future of nursing

What Does the Future of Nursing Have In Store?

If you do a GOOGLE search for the future of nursing, you will bombarded with the Institute of Medicine (IOM) 2020 report. This report has been discussed for the past few years now. I think it is feasible to look at some of the content as of July, 2017 and see how close we are. In addition, it is extremely important to analyze the current trends we are seeing in nursing as of today. I collect this data thru social media, networking, staying current with nursing blog posts, and reading comments. 

whats in the iom future of nursing report?

In 2010, the IOM established strategic goals for nursing in order to respond and adapt to the changing healthcare population. First off, what is so significant about the year 2010? Well, without getting political, this was the year former President Obama with the approval of Congress signed the Affordable Care Act (ACA) in law. The goal was to create healthcare that was high quality and affordable. With this buzz to improve healthcare, the Robert Wood Johnson Foundation aligned with the IOM to strategically determine how the nursing profession can help ensure meet the goals established by the ACA.

Goals specific to nursing were created in an effort to improve healthcare nationally.  One intervention to help ensure this was the creation of a committee to assess the nursing workforce with the goal of establishing a stronger nursing presence in areas where shortages exist. Strategies to help improve this workforce included:

  • Increasing nursing faculty and educational programs to ensure high output of competent nurses
  • Look for innovative solutions for nursing care delivery models
  • Attracting and retaining well qualified nurses in shortage areas
  • Restructuring the role of the nurse as a whole

Nursing has since taken on the expectation of helping to enhance healthcare and outcomes nationally. SO how does a once viewed profession of task doers and bedpan commandos now help fix healthcare?

4 Key Messages Resulted from the Committee:

  1. Nurses must practice to the fullest extend of their license through their education and training
  2. Nurses should prepare themselves through higher levels of education
  3. Nurses must be viewed as full partners with physicians and other members of the healthcare team
  4. Mechanism for improved data collection in order to improve systems and policies to improve patient care as a whole

I was first introduced to these concepts as a young nurse in a leadership role. Then I was ADN prepared and felt that my education was enough to take care of patient's under my care. After all I learned in clinical and other than NP school, nurses learned research and other management function in BSN and MSN schools. I thought how could that possibly help at the bedside. I am here to say that it does and it did and now I love research projects that can improve patient outcomes. 

Where are we now with these 4 initiatives?

#1 - Nurse practice accordingly to their education: When I google this and look to research I find little data discussing if nurses are indeed practicing to the fullest of their license and training. I am going to rely on anecdotal data and experience. I know first hand that each state has different laws impacting advanced practice nurse scope of practice and thus, already can say that we are not where we need to be. If you learn certain skills and theories in school, yet can only practice these in certain states then we have not met this goal.

Often I hear a nurse ask "Can we do that here" - I ask them "is it in your scope of practice and did you earn it in school?" Such a simple concept, yet we you then explore local and state laws you find certain procedures are not allowed. Not to be political here but many times I feel this has not changed simply to ensure someone much "higher" than a nurse can bill for it. Is this high quality care? OR DO WE MAKE PATIENT'S WAIT FOR THINGS NURSES CAN DO?

Take a minute and think about that and then think about why this country does so poorly when compared to countries around the world.

#2 - Nurses Need to Advance Education: The IOM goal is for 80% of all nurses to have a BSN or higher. So where are we now?

In 2012 more than half the nursing population (53%) obtained a BSN or higher. This was a shift from the past decade. Was this in response to the IOM report? Many will say yes as the efforts to show why a n advanced degree is better for patient outcomes came to fruition. I have personally discussed with many nurses from around New York state that many organizations will not offer a nursing position without a BSN at entry level. As organizations begin to see the importance of this initiative is has forced much of our workforce to meet this goal. To view more on nursing workforce facts Please see Fact Sheet 2015

I think overall organizations are supporting this initiative with strategies of entry level BSN criteria or requirements post-hire. I personally see the BSN students improving quality of care thru capstone projects that use current data, identify a problem, research best practice, and then implement solutions. This is why advancing your degree is so important to patient outcomes. If we all just show up and do the same thing day after day, we will never respond to the changes in disease and population health. Thus we will never advance as a nation. Keep getting those advanced degrees!

