nurses are what nurses do—are you where you want to be?

Domino JANUARY 2005, VOL 81, NO 1

Nurses Are What Nurses Do-

Are You Where You Want to Be? Elizabeth Domino, RN

he practice of nursing is changing, and so is the environment in T which it exists. Change affects

every aspect of nurses' lives on a daily basis. Changes in the health care environment and the manner in which change is being managed are shaping practice. Opportunities for continued progress in the field of nursing are available, and the resulting action-or inaction, in some cases-has the potential to influence nursing's future.' The question is, in what direction is this influence going?

This is a time of great change not just for nursing, but for every health care discipline. For example, during the past 20 years, 30 new diseases have been identi- fied, and the likelihood of their spread has increased significantly because of air travel, which has made international borders more permeable.' w'' Globally, populations are growing and aging, often beyond the resources available to meet needs, and needs are changing, too. In areas such as the United States, populations are demanding the use of increasingly complex and sophisticated equipment that requires advanced knowledge and specific training.'.' Furthermore, these changes are causing health care to enter a dimension of service so multifaceted that its practitioners often are forced to incorporate changes into interventions long before they have had time to adjust to the changes' impact.

In the practice of nursing, adaptation to continuous change has created nurses who must be able to move swiftly in response to change. Then, to maintain competency in safe practice, nurses must become lifelong learners.'.' They must

acquire additional knowledge through continuing education, which can be attained through informal, independent learning or through formal education.'

Education has a positive effect on the knowledge and competencies of nursing practice. Does the ever-changing environment in which nurses must practice safely and competently inspire a call for higher education? An individual's performance is guided by the skills he or she possesses, which means that no one can use knowledge he or she does not possess. In other words, "clinical nursing is fixed by the knowledge base."' 'FZRJ What measures, if any, are being taken to assess the adequacy or competency of an individual's knowledge base in a field wrought with continual adaptation to change?

Registered nurses must learn to read the warning signs. They must understand that they will be held accountable for every patient they care for amid the rapid changes in nursing practice.8 They must recognize that other forces (eg, a

ABSTRACT 0 NURSING PERFORMANCE, or the skills a nurse exhibits in practice, is limited by the extent or level of a nurse's knowledge base; hence, the expression "nurses are what nurses do" probes nurses' levels of satisfaction with their present educational status. 0 GIVEN THE RAPID CHANGES in health care today, nurses are questioning their level of commitment to lifelong learning in meeting ever-changing demands.

0 THIS ARTICLE EXAMINES MEASURES being taken to assess the adequacy of nurses' knowledge base in a field that requires continuous adaptation to change. AORNJ 81 (January 2005) 187-201.

AORN JOURNAL 187

growing, aging population; the nursing shortage) may change circumstances beyond individual control. To thrive in the health care environment, nurses must assess the effect of these changes and adapt to them-perhaps by re- turning to school. Nurses will continue to face dynamic changes in health care, and they must meet these changes with the knowledge, skills, and professional abilities they bring to practice, embrac- ing consequences as they unfold.*

SNAPSHOT OF THE FUTURE The National Advisory Council on

Nurse Education and Practice has found that nursing’s future role will be in the

Nurses will face dynamic changes

in health care, and they must

meet these changes with the

knowledge, skills, and

abilities they bring to practice.

management of care along a continuum that inter- faces with other health care networks and that integrates expertise and knowledge. Scope of practice will incorporate critical tlunking and problem solving; a firm foundation in basic sciences and knowledge of behavioral, social, and management sciences; and the ability to analyze and communicate data.3,6 The council be- lieves a baccalaureate education provides a solid base from which nurses can move into graduate education. A bachelor’s degree also may provide a base from which individuals can move toward other avenues of higher education within nursing, such

as teaching, management, or research. The groundwork nurses lay during

this time of change will be critical not only to the profession’s actualization, but more importantly, to its future-a future that is far different from the past that most nurses Amid change

in various health care environments and current practices, nurses must realize that individual decisions about adaptation to change will require a reactive or progctive stance on their part. This stance will provide a foundation for future implications in nursing practice. As a result, it is imperative that nurses develop positive attitudes about change and execute necessary interventions to combine political acumen with clinical knowledge and cultivate opportunities for shaping future growth in nursing practice.’

