Year One: Recollections and Reflections from Further Down the River.

Sean Clarke As we head into a new calendar year and a new volume of Nursing Outlook, I wanted to pass on some reflections on my first year on the job as Editor-in-Chief, but before I do, I wanted to share a bit of personal history. I came to the editorial office of Nursing Outlook from its editorial board and had a history working on other journals from my graduate school days onwards. What people might not know is the huge role journals have played in my career in nursing. Where I grew up, the local community college that housed an enormous nursing program was around the corner; their library was open to the public, which was wonderful for a library aficionado like me in the pre-Internet era. Because I had no health professionals in my family or in my immediate social circles, the idea that nursing might be a viable career choice came to me largely from the hundreds of hours I spent in that library’s stacks. The rows upon rows of books and journals introduced me to everything from the mysterious duties and rituals of daily nursing practice to nurses’ elaborate responsibilities in caring for patients facing a range of conditions and complications. Looking back, a Richard Scarry Busytown-like healthcare world emerged in my early adolescent brain that replaced the original one from my preschool years—characters playing roles in a fast-paced, uniquely compelling microcosm. (For those of you who don’t know this cultural reference, I suggest a quick Google search. For those of you who do recognize it, I hope you find it amusing. In either case, I readily own up to having unusual reading and entertainment tastes.) I relished this reading and loved the practical tone of the writing. I loved the way nurse authors guided and energized readers and wrestled them into committing to well-informed and skillful practice. I loved the jargon, the glints of insider humor, the regular reminders of the moral responsibilities nurses shoulder above and beyond any legal obligations (which were fascinating in and of themselves), as well as the forthright discussions about the sadnesses of life nurses were likely to witness as they walked alongside patients and families and how they could help themselves and others cope. I often found it spellbinding. When I eventually started meeting actual nurses in action through volunteer and paid work as I got older, I found so much about them and their work inspiring, and after a few false starts I eventually found my way into the profession. The rest, as they say, is history. In addition to learning about practice, I also read a great deal about the profession’s development and its issues and challenges. The books and journal articles on these topics created yet another multilayered world in my mind—one with a sweeping history that dated back to the Crimean and U.S. Civil Wars (and I was to learn later, much further), characters in the dramas of the founding of institutions, the authoring of blue-ribbon reports on the profession’s future, and the emergence and evolution of the profession’s associations. I also started to learn about the interplay of gender, race, and class in nurses’ work, and hear hints of questions around the social organization of work, the forces of supply and demand in the nurse labor force, and the values, politics, and economics underlying the operation of health care systems and how those forces trickled down to the world of patients, nurses, and nurses’ coworkers. These ideas eventually became the heart of my scholarship, teaching, and leadership. I remember the strongly expressed convictions around the baccalaureate entry to practice debate. I recall the articles arguing passionately about the theoretical and scientific basis of practice and 1980s-era nursing research textbooks cracking open the door to what many leaders saw as a key element of nursing’s pursuit of professional status. Most of all, I remember the profession’s leaders writing about a future where over time nurses would assume greater positions of authority and use their voices to advance the profession and the public good. I recall their impassioned calls for optimal educational preparation to equip nurses for exciting emerging roles. Those writings challenged and inspired me. Those leaders’ visions have been partially but not completely realized; there are certainly realities and reckonings that they could not have anticipated. They left a heritage—at times a remarkably proud one, in other instances an underwhelming and even profoundly disappointing one. Whatever our feelings about it in parts or as a whole, the heritage is unquestionably the base from which we now move forward, and we must keep studying its lessons. A quote from Sir William Osler, a towering figure in the history of medicine, hangs in many health science libraries: “He [sic] who studies medicine without books sails an uncharted sea.” The second part of the quote is usually left out by librarians: “… [H]e [again, sic] who studies medicine without patients does not go to sea at all.” I’ve always thought of the second half as an inducement to engagement in the realities of practice and reasoned action in scholarship and practice, rather than endless rumination. Osler wrote at a time when the basic science knowledge that would ultimately reveal the fundamental mechanisms of most diseases and guide rational diagnosis and treatment was just starting to emerge. I believe he was referring to the literature (“books”) as a means for clinicians to access distilled experience (especially in the days before anywhere-anytime digital access to information) as well as a tool for refining clinical judgment through reflection. However, I’ve always understood the quote, including the sometimes omitted second half, as also meaning that the interplay between the literature and the world of practice improves both worlds and that at times we need to learn from experience. I read the quote today as a stimulus for all of us, even the very practically-minded in pragmatically-oriented fields like nursing, to make regular trips to the library to learn from each other by partaking of the discourse about professional issues as well as clinical practice, even if more and more, the “library” is a virtual space rather than a physical one. I have been reading Nursing Outlook for 40 years. (There, I’ve said it—quantitative evidence of both a misspent youth and devotion to the journal in one sentence.) I am proud beyond words to work with a large behind-the-scenes team of tremendously talented colleagues to provide charts and maps for the current and future generations of nurse leaders in the pages of Outlook. My first year on the job as Editor-in-Chief has indeed been a ride on a fast-moving river—a metaphor I used in my first editorial. I don’t see the river slowing down any time soon—indeed, if anything the turbulence around us alluded to in our authors’ contributions seems to be accelerating. From geopolitical crises and national level malaise, all the way down to profound unease in the lives of individuals and families and anxiety and anger in workplaces all around the world, it’s obvious that we’re living through a period of upheaval. Through all of this, I am grateful to the authors who keep submitting their work to Outlook and working with us to format and polish their ideas. I am grateful to the peer reviewers who, time and time again, come forward and provide insightful feedback to authors voluntarily as an act of generosity to both the authors and our wider community. I am also grateful to you as readers who have come with us on this leg of the journey and continue to engage with our content in multiple ways. Moving ahead, we’ll continue to tackle at least two trends at Nursing Outlook that merit continued attention from the broader profession. The first is a pressing need for deep, thorough, honest, provocative, but respectful discussion and debate about the fundamental issues confronting us in our daily working lives at all levels and corners of the profession. This can and should happen in our journals, but we also need spaces and structures in our workplaces for this dialogue. So many are crying out for validation of their questions and guidance about what should be driving their decisions in their work in these difficult times. The second is a special sweeping challenge: the shortage of time and attention and the accelerating work pressures and personal struggles that so many of us are facing. Feelings of overwhelm are widespread in our profession right now, from those at the beginning of their careers trying to prepare for entry to the job market to those deep into their professional lives. Many are at the point of exhaustion. Doing more and doing it faster is demoralizing those in our ranks, creating new problems and diverting attention from deep-seated problems. More than ever, we need to truly consider the impacts of technologies, financial pressures, and workforce trends on our work. Even if it’s not feasible to slam on the brakes, we must talk seriously about what can be done to help those in our profession cope with overload. We need to consider that a deep rethink about how many of us are doing our work may be necessary. At their best, journals like ours are spaces for slowing down, reflecting and reorienting. It is urgent that we think about how scholarly venues in the profession can stimulate dialogue about these pressures and how we may either be assisting or worsening time pressures for ourselves and each other through the way we do business in scholarly publishing. On many levels, helping others manage time pressure and overwhelm is a critical responsibility for every one of us as leaders in the profession. In closing, I thank you all for making Nursing Outlook a part of your professional lives and for your ongoing support of the journal in these hectic and disruptive times. I wish you fulfillment and satisfaction in 2024 and look forward to more collaboration, good reading, and robust discussions.