Nursing in the 21st Century

1. Nursing in the 21st Century NUR 210

2. 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)

3. 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

4. 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

5. 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. Highlights

6. Nursing Professionalism at a Crossroad • Briefer professional hx than the traditional professions • Has been and continues to be primarily a women’s occupation

7. Problems • autonomy and independent decision making • career commitment • collegial relationships • professional worth or rewards

8. 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)

9. 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

10. 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

11. What payment should nurses receive for their services? • Retrospective reimbursement • Prospective prepayment • Managed care = managed cost • Better paying positions requires advanced degrees

12. 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.

13. 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

14. 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

15. 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

16. Nursing Options • Nurse-practitioner • Clinical Nurse Specialist • Nurse-midwife • Nurse anesthetist • Case manager/clinical manager

17. 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

18. 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

19. 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

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

21. 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

22. Manage or Administer Health Care Organizations • Skills related to management, leadership, and fiscal responsibilities • BSN provide these courses

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. Create Dual Careers • Artistic or Analytic • music, art, drama (pediatrics, mental health) • verbal skills, writers, high tech, people persons • Law and business

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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.

38. 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.

39. 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

40. 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.

41. “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