This article explores the effect of change on nursing practice and the value of higher education in facing these challenges. It also examines the need for development and enhance- ment of nursing’s autonomy within professional organizations for the pur- pose of keeping the voice of nursing strong and central to decisions being made for the discipline’s progress. This entails an exploration of individual responsibilities nurses must embrace to develop and maintain habits of lifelong learning.

PROFESSIONAL DEVELOPMENT There are several factors related to

lifelong learning. These include 0 critical reflection, 0 readiness to learn, and 0 nursing’s role amid change.

CRITICAL REFLECTION. It has been theorized that one of the characteristics of a profession is that its members continually engage in ongoing learning, not just to remain current, but also to facilitate individual growth and a refreshed outlook.y The act of learning is nothing more than a change in behavior, wluch begins with a change in an individual’s frame of ref- erence (ie, the way in which an individual views his or her world). Critical reflection can be considered an intrinsic process that stimulates an individual to question ingrained perceptions about

188 AORN JOURNAL

JANUARY 2005, VOL 81, NO 1 Domino

interpretation of and response to various situations and to question such examination by others. This is how individuals change the way they view life and ultimately change or direct their personal actions and behavior.' 'I

To promote professional development, nurses must first be able to identi- fy these inherent thoughts and associate them with behaviors that restrict their practice. This act of reflection can cause nurses to view practice issues from different perspectives and, in turn, stimulate the need for continuing education with a change in practice or continued learning from experience.' ' Professional development is the ultimate goal signal- ing the nurse's commitment to improv- ing nursing practice. Before this stage can begin, however, a readiness to learn must exist.

READINESS TO LEARN. Readiness to learn is a concept based on an individual's mental, physical, experiential, and intellectual ability to gain information from an experience. When combined with inquisitiveness, readiness to learn is considered to be suitable for the integration of knowledge."' People are not automatically inquisitive, however, something must spark their interest or stimulate a need. Attitude and perceptual change have much to do with readiness to learn, as does an individual's understanding of the material being taught."'" There are still other obstacles an individual must consider, however, when deciding to pursue continuing education.

Current nursing practice's needs and demands corresponding to constant

change have everything to do with the timing of learning."' Given the same information on more than one occasion, a learner may be more receptive to learning at one time than at another. For some individuals, obstacles (eg, personal, familial, institutional, financial) will heavily influence readiness to learn. Furthermore, adults typically are eager to learn when the information being taught is relevant, timely, and applicable to their everyday concerns. It is then that the desire to discover and apply knowledge through a change in behavior is possible."'"

Learning is related directly to a change in an individual's attitude and behavior. For change to be effective, a learner first must accept that new ways of practice make sense and that they will be credible and applicable to his or her practice. Learners also need to believe that new ways of practicing will be fruitful or will benefit individuals with whom they come in contact." If these criteria are not present, a readiness to learn through a change in a nurse's professional behavior may not occur.

Some nurses simply will be reluctant to change; these nurses' performance will be guided by the skills they possess. These laggards, as they are called, will do little more than the minimum to stay in practice." Attempts to alter their role will require a readiness to learn, which requires individual reflection and careful consideration of their potential to change. In addition, these individuals will need to develop an innate awareness of possible outcomes and the skills required to support a change in their behavior before any transformation will occur.' Unfortunately, a readiness to learn will remain reactive for these nurses, whereas in others, it is the impetus necessary for change. Change ultimately will shape individual and collective attitudes and perceptions necessary for lifelong learning and

190 AORN IOURNAL


Leaders are nurses who desire change to make a difference for themselves and others. They are able to critically reflect on,

envision, and embrace change.

eventually, for more successful nursing performance.

NURSING'S ROLE AMID CHANGE. What does an individual's role in nursing practice look like today? One thing is certain-hange is constant, and therefore, the role an individual chooses in nursing today will not be static.

It has been estimated that approxi- mately half of the knowledge a nurse possesses at graduation becomes obso- lete within three to five years, with the half-life of technology being even short- er." 'W The complexity of illness in today's patients, along with sophisticated levels of care, the rapid progression of research, and the development and use of intricate technology, have increased the need for competent professionals who are able to apply their knowledge safely and efficiently. In such an environment, complacency can result in fail- ure,4.V,l~.16 An assessment of an individual's professional attitudes, behaviors, and goals, therefore, can determine his or her ability and desire to change in nursing practice.'

