Mindfulness practice

Thank you, Dr. Cipriano, for your editorial on mindfulness practice to assist in the grief process (“Breath at the belly,” July 2010). A long-time Buddhist, I have practiced mindfulness meditation for 20+ years. Two years ago, when I suddenly lost my husband of 20 years, mindfulness practice kept me focused and in present time. I was able to fully experience grief in a way I believe is unique because of my Buddhist training. You said it well when you stated, “Grief becomes a purposeful, meaningful journey that teaches the importance of relationships and the experience of the here and now.” Being in the here and now can serve us well not just in health care, where we often deal with others’ grief, death, and dying, but in our daily lives.

Nina D’Andrea, MSN, RN
Sarasota, Florida

Professional judgment vs. practice guidelines

I commend Leah Curtin for pointing out that going by the book isn’t necessarily best in every situation (“Going from the gut,” July 2010.) Today, practice guidelines seem to be regarded as the Holy Grail.

I agree that guidelines are important in bringing evidence to the bedside to improve outcomes. But as an educator, I find it’s equally important to teach nursing students that nurses must use their professional judgment to interpret guidelines within the context of an individual patient situation. When a nurse follows a guideline, she does so because her professional judgment tells her it’s best to do so in that situation. When she decides not to follow a guideline, her actions likewise must be based on her professional judgment. In either case, the decision must be defensible. If the nurse can’t defend her decision, clearly she wasn’t using her professional judgment in the first place.

Mara Eisch, DNP, RN
Madison, Wisconsin

Alphabets are good for soup, not nursing

When I talk with patients, I’m amazed at how much they must learn and comprehend about matters that affect their lives—and in so little time. So I wonder, “Why does nursing add another patient stressor by having so many degrees?” Our “alphabet” of nursing degrees is too large. Even nurses can’t name, describe, or differentiate them all. We have the AD, BSN, MN, MSN, MEd, CNL, DNP, DNS, and PhD. Do we really need this alphabet soup? Why can’t we have just one BSN, one master’s degree, and one doctorate degree? Or perhaps just a BSN and two doctorates (DNP and PhD)? Having just three nursing degrees is less likely to confuse the public and the profession.

Simplifying nursing degrees would help us communicate more effectively with patients, families, each other, and other healthcare providers. I have had this discussion with colleagues from staff nurses to deans, and have found I’m not alone in my thinking. Can we take hold of our practice discipline and get back to basics? Every degree program should have its specialties (some with subspecialties), but the degree itself should be standardized.

Cynthia Chernecky, PhD, RN, AOCN, FAAN
Augusta, Georgia

Disconnect between education and practice

Several articles and a letter in your May issue illustrate the disconnect between nursing education and nursing practice. In “Helping new nurses set priorities,” Joyce Nelson states that novice nurses may feel overwhelmed by the choices they must make. But why should they? After all, setting priorities in complex situations is a fundamental nursing skill. Why do our graduates feel overwhelmed by something they should already know how to do? In her letter to the editor (“Nursing academics vs. practicing nurses?”), Leslie Durr offers an explanation: Nursing education is one thing; nursing practice is quite another.

In “Understanding the DNP degree,” Matthew Patzek suggests the DNP is the solution to the problem. But is it really? And how much money should we invest in finding out? Upping the ante with regard to education leads to a more costly system. How would we know the increased investment would be worth it?

Surely there’s a simpler answer: Introduce more real practice into nursing education. The most obvious way to do this is to require students to complete a substantial clinical internship before taking the state board examination. When I was in nursing school, my classmates and I worked in a clinical setting every day during our entire course of study. While that had disadvantages, it helped ensure we were competent practitioners at graduation.
We need large numbers of nurses who are ready to practice—not a cadre of semiskilled practitioners hoping to muddle through in environments that may or may not get them on track to full competence.

Burden S. Lundgren, MPH, PhD, RN
Norfolk, Virginia

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