Scott Chisholm Lamont, RN.

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This is the graduation speech I made on behalf of the RN to BSN grads at the UNM College of Nursing December 2001 ceremony. I think it has some points worth thinking about regarding the challenges facing nursing and nurses over the next decade.

Sailing beyond 2001: Nursing's looming challenges

Classmates, colleagues, and honoured guests: greetings. It is my privilege to address you on behalf of the graduates of the RN to BSN completion program, a group that you could say has already been in the game for a while.

The standard for graduation speeches is to be inspirational and congratulatory, and for the next five minutes, I am going to avoid that entirely. I am here to speak to you of challenges, and challenges tend to be daunting rather than inspirational. They present to us like icebergs – obstacles that are sometimes close at hand, sometimes on the horizon, not always easy to navigate around. Like icebergs, they may be obvious on the surface, but their foundations may be hidden, and subtle. Sailing on the good ship Nursing in today’s waters may seem reminiscent of a trip on the Titanic, slow to turn, yet nonetheless speeding into an uncertain night. Or perhaps it seems more like the voyage of Terror and Erebus, bravely exploring, not heeding the ice closing in on all sides.

What are the challenges that face us as nurses? The list is long. Many are known to the majority of you. I will bring up a few that perhaps you haven’t thought of.

Funding: Nursing is a science, and the development of any science requires funding. It also requires a large cadre of scientists, individuals prepared at the graduate level. These are things that we sorely lack. Less than 10% of the nurses in the US are prepared at the graduate level, and fewer than 2% at the doctoral level. Who will develop and disseminate new nursing knowledge? Who will teach tomorrow’s new grads?

Demographics: There will be fewer professional nurses for a larger pool of people with more complex needs. You cannot argue with demographics: like the position of the stars in the sky, you can study and predict, but you pretty much have to live with what you get. Yesterday, I received an e-mail news flash from the American Nurses Association, reporting that the Department of Labor Statistics is now predicting a shortage of more than one million nurses by the end of the decade. Speaking of the tip of the iceberg, we ain’t seen nothing yet. Increasing our numbers by enticing nurses from developing nations is a band-aid approach, not to mention morally suspect. We must grow our own nurses.

Career: The lack of career planning offered to working nurses, or even the lack of ergonomic planning for an aging workforce, seriously undermines career longevity. There is no point in attracting people to enter a profession that cannot meet their needs – they will leave.

Knowledge: Sue Thomas Hegyvary, editor of the Journal of Nursing Scholarship, recently wrote: “What is now publicized in many countries as a shortage of nurses could more accurately be called a long-standing shortage of nursing.” Noting the often inappropriate responsibilities of nurses, she suggests that increasing the number of nurses will not lead to a long-term solution, but rather the targeted application of nursing knowledge is the way to address this challenge. However, much of that knowledge has yet to be fully developed, and this will hamper our efforts. As Luther Christman noted: “You can’t use knowledge you don’t have”.

Education: This is important, and it is both a solution and a challenge in itself. Learning nursing knowledge is not enough, as Hegyvary implies. The key is learning how to use it, and that takes time and focus. The benefit of a university education is learning how to think. Yet nursing education itself is in dire need of reform. We can’t agree on preparation for entry to practice. The nursing boards are based on antiquated notions of what knowledge beginning nurses need to possess in order to provide effective care in today’s world. Despite suggestions from national specialty organizations, exposure to clinical specialties during generic preparation is generally lacking. There is not enough time to learn all that needs to be known to launch a successful career in the current model, which is why nurses committed to their career have to add to their education, again and again. This is not a slam on UNM, because this is not unique even to the US.

Do I think that we can navigate these waters safely, even while moving boldly? Yes, I do, and I think that the best example for us to follow is Florence Nightingale. Nightingale spearheaded the transformation of an occupation that was considered, at best, disreputable. She planted the seed that grew to become an educated profession of no small public standing. The image of her with lamp in hand, held aloft to light the way, revealing unmet needs, deeply determined, guided by both passion and science, is one that remains relevant to nursing today. Like Flo, driving forward health care reform with nursing knowledge, our unique contribution to healthcare, is something that we can do. As Gretta Styles wrote: “The ideal persists. The lamp burns on”.

There is work to be done. We are the ones to do it. To my classmates I say: be proud of all your accomplishments. It’s not easy to go back to school while maintaining the career you are trying to advance. To my newest colleagues I say: be proud of your choice. The reward of your efforts is to become a part of one of the most noble and worthy professions. To you all, faculty included, I say: Take everything your education has provided you with, take all of the hope and courage in your heart, and gird yourself with that. Then sally forth, and meet the challenge.

Cite as: Lamont, S.C. (2001). Sailing beyond 2001: Nursing's looming challenges. Available on-line at: http://www.thuntek.net/~sclamont/nursescott/essays/2001gradspeech.htm. Retrieved: [date].