PROFESSIONAL AITRIBUTES A professional is a leader who pos-

sesses a personal commitment to the ongoing acquisition of knowledge."^" In health care, leaders are nurses who desire change to make a difference for themselves and others. They are able to critically reflect on, envision, and embrace change. Change becomes an opportunity. It is not an obstacle, but a challenge for progression (ie, a step closer to goal achievement). A leader in health care today is someone who is in a constant state of readiness to learn. He or she exudes self-confidence, assertiveness, and a willingness to take risks." Today's leaders reflect these and other personal and professional growth and development characteristics, which ultimately guide them to a state of empowerment.

EMPOWERMENT. Within the field of nursing, empowerment is seen in nurses who are rooted in forward thinking, shared values, esteem for others, and opportunities for advancement. They are engaged in promoting others through professional training and performance evaluations. Empowerment promotes self-esteem, responsibility, and growth. It allows individuals to delegate responsibilities, give feedback, access information, provide support, and solve problems.is~'X

The common theme among empowered leaders is the presence of higher education, which is the power source driving and feeding their knowledge base.17 Empowerment inspires others to lead and feel competent, responsible, and independent through mentoring. Concepts of empowerment and mentorship are central to definitions of leadership and change."

MENTORSHIP. Mentoring is a reflection of leadership at its best. It provides partici- pants with the support and direction necessary to empower others." A form of informal learning, mentorship has become a responsibility of nurses at nearly every echelon of practice, as well as a valued opportunity for continued professional growth and development.

Mentors are leaders who serve as observers, commentators, and advocates.'y~zu Their mere presence is influen- tial. Mentorship no longer exists primari- ly at the bedside. Mentoring has expanded beyond facility walls and into areas of nursing research and scholarship, without which there would be no foundation for the growth of the nursing profession.21

Mentorship can enhance leadership in academic settings, clinical agencies, and policy arenas and increase satisfaction and retention of nurses and leaders in these roles. Through mentorship, nurses can help others grow, while encouraging each mentee toward self-actualization and autonomy.I7

AORN JOURNAL 19 3


Self-actualized nurses view obstacles as opportunities to excel and achieve autonomy. They have the intellectual and personal

energy to develop their professional values .and skills.

SELF-ACTUAUZATION. Research shows that self-actualization is positively and significantly correlated with an individual's degree of professionalism. It reflects a leader's potential to exceLUL3 According to Maslow's Hierarchy of Needs, self- actualized people are able to maximize their human potential by using their tal- ents and abilities fully." 'plM) In theory, reaching this level includes finding ful- fillment in individual accomplishments, as well as recognizing the potential to stand out as a change agent and lead others to see and do the same."

There are many barriers preventing some nurses from achieving self-actualization. Maslow notes that people will grow and actualize their potential only if the environment is right.u (P3m Environ- mental barriers related to job dissatisfac- tion, management issues, organizational policies, lack of autonomy, and decreased feelings of expertise keep many nurses today from

Self-actualized nurses view obstacles as challenges or opportunities to excel and achieve autonomy. These nurses are less anxious and have the intellectual and personal energy to develop their professional values and skills. They are self- directed and exude a higher level of self- esteem than others. The implication of achieving hgher or advanced education is not only understood, it is continually applied. This attitude and perceptual change aid in the development of personal and collective feelings of autonomy, with autonomy being the fundamental hallmark of professional ~tatus.l,",'~,"

AUTONOMY. The vision of autonomy char- acteristically is synonymous with the term "nurse" and is strongly correlated with a nurse's level of nursing education and experience."." Autonomy also is characteristic of membership and active participation in professional organizations, practice settings, clinical areas of expertise, and functional roles. Auto- nomy actively promotes responsibility to

these and other practices of professionalism. Autonomy relates to nursing's specialized knowledge base, service, commitment, professional identity and recog- nition, quality of care, and specialized code of practice.' It also is associated with the integration and application of independent and critical-thinking skills. Critical thinking is a purposeful activity in which problem-solving is initiated and judgments are made.'526 A specialized knowledge base from which the practitioner can draw is necessary.

