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

• International Nursing Index categorizes worldwide nursing articles

Highlights

1970’s• NP in expanded roles

gain national visibility• Nurses Coalition for

Action in Politics formed• ANA creates AAN to

honor outstanding nurses• Nurse theorist come into

national spotlight

1980’s• MS and Doctorate

programs increase

• Prof. Nursing journals increase

• More nurses are nationally “certified” in 17 specialty areas

• STTI increases its membership

• NIH has a National Center for Nrsg. Res.

Nursing Professionalism at a Crossroad Briefer professional hx than the traditional

professions

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

Problems

autonomy and independent decision making career commitment collegial relationships professional worth or rewards

Contemporary Nursing Issues

CONTROL OF NURSING PRACTICE• extended and expanded role for nurses

• 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 ADN 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

What will be the influence of nursing on health care policy? Viewed as colleagues of other health

professions rather than as extensions

Other professions has issues about unique services, educational preparation, and payment of services.

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

External barriers to practice options are presently decreasing, but have the potential to go either way

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

Nursing Options

Nurse-practitioner Clinical Nurse Specialist Nurse-midwife Nurse anesthetist Case manager/clinical manager

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

Nursing Functions

Dependent: performed under delegated medical supervision or prior routines

Independent/autonomous: initiated as a result of own knowledge and skills

Interdependent: overlapping functions shared between nursing and medicine

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

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

Theory development is needed to guide research and increase nursing’s scientific credibility

“New science” with much uncharted territory

Manage or Administer Health Care Organizations Skills related to management, leadership,

and fiscal responsibilities

BSN provide these courses

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

Entrepreneur

a contractor and also someone who undertakes projects requiring unconventional activity and some risk

20th century: private-duty nurses screening, counseling, and instruction before

same-day surgery home health care planning and coordination alternative birthing arrangements

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

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

Pioneer in Space Health

Expert care and sensitive communication will be basic to prolonged confinement

New information: weightlessness, sleep, nutrition, exercise, and mobility, stress, isolation

Create Dual Careers

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

Law and business

AIDS

1983: 1st major article about AIDS for general public was published

FACTS:• difficult disease to catch• CDC Universal Precautions• OSHA is enforcing CDC guidelines• Care required by AIDS clients in not unique

Health Care of the Elderly

Isolated by: early retirement, trend away from extended families and the trend toward segregated retirement communities

Most pervasive security need derives from a common fear of neglect

Changes in Medicare, Medicaid 2010: >40 million > 65

Similarities of Care

Misunderstood and ostracized by society Decreased functional abilities and

increasing dependency on others for assistance

Susceptibility to infection Nurses can be caregivers, respectors of

personhood, advocates and teachers

RESPONSES TO CHALLEGES: Continue Professionalism of Nursing

Extend Practice through Research

Increase Public Awareness of Nursing’s 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