Evolving Nursing Roles
Evolving Nursing Roles
The Institute of Medicine released a report in October 2010 that set out to answer the question, “what roles can nursing assume to address the increasing demand for safe, high-quality, and effective health care services?” . Three ways that the report suggests to do this are to utilize nurses to their full extent of education and training, a higher level of education for nurses and a stronger leadership role. . Nurses make up the largest segment of the health care workforce and have the capacity to positively impact healthcare in the future, especially with the changes coming from the Affordable Care Act. Nursing is one of the few professions that has several educational pathways to licensure.
In order to qualify to take the NCLEX-RN exam, one can obtain an associate’s degree in nursing (ADN), a bachelor’s of science in nursing (BSN) or can complete a diploma program. “The primary goals of nursing education remain the same: nurses must be prepared to meet diverse patients’ needs; function as leaders; and advance science that benefits patients and the capacity of health professionals to deliver safe, quality patient care”. . While these goals are ideal, the educational road to get there can be streamlined to be less confusing and “to prepare nursing graduates to work collaboratively and effectively with other health professionals in a complex and evolving health care system in a variety of settings”. .
New RNs are not always prepared for the job and there is a high turnover rate for “new grads”. Hospitals can help the transition by offering “new grad” or residency programs and longer orientation periods. RNs not only have to become efficient at the tasks of the job, but also be able to critically think a situation, delegate tasks to CNAs and LVNs, effectively manage time and become comfortable with communicating with doctors and other healthcare team members. The key is to better educate nurses both before and after licensure. . The Institute of Medicine’s report states that nurses are being underutilized.
The changing healthcare system in the United States requires that “the system undergo a fundamental shift to provide patient-centered care; deliver more primary as opposed to specialty care; deliver more care in the community rather than the acute care setting; provide seamless care”.. Gone are the days of just treating a patient in a hospital once he or she has become ill. Patients are being educated about disease prevention and health promotion in their communities, there is improved access to care for the poor and those in rural areas and there is hospice care available.
Nurses are at the core of this shift and help to provide a high quality of care more safely and with fewer errors. With the shortage of healthcare providers, advanced practice registered nurses should be given more responsibilities and a broader scope of practice. Some hospitals and healthcare facilities are already making changes and are seeing positive results. The impact of employing nurses in a substantial way will continue to improve patient care and promote health and wellness; however there are some issues that will need to be addressed. It is true that nurses are capable of doing more with their experience, skills and education, but nurse to patient ratios is a major factor in why nurses aren’t doing more.
It would be ideal if the nurse could provide care to a patient in the hospital, provide thorough education about the disease process and prevention, address any spiritual and social services needs and coordinate any home health or therapy requirements. However, with a nurse to patient ratio of 1:4 or 1:5 and several discharges and new admits every day, this is unlikely in the acute care setting. I strive to provide seamless care for my patients and give as much of myself and my time as I can, but I also have no choice but to rely on other sources, such as social services and case management.
Unfortunately, many patients who need these services and who could benefit from more education do not get it because of time constraints. It is my hope that as this shift occurs, there will be fewer patients who need to be admitted to the hospital and there will be more time to provide patients with the care and information that they need.
“Strong leadership is critical if the vision of a transformed health care system is to be realized”. . Nurses may not have originally thought they would be leaders when they entered the profession. Most likely they just wanted to help people. However, now more than ever, nurses have to become partners with other healthcare team members and help lead the way to reformed healthcare in the country. According to the IOM report, “being a full partner involves taking responsibility for identifying problems and areas of waste, devising and implementing a plan for improvement, tracking improvement over time, and making necessary adjustments to realize established goals.”
Nurses must use their leadership skills to work with others and advocate for their patients to make these improvements. Obtaining a higher level of education will assist students or RNs to develop leadership competencies and help them gain the confidence needed to work on these projects.
Creasia, J. L., & Friberg, E. (2011). Conceptual Foundations: The Bridge to Professional Nursing Practice (5th ed). St. Louis, MO: Elsevier. The Institute of Medicine. (2010). The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press.