One of the elements that sets professional nursing apart from other disciplines and ancillary fields is the diversity of nursing's knowledge base and the level of theory-guided interventions within nursing's scope of practice. Many look to this body of knowledge for direction and guidance. Today, members of the public hunger more than ever for the information that nurses provide-they even expect it.2' Others have expectations of nurses that are not conducive to the level of autonomy just described.

Unfortunately, many people in the medical community and other professional disciplines view nursing as a sub- servient role and in essence, reduce nurses' value and their influence on patient care.' In response, one of the fundamental issues nurses must tackle continually is changing this perspective because "the expectations of what nursing is, and what nurses do, drives what happens."'

EFFECT OF NURSING EDUCATION ON PRACTICE

Studies have shown that individuals' professional beliefs, attitudes, and behaviors are closely connected to the professional organizations to which they belong, as are their nursing roles, sources of supportive communication, and feelings of professional autonomy.lyZ",ZR Autonomy provides the authority that enables a profession to define its borders and the nature of its services.'

194 AORN JOURNAL

Professional groups can influence and direct change vital to their professional existence through active participation in professional organizations and the collective voice of the members.”

BENEFITS OF MEMBERSHIP. Some individuals believe that membership in a professional organization enhances nurses’ ac- countability, credibility, and professional development. These organizations teach members the significance of diversifying and deepening their commitment to lifelong learning.2o Programs offered by these organizations promote this convic- tion by encouraging scholarship, research, and leadership through certifica- tion programs, continuing education, conferences, and networking opportunities at meetings.“ Being an active member is key to m a h g the most of these opportunities.

Active membership promotes networking, but more importantly, it increases an individual‘s access to issues that affect nursing and health care. In- volvement allows nurses to unite, whether locally or nationally and to drive decisions regarding the future of nursing by legislators, communities, and other professions.16 The process begins with individual attitudes and perspectives, then progresses to feelings of interconnectedness and identity through professional autonomy, with professional autonomy being the strongest predictor of organizational and professional identification.28

MEMBER CHARACTERISTICS. Nurses who are active at various levels of organizational activity are known to develop and experience increased levels of self- confidence, self-esteem, and self-respect. These feelings generally result in enhanced abilities for independent thinking, problem solving, and, in some, the desire to pursue opportunities for higher or advanced levels of education. As a result, some nurses return to school, and others change careers. Active participa-

tion in nursing organizations has result- ed in increased levels of self-confidence associated with the professional growth of member^.'^.^^^ These individuals tend to see themselves as autonomous professionals who are able to make valuable contributions and, more importantly, as nurses who are able to commit to habits of lifelong learning.” Education, regardless of how it is obtained, tends to promote individual feelings of self- worth and professional growth. Ed- ucation promotes and strengthens the body of nursing.

LEVELS OF EDUCATION Nursing’s role in the

future requires nurses to manage patient care in collaboration with other health care discipline^.^,'^,^^ Consequently, nurses‘ scope of responsibilities is changing, requiring them to integrate clinical expertise with knowledge of community resources and, in some cases, lead- ing health care teams and participating in decision- making processes. The increased complexity of this scope of services requires nurses who can adapt to change. For this reason, the National Advisorv Council on

Active membership in a

nursing organization

promotes networking and

increases nurses‘ access to

issues that affect nursing

and health care.

Nurse Education and Practice is calling for baccalaureate-trained nurses to fill entry-level positions to meet some of these expanding needs in health care.3

The interdisciplinary health care teams with which these nurses are col- laborating consist of colleagues educated at the master’s-degree or higher levels. These teams include physicians, pharmacists, speech pathologists, physical and occupational therapists, and

AORN IOURNAL 19 5


others. Members of each of these disciplines recognize the complexity involved in providing direct patient care. They also understand the value of and need for higher education to deliver appropriate care.’ The nursing profession should expect no less from its members. The RN should not be the least educated member of the interdisciplinarv health care team.

