s going to require us to rethink the way that nurses come to work every day. In Ambulatory Care, for example, as nurses come into their practice environment every day, in the future, in this future world, they’re going to be practicing collaboratively as a member of a team that will include a physician and will include probably mid-level practitioners and will include a medical assistant or two or three, but the nurse will not be functioning primarily as a doctor helper. The nurse will be there functioning as a coordinator of care for the patients and as a navigator for the patients, helping the patients to transition the continuum of care to ensure that the patients are doing the follow-up that’s necessary, communicating with the patients regarding their responses to treatment, a totally different focus than what they spend their time doing today.
Tacey Ann Rosolowski, PhD:
Do you anticipate that there’s going to be some pushback on redefining nurses’ roles in that way? I mean, I can just imagine at a personal level, you know, you’ve got a group of people, “Well, wait a minute, so-and-so’s always done that. Why do we suddenly have to change and someone else has to take on that role?” What are your strategies, your visualizing for addressing those kinds of on-the-ground issues?
Barbara Summers, PhD:
Well, I absolutely do think that there’s going to be resistance, particularly in those circumstances where we have physicians and nurses who’ve been working together for ten, fifteen, twenty years. So we have to be realistic as we’re planning for the transition. We need to ensure that we have stakeholders involved and not driving the definition of nursing practice, but involved so that they understand the thinking behind the way that we are defining nursing practice, having the stakeholders involved in articulating what is the assistance that they need, particularly in the outpatient area. When they look to the nurses to be their helpers, what is it that they’re needing help with? And changing the paradigm from the perception that we’re taking something away from the physicians to one where we actually are going to be keeping the nurses and allowing them to serve the patients more comprehensively. At the same time, we’re going to be giving you more medical assistant help. So you’re going to continue to have all the help that you need, and we’re going to have the nurses engaged more effectively with the patients. And then recognizing that not every nurse is going to want to make this transition, nor is every nurse currently employed here going to be able to make the transition, and so having a period of phasing where we don’t say, “Off with your heads if you can’t function in this new role. Then you can’t work here,” but having a period of time where hopefully those nurses who can’t make that transition are towards the end of their career, and as they retire, we fill the position but not with someone functioning in exactly the same way. It’s a huge culture change. It’s going to take us a number of years to make this happen.
Tacey Ann Rosolowski, PhD:
Yeah. I’m just kind of getting my head around that, it seems, and, you know, working with shifts in self-awareness and how identity—
Barbara Summers, PhD:
All of that. How do nurses think about their practice.
Tacey Ann Rosolowski, PhD:
Right.
Barbara Summers, PhD:
We do have nurses and nursing leaders in Ambulatory Care who understand the opportunity here, but that doesn’t mean that there is not going to be tremendous resistance, because there will be.
Tacey Ann Rosolowski, PhD:
Interesting.
Barbara Summers, PhD:
So it’s not at all uncommon in the clinic to have a physician say, “Well, Barbara is my nurse,” or for the nurse to say, “Oh, I’m Dr. Smith’s nurse.” And, in fact, the last time I heard a nurse say that, and I said, “Goodness,” I said, “you know, what would you think about instead of saying, ‘I’m Dr. Smith’s nurse,’ if you just introduced yourself and said, ‘Hi, I’m Cynthia Strong, and I’m the registered nurse who practice with Dr. Smith’?” She looked at me like I had five heads. (laughs) So I think that that would be a good, like, thermometer to tell me about the potential obstacles that we have, that she thought it was perfectly fine to describe herself as being Dr. Smith’s nurse, as if she had no identity herself. You know, her identity was only in the context of Dr. Smith.
Tacey Ann Rosolowski, PhD:
Now, is this a generational thing? Are nurses who are graduating now less likely to have that kind of paradigm?
Barbara Summers, PhD:
Well, I think to the extent that we can leverage new graduate nurses and help them not fall into that trap, that would be tremendously helpful.
Tacey Ann Rosolowski, PhD:
Well, I’m also thinking, too, you know, with the movement that you are fostering to establish credibility, establish autonomy, I mean, it’s giving women their own identity as practitioners, so that I’m getting a sense now of how this is part of not only culture, but redefining how nurses understand themselves and what they do.
Barbara Summers, PhD:
Right, right. You know, you’re not Dr. Smith’s nurse; you’re Patient Jones’ nurse.
Tacey Ann Rosolowski, PhD:
Right.
Barbara Summers, PhD:
So we need to think about who is our duty to. Our duty is to the patient, not the physician. Our duty is to the patient, not the institution; that we don’t come to work to help Dr. Smith, we come to work to provide care to the patients and to collaborate with Dr. Smith.
Tacey Ann Rosolowski, PhD:
Or even we come to work to develop our own capacity to provide care—
Barbara Summers, PhD:
Absolutely.
Tacey Ann Rosolowski, PhD:
—and the first person who receives that is the patient.
Barbara Summers, PhD:
Right.
Recommended Citation
Summers, Barbara PhD and Rosolowski, Tacey A. PhD, "Chapter 21: Promoting “Top of License” Nursing Practice; the Future of Nursing at MD Anderson" (2014). Interview Chapters. 1258.
https://openworks.mdanderson.org/mchv_interviewchapters/1258
Conditions Governing Access
Open