#3  - Nurses are viewed as full partners with physicians and other healthcare members: I personally think nurses are taken more serious today than years ago, however I do not feel we are considered "at the same level" as our physician colleagues. Well I should say we did just have a nurse as the Attorney General of the United States! That was a huge win for nursing as many viewed her as a strong leader, both because of her naval career and that she was a nurse. I do still see the struggles of "I am the Doctor and you are the Nurse!" at the bedside. We must continue to work for a strong collaboration between nursing and medical providers. Nurses must have a strong voice. Strategies to improve this are MD-RN councils to improve communication, teaching Nurses to use strong communication techniques such as SBAR, as well as transformational nurse leadership that supports nurse led initiatives. Physician buy-in can be a struggle, however we must continue to conduct research to find best practices. We must include our physician colleagues as well as other discipline leaders. The more we collaborate the stronger this initiative will become. As I network with others, I know this continues to be a struggle. We must all know we are all here for the patient. We must deflate our egos and listen to one another to ensure policies, procedures, and standards for patient care are the best they can be.

#4 Improving Data Collection: This is slowly improving with the adoption of the Electronic Medical Record (EMR) in many organizations throughout the country. Unfortunately we are no where near a universal EMR which I feel would help improve data. Data is reported to national benchmarks, however the data is reported by specific organizations and transparency of data is not always optimal. As I write this post, finding statistics and figures is a challenge. We do know that more data in the form of nurse led research is needed in order to begin solving more problems. Data to help determine how to improve retention of the nursing workforce or as simple as ensuring nurses receive breaks is needed. 

So How Are We Doing Now?

The World Health Organization has placed the USA at #37 in the worldfor 2017

So we continue to rank poorly when compared to other countries around the world. France is #1 in the world with healthcare systems and patient outcomes. See where Canada ranks - Not as good as you may think!

The US ranked #11 in 2014 - See what criteria goes into healthcare ranking and why we are not doing as well as other countries - View Report Here

What Other Trends are Nurses Seeing?

It is safe to say that current trends in nursing can be correlated to overall trends in healthcare in our country. 1 VERY concerning trend is the overall reduction of nurses from the workforce. Nurses continue to leave the workforce due to a variety of reasons, The majority of reasons include stress, wages and pay, and higher expectations. As our baby-boomer nurses begin to retire, we must look to our younger generations to enter nursing as a career. With that said, as younger generations enter nursing, they have less commitment or loyalty to an area. Thus the churn of nurses moving around the profession has led to great instability. We see nurses entering and moving around very frequently. 

People are living longer! Nurses must work with older clients and greater technology. Nurses are faced with situations where ethics collide with technology. These trends can lead the nurse feeling torn as we keep people alive longer with less quality of life. 

As healthcare insurance and requirements change, hospital stays are shorter and shorter, thus giving the nurse a sense of assembly line care versus good old fashion quality of care. Wit this comes new techniques in care. Alternative ways of providing care can cause acceptance as well as confusion in the nursing workforce.

Educational trends are now leaning more towards online than traditional educations. I just recently met a student who is doing their initial RN training online. Not sure how i feel about that, but again these are the latest trends. 

Nurses are seeing people with diseases that have been dormant for years. Recent outbreaks of mumps and clusters of measles have popped up. This requires just in time education for nurses to effectively care for this population. 

Trends will continue to pop up as healthcare changes. Unfortunately for us we must wait and see what happens in our White House to see what direction we will be in over the next few years. 

What Trends are you seeing and/or what worries you about the Future of Nursing?

What trends in Nursing are you Experiencing?

Let me know what trends in nursing you are experiencing as ell as concerns you may have for the future of nursing!

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