Nurses should not be the least

educated members of the

health care team. Currently, only 43% of US

nurses hold degrees at the baccalaureate level or above.

ckrentiy, only 43% of US nurses hold degrees at the baccalaureate level or

A recent study identi- fied a clear link between higher levels of nursing education and better patient outcomes, with emphasis on the imbal- ances in the educational preparation of the nursing workforce and the fact that this difference may be harming patients.”] The study found a ”substantial survival advantage” if a patient was treated in a facility that employed higher proportions of nurses holding bachelor’s level or higher degrees in nursing.331 Other sources iden- tified similar situations in which education level

above.331 (plbzZ-lbL1)

was a factor in patient safety and quality of care.’ A common theme among baccalaureate-prepared nurses seems to be the critical thinking skills with which they graduate, as well as the quality and strength of their leadership skills, communication and problem-solving skills, and enhanced nursing diagnosis and evaluation abilities as compared to those of nurses graduating with associate degrees and diplomas in nursing.’ Policy makers note that education makes a difference in providing safe and appropriate patient care?

To continuously improve the quality of nursing’s scope of practice, enhance responsibility and commitment. to continued learning, and prepare for ever- changing and complex roles, nurses must consider , pursuing higher or advanced education.1612 Nurses also must get involved in professional organizations to influence decisions being made not only for nursing’s growth and development, but for their own growth and development. This will help nurses gain professional autonomy and political insight into issues affecting nursing today.”

EFFECT OF EXTRINSIC FORCES Lifelong learning seems to require

more than just individual commitment. Lifelong learning now is expected and mandated by various governing bodies and is influenced heavily by the public.1333 Today, pressures exist because of legislation that allows higher professional boards the authority and autonomy to develop, implement, and evaluate continuing competency requirements. Directives are being implemented to ensure state and local compliance and competence of health care professionals in better serving the public’s health needs.’’ The problem with this approach is that these directives also have the potential to discredit individuals’ professional responsibility and corresponding levels of autonomy to decide what is needed for practice improve- ment. This legislative action also increases the potential for giving professional boards the power to go beyond what their governing levels of authority may With respect to nursing’s scope of practice, this higher level of influence has the potential to shape the practice of nursing without the advantage of a collaborative approach specifically involving nurses, their employers, and their state boards of nursing.”

196 AORN JOURNAL


SCOPE OF PRACTICE. This brings nursing's scope of practice to the forefront because nursing's future is affected by these and other factors. Decisions that can affect health care issues and influence nursing in the clinical environment are being made in higher places and are resulting in policies that drive the sys-

The ability to affect policy formation is within easy reach, if nurses get involved. When nurses do not get involved, health care suffers from lack of participation because there is no voice advocating for nursing's stand on issues that shape practice."'

Health policy decisions drive the dis- tribution of health care resources, in- cluding tangible and intangible human resources and related health programs."' Amid this rationing are budg- ets, spiraling costs, public demograph- ics, and acute and chronic illnesses that require the use of limited and multifaceted resources that need knowledgeable individuals to operate and manage them. In this type of environment, nurses cannot afford to remain static. They must become empowered to flex their political muscles through education, leadership, and collective action.' "

HEALTH POLICY. Knowledge of health

policy is the place to begin. The health care system is a complex structure of various organizations that set priorities and policies for the provision of services through federal and state regulations.' Y 14 These regulations have the ability to influence nursing practice environments, and nurses have the power to influence the regulations. Nursing's influence is best exerted through the establishment and mainte- nance of individual and collective part- nerships with communities, govern- ment agencies, and legislators."" A lack of basic knowledge of health policy and the processes involved in its application results in political apathy.

Knowledge about the political process and public policy formation is essential.'" It can be gleaned from a commitment to lifelong learning and by reading materi- als on the subject. It also can be achieved through the curriculum content of higher education. When paired with active membership in professional organizations, the effects are synergistic.""' These organizations already have the legislative and educational components necessary for contributing to the development of nursing's political knowledge base.?" The primary component that often is missing and that is needed for change to occur is the active participant.

INDIVIDUAL RESPONSIBILITY. Unfortun- ately, participation in health care and organizational issues tends to be more reactive than proactive. Some nurses do not realize the effect that their lack of representation has in the political arena. If nursing's knowledge and expertise is not shared with politicians and reflect- ed in quality health care legislation that is cost effective, public policy will not be molded."" Taking the path of least resistance can cause nurses to lose much of the power and influence over practice issues that have made nurses autonomous and, more importantly, patient advocates.

