Hi Carmen

I think academic stress experienced by our students is because of curriculum obesity or saturation especially in the nursing profession. Each faculty member do have some expectations and it is also aggravated by the teaching approaches that we employ, for instance in our case- PBL which mostly self directed

Having taught a number of nurses at the doctoral level and also chairing a research committee on online nursing education I can attest that academic stress is very real. The vast amount of knowledge--often on par or above in some ways, that of pharmacology and medical students--they must learn and synthesize in nursing today is incredible. More than once I've had to tell my nursing students to take care of themselves, in other words, "Healer heal thyself"---remember, they are in the healing professions--they should refrain from all the egregious behaviors that beset the population they serve, such as using tobacco, high caffeine, alcohol, and other substances that diminish health status. High pressure does not justify letting one's health status go. 

Thank you all for the conributions above.  Is there any model or strategies tha may help students to refrain from maladaptive behaviours?  What are the essential elements for a good nursing curriculum?

The model of Practitioner/Researcher, an almost totally forgotten model for physicians was once touted and soon drowned out by McMedicine and reimbursement codes that shaped diagnosis more than hands on case history and assessments, I believe, is a worthy model for Nurses, particularly Nurse Practitioners who work more independently. As the scope of practice continues to expand, as I fee it should in a framework of increased knowledge and research. In the current allopathic model of patient care, which in my opinion is highly lacking of the personal and introspective touches needed for true efficacy, it appears more and more that nurses, in general, are going to have to  pick of the slack by expanding their role and depth in the diagnostic/treatment/follow-up protocols of medicine.  

Hi Max,

The context you allude to is alive and well - enforced by all sorts of agendas within Western medicine. Particularly, in relation to prescribing rights (the main last bastion of medicine - apart from diagnosis), advanced nurses expanding training and roles mean that there is a real blurring between nursing and medical practice - where there once was a very clear delineation. I have predicted previously that, in the not too distant future, nurses and doctors may not exist as discrete and separate professions. Instead, a more efficient and cost-effective model would be to have a 'generic' health practitioner - who is an equal mix of both current roles. 

Back to my earlier point, take prescribing Nurse Practitioners in New Zealand. They are primarily community-based and recent legislation to expand their prescribing and diagnostic roles is in direct response to the looming crisis related to a national shortage of GP's - and guess which practitioner is likely to be the most effective and cheapest in the long run!!

I'm all for nurses having an expanded role and say in wider health services agendas. My only real concern, is that this might mean adopting a 'hardline' biomedical approach to practice - so that nurses eventually just become clones of doctors. 

The specialization of medicine has really hurt public access to basic healthcare, as Dean alluded to above. In the US, there tends to be the allure of higher income, consultation opportunities to satisfy insurance certification, and an over abundance of useless testing and surgeries that create more waste and debilitation than offset by patient benefit. For this reason, the saving grace, as you well noted, is the Nurse Practitioner, which in most states now can prescribe and even diagnose. In some states real time supervision is required, in others they can work somewhat independently.  In the US Urgent Care satellites plugged into the larger medical services appears to be the most efficient model. I noted in my trips to New Zealand that there are a lot of these, too. Efficient, low cost, high quality, and I note more and more staffed almost entirely by NPs and APs, with usually a figure head Medical Director with an MD or DO that no one ever seems to see. I find these kinds of facilities more patient centered, more flexible, less apt to follow herd prescribing patterns, and more independent from the drug reps' influence. Ideal in so many ways. 

Correct Max - a peppering here and there of 'nurse-led clinics' in New Zealand has already shown many practitioners 'the way to go'. They have been successful in a short period of time. However, to the flip side. Is there the political resolve to continue to follow such models when protective, all-powerful medical lobbies are monitoring any threat to 'their patch' very closely. Time will tell. 

Yes, the turf wars. So unethical and unnecessary when we are speaking of the essential altruistic mission of healthcare. Saving lives is not, as you know, a domain, but a collaboration that requires the skills and dedication of ALL players at the table. I noted back in the late 1980s when Vanderbilt embarked on its first Nurse Practitioner Training Program (I knew the Academic and Clinical Director of the program personally at the time), that advanced nursing training was closer to the research knowledge base than many medical school programs of the day. They even used similar if not identical textbooks, and where the texts were not aligned, the nursing program had the newer and more up-to-date textbooks. The rigor of examinations at the masters and later doctoral level or nursing were on par with the examinations of physicians in terms of general care. And as fewer and fewer physicians render hands on care and leave most diagnostics pathologists who don't even see patients up close and personal, the need for nurses to step up to the plate is growing with each passing day. That is why, when asked, I suggest all nurses go on to the masters and doctoral levels. All are needed, of course, but there is huge void now in just about every country in the world, and nurses need to be ready to fill it.  

In the case of NZ, Dean, what I hear from my acquaintances in NZ is that the Nurse Practitioner Model of Community Clinics will not only continue on but will likely become the norm over time because of the GP shortage. So that it may be the communities rather than special interests making the decision.

Hi Max,

Agreed with your last two posts. I'm actively involved in post-grad nursing programmes and supervise lots of Master's students. We certainly need more doctoral students in nursing - but the future is looking rosier over the last 5-years or so. More nurses, both to meet Nursing Council professional competence and development requirements - and career progression, are seeing more and more nursing entering post-graduate programmes. The irony is that, while a longer under-grad programme, many doctors do not enter into post-graduate studies as a 'right-of-passage'. 

Yes - the Nurse Practitioner programme has been a resounding success - and even the GP bodies acknowledge that they will either be direct partners - or NP's may eventually replace GP's altogether. I think that all parties are 'at the table'; medics, community, government etc - but the 'wave' has hit already to envisage any U-turn on this one. 

Dean, my wife Glenys is there in your city now at a reunion for her Occupational Therapy classmates from many years ago. Plus, I have a granddaughter going to your university, as well, third year, I believe, maybe fourth. So, wondering how your program is going? Heard it was an astoundingly successful nursing program worthy of emulation. Congratulations on the good work!