A disturbing movement has occurred at the University of California, Los Angeles (UCLA) that directly affects the profession of nursing. This movement is an initiative that proposes to abolish the undergraduate program in the UCLA School of Nursing.
Although the graduate program will remain, it will be downsized and restructured, eliminating all but three specialty options - nursing administration, nursing education, and primary care. The currently autonomous School of Nursing and its remaining faculty will then be placed under the administrative purview of the Provost of Medical Sciences, who is currently the Dean of the Medical School. This restructuring is the result of a desire to cut costs; yet the cost savings from this proposal are relatively minor. The initiative, if implemented, has major national implications for the profession of nursing.
According to the March 22, 1993, issue of IiS News and World Report, the UCLA School of Nursing is ranked among the top five nursing schools in the nation. Of the nine universities that comprise the University of California system, UCLA is the only university that offers a bachelor's degree in nursing. The Baccalaureate Program prepares nurses for work in clinics, hospitals, home health, and public health. The Graduate School prepares nurses for advanced clinical practice and research.
The School of Nursing, if placed under the administrative purview of the Provost of Medical Sciences, will be assimilated into the School of Medicine. Assimilating schools of nursing into schools of medicine will ultimately weaken both. This proposal ignores that the contributions and approaches of schools of nursing and medicine are fundamentally different, yet complementary.
Schools of nursing and medicine perform different functions in preparing students to care for the complex needs of patients. Both approaches and philosophies are required to achieve a functional, comprehensive system that makes quality care available to the largest number of individuals. It is naive to assume that one discipline can address all the complex needs of patients.
Nurses, particularly gerontological nurses, provide a spectrum of care in a variety of settings. Education at a baccalaureate level prepares nurses for these roles and is the level of entry for advanced nursing practice. Placing nursing under the auspices of medicine will result in a shift in educational and research priorities, the redistribution of resources, and the loss of autonomy, authority, and decision making power necessary to maintain nursing's unique contribution to science and health care. Such action will eventually lead to the disappearance of nursing and its replacement with "service technicians."
The American Medical Association has already taken steps to discourage the move toward independent nursing practice. This proposal comes at a most unfortunate time because current resources require shifting while the nation is continuing to grapple with the increasing demands for care for the growing geriatric population. Health care reform will place a premium on nurses because of their focus on primary care, cost-effectiveness, and case management. This situation requires increased numbers of registered nurses with baccalaureate and advanced degrees to provide primary and preventive health care in settings outside acute care.
The real issue is the precedent that UCLA is setting. There is no doubt that UCLA is nationally and internationally recognized as a center of academic excellence and will continue to serve as a model in this arena. If the proposed initiative is implemented, I believe it will serve as a blueprint for restructuring schools of medicine and nursing throughout the country, thereby beginning a national trend. This trend will be reinforced by the tremendous competition for clients under the proposed health care plan.
Now is a critical and opportune time for the profession of nursing to formalize and expand its contributions in the national reformation of health care. Health care reform and managed care require increased numbers of nurses. If schools of nursing are assimilated into schools of medicine, then nursing science, the contributions to caring for the elderly, the chronically mentally ill, the homeless, high-risk patients, minorities, and women's health will be jeopardized. Compromising quality for cost is not the answer.
This editorial represents the opinion of the author only. For individuals who would like to support the UCLA School of Nursing, please contact Ada M. Lindsey, RN, PhD, Dean, UCLA School of Nursing, 10833 LeConte Avenue, Los Angeles, CA 90024-1702.