Letter to the Editor: Response to AACN Commentary

Article Outline

• Reference
• Copyright

To the editor:

We appreciate the opportunity to respond to the concerns expressed by Drs. Lancaster and Bednash regarding our recent article on Professional Polarities in Nursing. We value the many efforts made by the American Association of Colleges of Nursing (AACN) to respond to the call to re-envision nurse education and advance our profession. We could not agree more that there is a need for innovation and for finding a way to harness the collective energy of nursing; this is the whole premise of our introduction of Polarity Theory as a model for addressing the many seemingly contradictory, yet synergistic issues in our profession.

The suggestion that the application of Polarity Theory in nursing will cause greater division rather than harmony intrigued us since the goal of polarity management is to maximize the value gained from each of 2 distinct perspectives or needs while minimizing consideration of either to the exclusion of the other. Drs. Lancaster and Bednash assert that our article’s central concept is “that preparing a sufficient nursing workforce can only come at the expense of patient safety.” Additionally, they suggest that “The authors believe that preparing an adequate number of nurses and promoting patient safety are mutually exclusive.” This is not an accurate representation of our discussion as evidenced in the following quote from the article, “Rather than seeing the nursing shortage and the advancement of patient safety as insurmountable problems that must be solved, Johnson¹ would view them as an interdependent paradox. Nurse leaders cannot advance patient safety without having an adequate supply of nurses nor can they address the nursing shortage without recognizing the emergent clinical complexity of keeping patients safe.” The polarity model displayed within our article explores this paradox further by proposing that if nursing has a singular focus of quickly developing a sufficient supply of nurses; it may result in an inadequately prepared clinical workforce and a lack of professional advancement and stature. In contrast, if we focus exclusively on improving patient safety through augmenting the educational level of nurses, we may have an inadequate number of nurses to perform basic care and possibly further disenfranchise the majority of nurses in this country who hold an Associate Degree in Nursing (ADN). Perhaps the usual connotation of a polarity contributes to the confusion and concern that this theory undermines cohesion. We are not talking about things that are polar opposites; we are talking about issues that must be viewed in tandem.

Our examples of the Doctor of Nursing Practice (DNP) and Doctor of Philosophy (PhD), as well as Clinical Nurse Leader (CNL) and Clinical Nurse Specialist (CNS) were given as illustrations of potentially emergent polarities within our profession. We appreciate and concur with the delineation given by Drs. Lancaster and Bednash between the CNL and CNS roles and also recognize and did not wish to imply that the DNP- and PhD-prepared nurses were adversarial roles. Our goal in the article was to pose the need to view these 2 currently debated professional models concurrently, using Polarity Theory, rather than perceive them as oppositional realities. In retrospect, perhaps our use of versus in the sub-headings of these discussions contributed to the perception that we were viewing them in an “either/or” sense. Furthermore, we hoped to emphasize the value of the management process Johnson¹ advocates when dealing with “interdependent opposites,” most particularly the need to include “all groups in describing, diagnosing, and designing its critical elements.” Without broad-based discussions that include grassroots nurses in addition to high level executives and educators, the introduction of new titles and degrees and the dramatic changing of roles further confuses the public, employers, payers, and interdisciplinary colleagues. It also limits the consideration of alternative pathways for accomplishing the same objectives and leads to the possibility of disunity in nursing.

While we applaud Drs. Lancaster and Bednash’s description of the efforts made to be inclusive of all groups in considering a new vision for nursing education and, while we recognize and appreciate AACN’s intent, we would not concur that all essential stakeholders participated in the discussions nor would we support that consensus has been reached. In reality, there is no uniform view among nurses on any of the issues addressed in our article. As would be expected, the group most intimately involved in making the decisions offers strong support for these initiatives, while those more peripheral to the discussions are still expressing dissent. Polarity Theory asserts that failure to engage nurse educators and practitioners who are affected by these changes results in “sitting on energy” and ultimately contributes to further schisms within the profession. A truly successful response to the calls from the Institute of Medicine (IOM), Robert Wood Johnson Foundation (RWJF), and American Hospital Association (AHA) requires addressing the nursing shortage and patient safety synergistically. It also will require significant funding if efforts to re-envision practice and education are to be successful. Essential dialogue must be hosted among Associate Degree Nurses (ADN), Baccalaureate Degree Nurses (BSN) and Advanced Practice Nurses (APN). Additionally, nurse educators teaching in all educational levels and nurse executives of both large health systems and small rural-based facilities must be engaged. While such discussions are a tremendous challenge, their absence fosters mistrust and further dissension in nursing.

Irrespective of whether the conversation is about ADN or BSN entry into practice, care versus cost in nursing service delivery, or a clinical or research-focused doctorate, the need to consider and manage multiple perspectives is imperative to achieve the best solution for the new realities of nursing in the 21st century. Polarity management offers a way to make sense of this dilemma and a way to explore and design innovative solutions. Integrated discussions that incorporate a full range of stakeholders and the broadest array of perspectives on how nursing needs to evolve are critical. We must view our profession as a tapestry woven with different types of nurses in practice, different vehicles of education, different kinds of patients needing nursing, and different care environments. If we pull on one thread in that tapestry, it changes its’ composition and impacts all of the other elements. It is true that debate does not necessarily equal dissension, but it is also true that chronic discord and an absence of shared vision have been major obstacles to our profession’s ability to improve the health of society. To mobilize nurses to take on this challenge we need nursing leaders who will facilitate the dialogue and a process that will honor and engage every type of nursing professional. Polarity Theory holds refreshing potential for making that a possibility.

Back to Article Outline

Reference 

1. Johnson B. Polarity Management: Identifying and Managing Unsolvable Problems. Amherst, MA: HRD Press, Inc; 1992;
   • View In Article