Chapter 16: Nursing’s Future Challenges

1. Chapter 16: Nursing’s Future Challenges Bonnie M. Wivell, MS, RN, CNS

2. Overview • U.S. is the wealthiest of the industrialized nations and still falls short of the goal of having a healthy nation in spite of spending nearly $2 trillion annually on health care • 45 million Americans have no health insurance • Infant death rates remain high – nearly 5 per 1000 babies • Fitness levels declining as obesity is increasing • U.S. spends more of its GDP (16% in 2004) on health than any nation in the world

3. Societal Challenges Demographics: study of vital statistics and social trends Birthrates Morbidity rates (illness) Mortality rates (deaths) Marriages Ages of various populations Migration patterns Futurists: people who try to project what will occur, draw conclusions about what these trends mean for the future

4. Societal Challenges Cont’d • Aging Population: • By 2020, 21.8 million will be 75 + years old • “Baby boomers” knowledgeable, expect more and tolerate less • Centenarians: represent one of the fastest growing groups in the U.S. • 1 of 2 people over 90 will develop Alzheimer’s • Euthanasia/assisted suicide; Netherlands and Belgium legalized it • End of life care/palliative care

5. Societal Challenges Cont’d Poverty Working poor basic needs not met; has grown since reform of 1996 Medically indigent don’t qualify for Medicaid but cannot pay for health care Disenfranchised have no power in political system & limited access to health care, Government with limited resources must look at more strategies for health care for these vulnerable populations

6. Societal Challenges Cont’d Cultural diversity: people from different racial, ethnic, religious, social, & geographic backgrounds Homogeneous: similar cultural beliefs and practices Heterogeneous: cultural mix Nurses need to take cultural beliefs, values and practices into consideration when planning and implementing nursing care Urbanization: move from rural areas to cities Decaying inner cities with large populations of poor people create major social problems Homelessness, drugs, gangs, single-parent households, mental illness, violence, and crime

7. More Societal Challenges Environment: gradual deterioration of the world’s air, water, and plant and animal life Acute and chronic respiratory diseases, debilitating allergic reactions and cancers are increasing Epidemiologists study origin/spread of disease and believe that environmental decline increases incidence of certain diseases Emerging MDRS of organisms will challenge health care resources Disasters: an event or situation that is of greater magnitude than an emergency disaster; can be natural of man-made Core preparedness competencies Practice 2 times/year

8. More Societal Challenges Cont’d. • Bioterrorism: refers to use of biological or chemical agent as a weapon • Keep up with emerging information to be prepared • See CDC’s bioterrorism website • Unhealthy life styles: obesity, tobacco use, lack of exercise, eating disorders, stress, HIV/AIDs and drug use • Cost Containment: must do more with less • Regulation of Health Care: costs rise with aging, increased use of advanced practice nurses for primary health care

9. Challenges in Nursing Practice Differentiated Practice Levels: ADN/BSN, MS + Should have different, well-defined roles Possibly different levels of licensure Only health care profession for which entry into practice is less than a baccalaureate degree Credential for entry into a profession and educational standards are rising in all fields but nursing This has hampered nursing’s quest for professionalism Differentiated practice can only be realized if we give up the notion that “a nurse is a nurse is a nurse”

10. Challenges in Nursing Practice • Cost Containment: managed care, capitation • Nurses will need resource management skills • Business expertise will be needed as much as clinical experience • UAP utilization and delegation • Autonomy & Accountability • Shared governance: participation by nurses on strong policymaking hospital committees; mandated by JACHO • Practice in community settings; autonomy and accountability will become increasingly important • Life long learning a requirement

11. Technology & Nursing Informatics • Nursing informatics: the organization and use of nursing data continue to change • Telecommunication (telemedicine) will improve access to medical services for rural and elderly • Genetic engineering & genomic revolution • Makes it potentially possible to treat & prevent genetically transmitted and predisposed diseases • Designer medicines are drugs tailor made to treat patients based on their individual genetic makeup • Complementary & alternative therapies more utilized as persons take responsibility for their own health • Internet can provide reliable medical & health information

12. Challenges Continued Practice in Community Settings: Nurse managed clinics serve inner city/rural areas; school nurses needed in large numbers as well as hospice nurses and those specializing in gerontology and chronic illnesses Cultural Competence: patient/families & health care providers cultural sensitivity due to change in the nation’s demographics Maintaining Health Work Environment: needle sticks, latex allergy, shift work, risk of violence in workplace, bloodborne diseases, back injuries

13. Challenges in Nursing Education Outcome-based Education: student competency and evidence-based education required to maintain accreditation Diversity: students reflect US demographics; culturally competent education; distance learning increases access Education about chronic diseases, gerontology, hospice Foreign language requirement for BSN Culturally competent care as an outcome criterion for graduates

14. Challenges in Nursing Education Continued • Technology & Nursing Informatics’ Impact • Computer competence • Internet utilization • Faculty required to actively practice to keep up with changes • Lifelong learning a requirement • NCLEX changes • New grad internships

15. Challenges Continued Collaboration: Nurses with more education equal footing with physicians & others, interdisciplinary Reforms in Health Care & Higher Education: Graduate education producing practitioners to meet consumer demands Curricula standardized & streamlined to reduce cost and confusion and improve student mobility Nurses will need to be well versed in the costs, budgeting and finance of health care Faculty Shortage/Student Shortage: current faculty retire, few younger nurses into education as salaries lag; students turned away as no one to teach them; fewer students means fewer nurses; medical schools respond by producing hospitalists (care for patients only while hospitalized)

16. Challenges to Entire Nursing Profession As the largest health care profession in the US, nursing should have a powerful voice and presence at every table where substantive health care issues are discussed. Use of Collective Power to resolve issues, but only 10% of all nurses belong to their professional association Nursing Agenda for Future: 2001 Nursing Profession Summit (ANA grant) Steering committee formed and established the document entitled Nursing’s Agenda for the Future How nursing should look and where it should be by the year 2010; you help decide; involve nurses in charting own future Nurses can accomplish more working together FOCUS, UNITE, ACT! “Be the change you wish to see in the world”