Good afternoon everyone. Thank you for coming here today to be with our class as we celebrate the culmination of many years of hard work. Without the encouragement of all of you--our family, friends and faculty--we would not have made it here today. Your support has been invaluable.
Sometimes in life, it pays to read the extra credit question. About three months ago, and approximately three years since I'd first been asked it, I finally found the answer to a question I had been faced with the very first day of graduate school. Back in February, on one of those freezing nights when snow brought all of New Haven to a halt, I was stuck in the YSN computer lab trying to finish a never-ending assignment when I got frustrated and decided to skip ahead to try my luck with the extra credit question at the end. In reading it, I was thrown back three years by a single sentence: "What does it mean to you to be a 'good nurse'?" As I looked at the page, I could not help but laugh. Here I was, a few months from graduation, and I was face to face again with the very same thing I had been asked on the first day of school three years back. One look at those words and, suddenly, it was September 2003 all over again in good old Room 118. I could hear Professor Linda Pellico's voice booming across the classroom, smiling, asking the group of us two things we could have hardly known the answers to at the time: "Why do you want to be a nurse practitioner? What is it that brought you here?" Now I'm sure to all of you sitting here right now at a nursing school graduation that these don't exactly come across as mind-bending questions to pose to a room full of people who had just moved from all over the country to work towards a master's degree in that field. Surely, we all must have had our reasons that day. But as it turns out, we could not have known our full answers yet. "Why nursing?" is no easy question; it is something that takes years to know, something you have to answer from the inside out.
People would ask us, Linda told us on that first day, possibly for the rest of our lives, why we wanted to do a job that involved bedpans and long hours. It was far from glamorous. Friends, strangers--even our own families, she warned--might wonder why motivated students like ourselves had chosen this field over the prestige of medicine, the power of a law degree. Before we entered into this profession, she stressed, we needed to know for ourselves why we were here. Maybe you already knew your reasons on that day back at the beginning of school. Maybe, unlike myself, you entered here as a registered nurse already and could easily say why working towards an advanced practice degree was right for you. But, I didn't really know what it was to be an APRN then, to be a nurse. At least not in the way that I know today.
It takes being in the midst of something powerful to truly understand its meaning. And nursing, while often unsung, is a powerful thing. Before I came to YSN, I could have had no idea how much it meant to simply hold someone's hand, even if done through a pair of rubber gloves. I had no concept of how moving it could be to be the first person to hold an infant, to bear witness to a last breath. Life outside of nursing does not prepare you for the raw emotion that this field requires. No, when I started here, I thought I was at YSN to learn how to become an efficient provider, able to see patients, diagnose, prescribe; to learn to be a practitioner who just happened to be a nurse. But the thing I have learned over time here is that nursing doesn't just "happen" to be a part of what we do as advanced practice clinicians; it is the core of it. What we have been taught in our years at Yale is far more than just how to diagnose and treat patients in a timely manner. What has been impressed upon us by our professors, our preceptors--and most of all, our patients--is the importance of being truly present with people when they need us most.
Yet, it is this key piece of nursing that is being pushed to the margins. In a recent article from the Journal of Critical Care, nurse-clinician Patricia Brenner warned that the very aspect of nursing that sets it apart is in danger of being lost altogether. In the current U.S. culture, so focused on measuring so-called "quantifiable outcomes", nurses are often led to believe that "what can't be counted does not count" (Brenner, 2004). Somehow instead, the amount of patients we see in a day, the number of flu shots we give-- things that are cut and dried and easily measured--have replaced compassion as the current measure of what makes one a "good" nurse practitioner. Yet, what about the use of touch, the act of caring? What about being truly present with someone in pain? To reduce the work of nursing to nothing more than the rote application of clinical skills is to strip away from it something vital, maybe even its essence. The caring piece of our field, though difficult to measure quantitatively, is and always will remain one of the most powerful aspects of the job.
If you ask your patients what they remember most about a stay in the hospital or their last primary care visit, I doubt they will tell you they were impressed by the evidence-based measures used in their care, though surely these things contributed to their health outcomes. What they remember, instead, is you; whether you really listened to them, whether you gave them your time, whether you didn't just say "everything will be alright" without knowing what scared them in the first place. In the end, it is the conversion of scientific knowledge into compassionate care that benefits patients most. The work of advanced practice nursing involves not only understanding protocols and being well versed in the research literature, but having the ability to appreciate the needs of an individual patient in an individual moment. Nursing is medicine in translation. And that unique art, the balancing of care and cure, is what we have been truly immersed in learning in our time here at YSN.
So, what should we be most proud of standing here today? Knowing that we leave this school to enter a profession whose most important contributions can never truly be defined by the results of an outcomes measure. "Good nursing"-that complex and rare thing we have been taught here at YSN--is not something that a checklist or a survey will ever be able to quantify. Cost-effective nursing, studies can define. Safe nursing, yes. But good nursing is something all its own. It is found not in hard data but in moments of skilled caring. It is listening, touch, going beyond the standard protocol. It is in being truly present with people. And it is not easy.
So to each of you standing here with me today, know your answer to the question "Why nursing?" Be proud of who you are and what you have to offer. We may be new. We may have some hard days out there as we try to keep up in a healthcare market so focused on the bottom line. But remember that what you came here to learn and are leaving here able to do is to care. It is in what you can give to your patients not only with your minds, but by the work of your hands and your hearts, that sets you apart. Leave here today and show everyone why you chose to be a nurse: because what can't be counted does count, maybe more than anything else.