198 AORN JOURNAL


ABILITY TO ADAPT This is a t ime of great change for

health care. A m i d changing demo- graphics, chronic health conditions, exploding scientific a n d technological advances, enlightened consumers, and spiraling health care costs, the implications for safe and efficient practice in nu r s ing a re chang ing constantly.’ Nurses must take the time to critically reflect on their levels of knowledge and skills in relation to the demand for more advanced knowledge in caring for today’s patients. A nurse‘s ability to adapt will depend on his or her commitment to lifelong learning and the acquisition of new knowledge-a hallmark of professional behavior. It can no longer be said that “a nurse is forever competent.”” To be valuable health care practitioners, nurses must commit to lifelong learning. After all, nurses are w h a t nurses do. 9

Elizabeth Domino, RN, MSN, MPA, ARNP-C, CNOR, CRNFA, is an orthopedic nurse practitioner a t Orthopedic Specialists of SW Florida, Ft Myers, Fla, and an independent certified RN first assistant.

NOTES 1. A Nolan, L Hazelton, “Remaking the nurse‘s role,“ in Tlic Practising Nurse (Sydney, Australia: W.B. Saunders/ Bailliere-Tindall, 1995) 3-37. 2. C E Engel, “Health professions education for adapting to change and for participating in managing change,” Educntioii for Health 13 (March 2000) 37-43. 3. ”Fact sheet: The impact of education on nursing practice,” American Association of Colleges of Nursing, http://~owc~.nocn.ilclie .ed~r/Edliiryact/ir~dc.u.Iitiii (accessed 5 Nov 2004). 4. M S King, P L Smith, L L Glenn, ”Entry- level com etencies needed by BSNs in

the next 10 years,” Journal of Nursing Educntioii 42 (April 2003) 179-181. 5. T Porter-OGrady, “Of hubris and hope: Transforming nursing for a new age,” Nurs-

acute hea r th care agencies in Tennessee in

irig Economics 21 (March/ April 2003) 59-64. 6. S Bach, “Looking for satisfaction,” Nursing Standard 18 (Oct 8-14,2003) 25. 7. N J Girard, “Lifelong learning,” A O R N Journal78 (September 2003) 365-366. 8. P A Blair, ”Determine your scope of practice,” Nursing Managenrent 34 (April 2003) 20,22. 9. A M Stein, “Foreword: Professional transformation,” Holistic Nursing Practice 16 (October 2001) vi-viii. 10. S B Bastable, Nurse as Educntor: Principles of Teacliirzg and Learning for Nursing Practice, second ed (Boston: Jones and Bartlett, 2003) 84-85. 11. J McClaran et al, “Can case management be tau ht in a multidisciplinary forum?” Jourmfof Continuing Education in the Health Professions 19 (Summer 1999) 181-191. 12. E Brzytwa, L Copeland, M Hewson, “Mana ed care education: A needs assess-

es,” Journal of Nursing Education 39 (May

13. L W Eustace, “Mandatory continuing education: Past, present, and future trends and issues,” Tlie Journal of Continuing Educa- tion in Nursing 32 (May/June 2001) 133-137. 14. M L Armstrong et al, “The impact of graduate education on reading for lifelong learning,” The Journal of Continuing Education in Nursing 34 fJanuary/February 2003) 19-25. 15. L Kuokkanen, H L Leino-Kilpi, J Kata- jisto, ”Nurse empowerment, job-related satisfaction, and organizational commitment,” Journal of Nursing Care Quality 18 (July-September 2003) 184-192. 16. M Coffey-Love, “Said another way. The nursing shortage: What is your role?” Nursing Forum 36 (April-June 2001) 29-35. 17. A B Hamric, J A Spross, C M Hanson, Advanced Nursiii Practice: A n liitegratiue Approach, seconcfed (Philadelphia: W B Saunders Company, 2000) 280-308. 18. S L Campbell, “Cultivating empowerment in nursing today for a strong profession tomorrow,” Journal of Nursing Educatioii 42 (September 2003) 423-426. 19. S Haley-Andrews, ”Role play: Mentor- ing, membership in professional organizations, and the ursuit of excellence in nursing,” Jouriinl ofihe Societ!y of Pedintric Nurses 6 (July-September 2001) 147-148,151. 20. A M Stein, “Learning and change among leaders of a professional nursing association,” Holistic Nursing Practice 16 (October 2001) 5-15. 21. M W Byme, M R Keefe, ”Building research competence in nursing through

ment o ? employers and educators or nurs-

2000) 197-204.

