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The nursing profession has grown tremendously in the areas of respect, accountability, and impact on patient and organizational outcomes. Several significant challenges, however, must be addressed so that the difference nurses can make is fully realized and the joy and fulfillment that the practice can bring to nurses is fully appreciated.
External forces impacting the healthcare business, including governmental regulation, changes in reimbursement, and complex requirements for serving sicker and older populations, all directly influence nursing practices. Historically, nurses could focus on facilitating the healing process, educating patients, and reducing suffering. Today’s nurses must also participate in time-consuming initiatives to enhance healthcare value as defined by the government, incorporate complex technology in diagnostic and treatment processes, and reduce costs, all while performing their traditional care-oriented functions. Exacerbating this problem is the fact that physicians, who are intended to partner with nurses, are burning out at a rate high enough to be considered a public health crisis. The pressures from these factors can be exhausting, and leaders must address the associated disengagement that continues to climb. To combat these pressures and enhance nursing retention and productivity, successful organizations are implementing measures to improve nurse engagement and emotional health.
Healthcare reform also left nurses with hope that patients would seek regular care at local access points that would be more health-promoting, leaving only the sickest patients to be treated in hospital settings. This has not yet been realized. Patients continue to seek episodic care in hospitals rather than primary care sites, and highly acute patients still compete for nursing care in the same hospital settings. This pushes nurses to ration care so they can provide for everyone, and although stressful, they do it well. Many nurses are even seeking advanced degrees to better influence care at all touchpoints on the continuum, while assisting leaders in driving care to the appropriate access points. As a result, nurses are more relied upon and respected now than ever for their contributions both inside and outside of the hospital.
Consumer experience also matters differently now. In the past, patients’ expectations were primarily related to healing and reduced suffering, and nursing interventions were carried out accordingly. Today, patient experience is measured by the government and publicly reported. Those published reports frequently do not correlate with what nurses really believe their patients need, but the same nursing professionals are held responsible for the results because of the nature of their interactions with the patients evaluating the care they’ve received from a wider range of professionals. Further, organizations count on nurses to influence scores that are measured by tools that don’t necessarily give nurses appropriate credit for the very complex, highly technical, and scientific care they must deliver with compassion.
Lastly, one of the most significant trends that nursing leaders are addressing today is the widening gap between an experienced nursing workforce and the complexity of care required by the population served. An experience shortage is developing because the knowledge and skill of baby boomer nurses is disappearing as they retire, while the complexity of the patient population is simultaneously increasing. The gap driven by these two countervailing forces needs to be recognized and urgently addressed. To do so, progressive organizations are quickly implementing nurse residency programs and formal onboarding programs that seek to bridge the gap and advance the practice of nurses.
Overall, nurses are more recognized for the impact they make on the survivability of healthcare organizations, and nurse leaders are increasingly becoming active members of the executive teams. Nursing contribution at all levels of the organization and well-organized nursing strategic plans greatly influence healthcare system success.
