Who is a nurse?

Students making career choices will increasingly turn to nursing, if they heed official career predictions.

registered nursing as fifth on its list of “hot careers that don’t require a four-year degree.”

But this list’s title reflects one of the biggest controversies in nursing: What entry-level education should be required for nurses? Many of our panelists called for consistency in the basic education of nurses.

This is more than a theoretical point. Aiken points out that her 2003 study found that hospitals in which a higher proportion of direct-care RNs held BSNs had lower mortality rates, and notes that further research in this area is needed. In her view, “we are falling behind” because many other countries require a baccalaureate degree for entry-level nurses.

“Nurses must be knowledge workers who have the ability to analyze and synthesize data,” says Burnes Bolton. “We need to have an education system capable of producing that type of nurse.”

Jeanette Lancaster, RN, PhD, believes we need a more highly educated workforce because of the complexity of patient care, advances in technology, and patients with chronic illnesses who are living longer and need more specialized and sophisticated care. “There is a need for highly skilled nurses in clinical practice,” she says.

Facing the faculty shortage

Lancaster believes that in the next 5 to 10 years, nursing schools will face a worsening crisis, with enrollment increasing as more faculty members retire. Faced with this situation, schools are looking for options. “More and more advanced practice nurses in hospitals are participating in the education of students,” says . This partnership benefits both the students and the clinicians, who believe it keeps them on top of their game.

Some schools are developing certificate programs to help nurses prepare to be faculty members. These nurses have a shared teaching/clinical position or alternate periods between practitioner and teacher. “Schools will continue to rely on practice partners for help in educating students,” Lancaster says.

 

Educational delivery and teaching methods

Content delivery and teaching methods are changing, too.

Delivery. Distance learning has become a popular way to get a nursing degree. Although few people advocate online learning for basic nursing preparation, it has become an increasingly common option for nurses seeking to enhance their education.

Schools also are experimenting with the order in which courses are taught. Some are giving all the classroom work up front, then following that with the clinical work—similar to the model used in business schools.

Teaching methods. Patient simulators can help students prepare for complex situations before they ever lay a hand on a patient. These are not the same simulators you may have used as a student. Today, a patient simulator can take a student through a complex scenario without the instructor needing to make multiple setting changes along the way.

Such complexity comes with a price—thousands of dollars per simulator. To offset the cost, look to schools, hospitals, and even businesses to partner to create regional patient simulation centers.

 

Is the nursing process a sacred cow?

Is the nursing process a tool for the future—or a problem-solving process that has outlived its usefulness? “The nursing process is an iterative, industry-based, predigital model,” asserts Porter-O’Grady. “It’s an impediment. We need to suspend attachment to data and think in a multilateral, multifocal, and integrative way.”

Not so fast, caution other panelists. Patton believes the nursing process “helps to distinguish nursing. It teaches us how to think, plan, act, and evaluate. We use it in our entire life.”

Lancaster believes that no matter what terminology is used in the future, “the bottom line is critical thinking. The nursing process is the foundation of the problem-solving process and has been around for many years. It fits with evidence-based practice.”

 

Surviving in the new world

We asked our panel what it will take to survive in the nursing world of the future. Being open to change topped the list. “Our work isn’t changing. Change is our work,” Porter-O’Grady says he tells nurses. “If you looked at change like that, it wouldn’t be an enemy.”

Like other panelists, Porter-O’Grady emphasizes the need for continual learning, but that doesn’t mean nurses need to know everything. “I need to have a mental model in which I have access to the most current data and information possible.”

Patton advises, “See opportunities instead of challenges. There are opportunities for significant reforms in our healthcare system.” Patton adds that nurses need to learn political skills so they can influence others, and should try to understand the business side of healthcare.

 

Advice for nursing leaders

Several panelists pointed out that some nursing leaders are uncomfortable with change and struggle with transforming the system instead of serving as role models. They fear these leaders may be abdicating their leadership roles.

“Unfortunately, you can hear a sucking sound as leaders are pulled out of leadership roles into operations,” Porter-O’Grady says.

What advice does our panel have for nursing leaders? Porter-O’Grady encourages them to make it safe to discuss what nurses can stop doing and make sure they’re letting go of the right things. He urges them to model change and to discourage their staff from saying “I want to do the most I can for my patients,” because there’s no relationship between volume and value.

He believes leaders have to be comfortable with change and with being vulnerable; they have to be comfortable admitting, “I don’t know, but I can find out....I’m not sure how we’ll get there but I’ll be with you. I won’t desert you.”

Burnes Bolton advises nursing leaders to work together during this crucial time. “We have the attention of the federal government and organizations like the Institute of Healthcare Improvement and the Robert Wood Johnson Foundation."

Our panelists express concern about a leadership gap and wonder where the next leaders will come from. While new leaders are emerging, the panelists emphasized they have the responsibility to mentor future nurse leaders. “They know that the more impact they have on their profession and their colleagues, the more service they can provide to patients. It’s a different way to serve,” Porter-O’Grady says.

 

Moving forward together

As we move forward, nursing will continue to evolve. But some of the basics won’t change—basics such as advocating for patients, seeing how all the pieces fit together for the patient and, most importantly, caring for the patient as a human being.