200 AORN IOURNAL


mentoring,” Journal of Nursing Scholarship 34 (Fourth Quarter 2002) 391-396. 22. S J Fetzer, “Professionalism of associate degree nurses: The role of self-actualization,” Nursing Education Perspectives 24 (May/June

23. B Ulrich, ”The nursing shortage and potential solutions: An overview,” Nephroloay Nursing louriial 30 (August

2003) 139-143.

- , . - 2003) 3641376. 24. T H Warner, ”The Effects of Job Satisfac- tion and Organizational Commitment on Intent to Leave Among Nurse Anesthetists: A Comparative Study” (doctoral disserta- tion, Walden Universi Minneapolis, 2001).

diploma education: Increased value to practice,“ British Journal of Nursing 12 (October 2003) 1096-1104. 26. C Martin, “The theory of critical thinking of nursing,“ Nursing Education Perspec- tives 23 (September/October 2002) 243-247. 27. S T He yvary, “What you believe, you do,” Joir ma? of Nursing Scholarship 32 (Fourth Quarter 2000) 328. 28. J Apker, W S Ford, D H Fox, ”Predict-

25. C Swindells, S Wil ’y. mott, ”Degree vs

ing nurses’ organizational and professional identification: The effect of nursing roles, professional autonomy, and supportive communication,” Nursing Economics 21 (September/October 2003) 226-232,207. 29. K E Des Jardin, “Political involvement in nursing-Education and em owerment,“ AORN Journal74 (October 20017 467475. 30. R M Gunnar-Vaughn, “Strategies at work: Simple steps to satisfaction,” Nursing Management 34 (May 2003) 20-24. 31. L H Aiken et al, ”Educational levels of hospital nurses and sur ical patient mortal- ity,” JAMA 290 (Septemter 2003) 1617-1623. 32. H M Tzeng, “Demand and supply for nursing competencies in Taiwan’s hos ital industry,” Nursing Economics 21 (May June

33. C M Kelley, “Investin in the future of

Nursing Editcation Perspective 23 uanuary/February 2002) 24-29. 34. S S Cohen, P Milone-Nuzzo, “Advancing health policy in nursin edu-

in Nursing Science 23 (March 2001) 28.

2003) 130-139.

nursing education: A cry B or action,“

cation through service learning,” A f va~zces

Prescription Medication Use in United States Increases lmost half o f a l l people i n the United States take a t least one prescription medication, and one i n

particular, increased significantly between 1996 and 2002.

six take three or more medications, according t o a Dec 2, 2004, news release from the Centers for Survey found a 13% increase between the periods Disease Control and Prevention (CDC). These data 1988 t o 1994 and 1999 t o 2000 in the number of were reported in Health, United States 2004, a Americans taking a t least one medication and a report presenting the latest health data collected by 40% increase i n the number taking three or more the CDC‘s National Center for Health Statistics and medications. Forty-four percent reported taking at other federal health agencies, academic and profes- least one medication during the past month, and sional health associations, and international health 17% were taking three or more i n the 2000 survey. organizations. Although prescription medications comprise

Prescription medication use i s growing among only 10% of to ta l health care expenditures, they people o f a l l ages, and use increases with age. Five remain the fastest-growing expenditure. The price out of six people aged 65 years and older are tak- of medications increased 5%, bu t expanded use o f ing a t least one medication, and almost 50% of medicines increased to ta l expenditures by 15.3% i n older adults take three or more medications. 2002. Medication expenditures have increased at

Adult use of antidepressants nearly tripled least 15% every year since 1998. between the periods 1988 t o 1994 and 1999 t o 2000. Ten percent o f women aged 18 years and Almost Half of Americans Use a t Least One Prescription older and 4% o f men take antidepressants. Pre- Drug Annual Report on Nation’s Health Shows (news scriptions for nonsteroidal anti-inflammatory drugs, release, Atlanta: Centersfor Disease Control and Pre- antidepressants, blood glucose/sugar regulators, vention, Dec 2, 2004) http://www.cdc.gov/od/oc/media and cholesterol-lowering statin medications, i n /pressrel/r041202. htm (accessed 8 Dec 2004).

The National Health and Nutrition Examination A

AORN JOURNAL 201

nurses are what nurses do—are you where you want to be?

Documents