History of nursing practice and development

Future of Nursing

Nursing history

The future of nursing: Leading change, advancing health

According to the Institute of Medicine (IOM) report The future of nursing: Leading change, advancing health, the future of medicine as a whole is inexorably tied to the future of nursing. Nurses are increasingly called upon to perform complex tasks as more of the healthcare burden gets shifted to nurses in the name of managed care and cost-cutting. The expanded population base of patients due to changes in legislation such as the Affordable Care Act (ACA) and the aging of the population further underlines the need for appropriate education of tomorrow's nurses and the reeducation of the nurses of today. This will require major policy changes and overhauls.

First and foremost, nurses must be better prepared to cope with a population that is very different from the population nurses treated in the past. Not only is it older, but there are more chronic conditions such as heart disease and diabetes, given the rise of obesity and lifestyle-related illnesses. Although containment of infectious diseases such as the flu is important, the model of healthcare must shift to some degree from an infectious model to one of prevention through improving wellness factors. Technology has also changed the ways in which nurses must cope with healthcare. "Nurses also are being called upon to fill expanding roles and to master technological tools and information management systems while collaborating and coordinating care across teams of health professionals" ("The future of nursing: Focus on education," 2010: 1). Technological literacy has become synonymous with competence at one's profession.

There is a critical demand, according to the report, for improved nursing education to meet these changes. Nursing has multiple pathways to entry but the greatest demand at present is for nurses with advanced degrees. The need for more nurses who can act as primary care providers, nurse researchers, and nursing faculty means that there is a greater demand for graduate-level educated nurses. Increasing the number of nursing faculty is perhaps the most critical of all of these needs, given that many nurses are actually being turned away from nursing programs, despite the nursing shortage, simply because there are not enough qualified faculty members for staffing. So-called 'bridge' programs which enable nurses to enhance their current credentials are one way to accomplish this objective. But as well as educational institutions providing programs for nurses to add to their credentials, healthcare institutions themselves must be supportive so nurses can balance their existing duties with their learning. The benefits can be great for all once the logistical challenges are worked out: "Bridge programs and seamless educational pathways also offer opportunities for increasing the overall diversity of the student body and nurse faculty with respect to race and ethnicity, geography, background, and personal experience" ("The future of nursing: Focus on education," 2010: 1). Nurses must be sensitive to the needs of patients and cultural considerations which impact wellness.

The IOM argues that properly-prepared APRNs can function in the place of physicians, subsuming many of physicians' duties and thus rectify many concerns about both cost and provider shortages. This must be recognized by legislators. "APRNs are not acting as physician extenders or substitutes. They work throughout the entirety of health care, from health promotion and disease prevention to early diagnosis to prevent or limit disability. APRNs sometimes provide services that many people associate with physicians, such as assessing patient conditions or ordering and evaluating tests, but they also incorporate a range of services from other disciplines, including social work, nutrition, and physical therapy" ("The future of nursing: Focus on scope of practice," 2010). Nurses are less costly to employ than physicians but also the focus of patient-oriented care is particularly suited to the 'nursing perspective' which is always focused on the patient. To fully enjoy these benefits the IOM demands that state legislatures recognize the ability of APNs to provide an expanded range of service (as many states have done so already). On a federal level, it also suggests that Congress expand its "Medicare program to include coverage of advanced practice registered nurse services that are within the scope of practice under applicable state law, just as physician services are now covered" ("Report recommendations," 2010).