Nursing - today and beyond

Nursing is in the midst of revolutionary changes. How are these changes affecting the profession today—and how are they likely to affect it in the future? For the premier issue of American Nurse Today, we decided to examine current trends in nursing and healthcare, and predict future developments that could influence nursing in years to come.

For help with our analysis and predictions, we turned to several nursing experts and leaders, as well as pharmacy and future studies experts. We also tuned into the “buzz” in the nursing profession and explored several innovative national programs.

We found that nursing remains a vibrant profession. Yes—we have controversy and divisiveness. But we also see a wealth of positive energy that’s driving change and improving the lives of nurses and patients.

 

Driving forces


Many forces are driving changes in nursing and healthcare. Healthcare associations continue to issue new guidelines that influence nursing practice. Let’s look at a few other driving forces.

Portability and mobility

Talk to Tim Porter-O’Grady, RN, EdD, for any length of time and you’re likely to hear the words mobility and portability again and again. He sees these features as the basis for any healthcare delivery model. “Portability and mobility are the cornerstones of technotherapeutic interventions,” he states. The growth in freestanding clinics, ambulatory care centers, and other nonhospital settings supports his view.

Technology will extend patients’ lives—and Porter-O’Grady reminds us that we’re not aging the same way previous generations did. Many Americans are “aging in place,” with communities finding ways to support older people in their homes. Futurist Andy Hines, MS, says, “Baby boomers are going to want to avoid institutions for themselves and their parents.”

These forces mean that much of the patient’s healing takes place where nurses don’t typically deliver round-the-clock care—the home. Unfortunately, most nurses have been educated in a hospital-based model, which doesn’t mesh with today’s trends. Porter-O’Grady urges us to remember that patients don’t necessarily benefit from a hospital stay. “There is a direct line from length of stay to increased morbidity and mortality.”

At the same time, Hines remarks, “There’s a shift away from institutional care toward individual responsibility, and a move from hospitals and nursing homes to retail, kiosks, and home.” He adds that consumers want more personal control over their healthcare, so we can expect more self-diagnostic tests and innovative ways to deliver care.

Porter-O’Grady knows it isn’t easy for seasoned nurses to accept these changes. “Some nurses are mourning the loss of all they used to do for patients, but that loss isn’t a bad thing.” He advises hospital-based nurses to focus on helping patients make the transition to where they’ll be healing—at home.

Evidence-based practice

You can’t turn around in nursing without encountering the term evidence-based practice (EBP). It’s on the lips of everyone from staff nurses in ambulatory care centers to heads of government agencies.

EBP is one reason facilities designated as Magnet hospitals by the Magnet Recognition Program have been so successful: They’ve set up systems that foster evidence-based care, bringing improved patient care and nurse satisfaction. EBP also serves as the foundation for the disease management work done by nurse practitioners (NPs) and many other nurses.

EBP is more than a buzz term, says Porter-O’Grady. “It’s about getting a handle on what we do that is valuable—what difference it makes. Can we do it again, and can we do it even better the next time?”

Emphasis on safety and quality

Patient safety and quality of care are two trends that have benefited nursing. Rebecca M. Patton, , RN, CNOR, cites the National Quality Indicator Database as an example of a program that’s tracking nurses’ impact on patient care outcomes. This database of nurse-sensitive indicators, with data from almost 1,000 hospitals, is one of several that show nurses’ importance in the delivery of safe, high-quality care in every setting.

Because of the quality push, healthcare workforce leaders may see more pay for performance—payment by third-party or government payors based on the quality of care delivered by the facility. Linda Aiken, RN, PhD, believes nurses must be involved in establishing payment criteria.

 

Greying nurses

Whether or not they’re satisfied with their jobs, nurses will continue to spot grey hairs in the mirror as they age. The physical workplace environment will need to be adapted to keep older nurses in the workforce. “We need their experience,” says Burnes Bolton, “but we need to take the burden out of care.” Technology can help accomplish this. She cites the example of using gurneys as patient beds so nurses can avoid back-straining patient transfers.

As the core of the nursing workforce nears retirement, younger nurses are entering the profession, creating intergenerational teams. Nurses of different age-groups need to understand and accept each other’s perspective and appreciate what everyone brings to the team.


Let’s look at a few other factors affecting the nursing workforce.

Physician shortages

A shortage of physicians will increase the demand for NPs. “The sense is that the physician shortages are severe,” says Buerhaus, and these shortages aren’t likely to end any time soon. As the demand for healthcare keeps growing, “we’re going to need NPs in huge numbers, and they could take over much of what medicine does today in our lifetime.”

Foreign nurses. Buerhaus foresees more foreign nurses working in the —double or triple today’s number. He speculates that by 2020, as much as 25% of our nursing workforce may have received their nursing education outside the United States.

Hines agrees that foreign nurses are here to stay. He also raises an issue nurses have long faced: How do the standards of one country apply to another? Common standards are needed for the emerging global workforce. At the same time, Patton cautions that using foreign-educated RNs must not detract from the need to offer all nurses a better work environment.

Staffing ratios.

Will legislated ratios play a role in the upcoming demand for nurses? Aiken and Buerhaus say no. Aiken believes legislated ratios “will never dominate because most of the institutions in this country are in the private sector; few are government owned.” However, she does think legislation on public reporting will become more common—and these reports may include ratios. She predicts hospitals will increasingly move to better staffing as a result of the evidence.

Buerhaus warns, “If ratios catch on and become federally mandated, it would lead to the demise of the nursing profession. The public would lose trust because they won’t really see better outcomes; the science isn’t there to show it.”

Healing spaces, empowered nurses

Our panelists concur that although nurses’ work environments are improving, more needs to be done. Hospitals already are working on reconfiguring rooms so nurses don’t have to walk so far and supplies are easily accessible. Some have gone a step further, creating healing spaces—quiet areas with calm colors, meditation rooms, and gardens.

Some hospitals are working to make the environment more personally satisfying by offering mindfulness retreats and posting affirmation messages that nurses can read while on duty. Still others have adopted caring models that refocus nursing delivery on caring.


Seeking a balance

Hines predicts the power will shift from the healthcare institution to the individual nurse as nurses seek to balance work and personal life work. “The schedule and quality of life for many nurses is dreadful,” he says. “You have these long, tiring shifts of 12 hours on your feet, and lots of on-call and overtime. This runs counter to the social trend toward a greater work-life balance. Right now, the institutions have power over the nurses, but that could shift as nurses realize the opportunities outside the institutional setting.”