The Doctorate Mindset

graduation cap goldFrom day one in the Frontier DNP program, our doctoral advisers have shared that we would have a completely changed method of thinking over the next year. In fact, they shared that this would be somewhat isolating in that we will see the world, science, conversations and truth differently than our peers.

I think I started to see this initially as I moved through homebirth and neonatal resuscitation literature, but not nearly as much as when I witnessed the movement of midwifery related bills through legislature this session. It greatly concerns me that bills are written and amended without scholarly review or even comment from associated professional organizations. It is down right frightening that legislative leaders attempt to control the practice of midwifery or ignore the impact of their bills on our practice completely.

Statutes can not keep up with current evidence and certainly legislative leaders are not the experts in such matters, and therefore, not the appropriate people to regulate such practice. This seems to be well recognized with the practice of medicine, but midwifery seems to be a profession that is viewed as inept to self regulate. Sadly, this is partially deserved as we have been slow to step up to the plate with regards to doctorate level researchers and clinical experts so that our own body of evidence is limited and our presence among leadership is scarce. Nurses have been the work horse, rather than a united league of clinicians protecting our claim on healthcare (unlike our associate physicians who have made brilliant progress in this regard).

Professional organizations are the go-to source in the United States for discerning how best to manage the care of healthcare consumers. As new literature is published, these organizations critique the scientific rigor of each study in effort to identify “best evidence.” The validity of such science is then examined and reviewed for how it should be applied to clinical decision making. However, the individual clinician has the ultimate responsibility to discern what is in the client’s best interest, appreciating individual concerns, preferences, and choices. Removing the freedom of the practitioner to judiciously apply their critical thinking skills, which government regulation imposes, creates a strictly technical procedure and ignores the rights of healthcare consumers (Melnyk & Fineout-Overholt, 2011).

“Each patient has only one particular life and is concerned with his or her particular chances.” (Melnyk & Fineout-Overholt, 2011, p 172.)

Statutes would also limit the growth of the profession in that it would ignore expertise among providers, or inspiration to expand into new areas of science. For example, nurse-midwives are taught a core competency. We are expected to be knowledgeable in particular areas and have clinical competency within a specific scope. This is not the box however that we are to remain; rather, we are challenged to explore and build upon that foundation. Our particular midwifery practice offers frenotomies for clipping of tight newborn tongue ties, which is beyond the core competencies as a nurse-midwife. This required additional training and if legislative leaders were given opportunity, they would certainly create a box that would eliminate my ability to continue providing such care.

“The right to search for truth implies also a duty: One must not conceal any part of what one has recognized to be true.” Albert Einstein

As doctoral practitioners we are also responsible for evaluating the evidence in an unbiased manner, which is both liberating and humbling. The integration of our own clinical expertise and considering our client’s preferences for care, while being aware of the best available evidence from systematic research is an art that can not be restricted by governmental officials. The licensing of professionals who have proven a high level of safety, demonstrating a positive impact on the health of constituents, is where such statutes should stop.

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