Nursing in the 21st Century

NUR 210

Nursing as an ART

“Nursing…its very essence lies in the creative imagination, the sensitive spirit, and the intelligent understanding that provides the very foundation for effective nursing care”. Donahue(1985)

Nursing as a SCIENCE

Nightingale identified nursing as a scientific discipline separate from medicine

Educational foundation and basic college credit in scientific disciplines R/T nursing

Highlights

1950’s• Code of Ethics (ANA)• 1st CNS programs• Nursing Research first

published (1952)

1960’s• Post BSN programs

increase• Nursing researchers

pioneer clinical investigations

Highlights

1970’s• NP in expanded roles

gain national visibility• ANA creates AAN to

honor outstanding nurses

• Nurse theorist come into national spotlight

1980’s• MS and Doctorate

programs increase• More nurses are

nationally “certified” in 17 specialty areas

• STTI increases its membership

Nursing Professionalism at a Crossroad Briefer professional hx than the traditional

professions

Has been and continues to be primarily a women’s occupation

Factors Influencing Nursing Practice Scope of Practice Standards of Practice Licensure Specilization Advanced Practice

Contemporary Nursing Issues

Role: a pattern of behavior associated with a distinctive social position

• Extended role: a role lengthened in a unilateral manner (PA)

• Role expansion: multidirectional spreading out (NP)

What services should nurses provide? The profession with help from society it serves

should decide what services to offer?• Managed care

• Professional competition

• Chronic conditions

• Aging population

How should nurses be educated?

Half of RN’s are AD

Need for master’s prepared nurses as clinicians, managers, administrators, and instructors.

Doctoral-prepared are needed as leaders in all specialty areas, including education and research

What payment should nurses receive for their services? Retrospective reimbursement

Prospective prepayment

Managed care = managed cost

Better paying positions requires advanced degrees

Changing Images

Diversity: most nurses are white and female, great need for multicultural diversity, as well as more men

Specialty areas: • Clinical: age groups, illnesses, abilities or disabilities,

and locales

• Functional: management/administration, research, and teaching

Traditional vs. Nontraditional Career Options

More practice options are possible

Trend toward more advance preparation

Continued: More attempts are being made at collaborative

practice

Move toward primary care and community and home health care

Increasing emphasis on wellness programs in schools, residential living communities, and industry

Advanced Practice Options

Nurse-practitioner: NP Clinical Nurse Specialist:

psychiatric/mental health: CNS,PMH Nurse-midwife: CNM Nurse anesthetist: CRNA

Future of Practice Options

Must take leadership roles

Need to find or generate job opportunities that allow them to practice as prepared and grow to their full potential

Evidence based practice

Nursing Functions

Dependent:

Independent/autonomous:

Interdependent:

Educational Requirements

ADN: 2 years (minimal to be RN) Move to see the BSN as eligibility to

receive professional licensure Prepare for generalist, entry-level staff

nurse positions MN, MS, MA DNS, PhD, DN, JD, EdD, DPH, “DNP”

Nursing Education: Future Trends Changing Student Profile Educational Mobility Shortage of Qualified Nursing Faculty Technology and Education Changing Health Care Settings The Aging Population

Research and Theory Development Clinical trials, intervention research, or

experiments conducted in the real world of practice (Evidence Based Practice)

Theory development is needed “New science” with much uncharted

territory

Manage or Administer Health Care Organizations

Skills related to management, leadership, and fiscal responsibilities

Teach Consumers or Professionals Teaching self-care and resolution of responses

to pathology

Opportunities to teach outside the hospital: shorter stays and increased severity of illness

Need for nurse educators

New Wave of Technology

implants, genetic therapies, imaging devices medical artificial intelligence such as

computer-assisted surgery, ECG and fetal monitoring interpretation, clinical dx., and genetic counseling

telemedicine devices for home use

Future Trends

Genetic testing: determine treatment New cancer treatment before symptoms New therapies for Alzheimers New drug delivery systems Stem cell research

Computer Skills

NIC/NOC: computerized interventions and outcomes

Word processing, file management, accessing information

Data management for staffing and scheduling, accessing expert practice consultants, finding appropriate educational material for client-patient use

Nurse Informatics

1994 ANA recognized the field of nursing informatics (NI)

integrates nursing science, computer science, and information science in identifying, collecting, processing, and managing data and information to support nursing services

certification available

Sports Health and Physical Fitness Interest in prevention Lifetime individual sports offer potential

involvement of an entire society Physical fitness of children Fitness facilities in the workplace

Create Dual Careers

Artistic or Analytic• music, art, drama (pediatrics, mental health)• verbal skills, writers, high tech, people persons

Law and business

RESPONSES TO CHALLEGES: Continue Professionalism of Nursing

Extend Practice through Research

Increase Public Awareness of Nursings’ Contribution to Health Care

Increase Nursing Influence on Health Care Policy and Delivery

Continued:

Become More Globally Aware

Increase the Number of Nurses in Health Care Leadership and Administrative Roles

Achieve Cultural Diversity and Gender Balance in Nursing

Globalization Need to learn about health care beliefs and

practices of other cultures

International nursing forums

Nursing and health care products, publications and methods and the expanding nursing knowledge will find new possibilities in a global economy

Social Change “Three driving forces--aging, technology, and

costs--will reshape health in the future”

1.6 million new jobs are projected in the health care industry from 2000 to 2010. RN account for more than a third of these jobs.

A shortage of more than 1 million nurses by the end of this decade.

Medicine and the Public Eye

15,000 Web sites that offer some form of medical advice

Nurses are a resource for consumers regarding how to find and evaluate medical information via the Internet.

Quality of Care

Health care as a “purchase” Nurses in a position to offer the best services

for the best prices (role of NP) Health care will be a focus on the value of the

product Quality measures will direct our activities at

work and require us to constantly maintain a level of excellence

National Health Expenditure 1.5 billion in 2000, 2.2 billion in 2005

move from inpatient to ambulatory services

outpatient and home health care costs grow at 10% per year.

Hospital spending grew at < 3% per year.

“IMAGE” of Nursing

Directly related to what the profession offers society and the value placed on that service.

“Nightingales” TV program d/c due to public outcry from nurses

“Pearl Harbor”, “ER”, Desert Storm