Nursing's Future: Challenges and Opportunities

Alabama Nurse,  Mar-May 2005  by Wilkes, Ruthanne,  Butler, David,  Trammell, Nicole,  Faulk, Debbie

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Nursing possesses a rich history characterized by compassion, dedication and service. As society's culture continues to experience change, the profession of nursing is undergoing continuous evolution. The future of nursing holds a myriad of challenges. These challenges include both external forces as well as influences from within the profession as the role of the nurse is further defined. Although often uncomfortable, change is inevitable and should be embraced. It is the responsibility of nurses to shape the future rather than merely react to the shifts in the tide. Nurses will be positioned to appropriately respond if they adopt an attitude of expectancy, recognize challenges as opportunities, and are adequately prepared to take an active role in shaping future practice. This article will reflect changes we anticipate will impact nursing at the close of the first decade of the 21st century. In addition, we will describe driving forces and key elements in strategies necessary to navigate the waves of change.

Globalization

Factors contributing to globalization include advances in information technology and communications, international travel and commerce, the growth of multinational corporations, the fall of communism in Eastern Europe and the Soviet Union, and major political changes in Africa and Asia (Heller, Oros, & Durney-Crowley, 2000). Although this death of distance has contributed to the spread of disease, it has also fostered an environment with unprecedented potential. The opportunity for sharing of information regarding advances in medicine and "best practices" among cultures and health care systems will require the nursing profession to broaden its perspective. The concept of community may require redefining in order to consider the impact of international issues in healthcare. Future nurses will especially need to be efficient managers of information. Necessary skills include the ability to access, retrieve, interpret, assimilate, analyze and apply information. Nurses will be looked to for guidance and leadership in coordinating care as diverse populations move across health care settings. Not only is a broadened perspective necessary regarding the view of society, but also for a focus on the individual. Future nurses will face the challenge of maintaining a holistic approach to client care in an environment of growing specialization. Focus on health promotion, maintenance, and revitalization will continue to grow.

Rising Costs of Health Care

The cost of health care has been a major concern for decades. The Center for Medicare and Medicaid projects that healthcare spending will continue to escalate. Despite the fact that the majority of healthcare is publicly funded and out of pocket expenses account for only approximately 14%, heightened consumerism exists along the spectrum of healthcare. As a result, increasing demands for quality, accountability, and cost-effectiveness are shifting the focus of evaluation from process to outcome measures. Along with this, emergence of patient satisfaction and functional status are being recognized as indicators of quality health care (American Association of Colleges of Nursing, 2002). This shift in attention provides nursing with an immense opportunity to herald the positive impact of nursing care on patient outcomes. Current studies are revealing distinct correlation between positive patient outcomes and number and skill mix of nurses (Department of Health and Human Services, 2001). Although additional research is needed, nurses should communicate this relationship between nursing care and positive patient outcomes in order to accentuate the value of nursing.

The realization that 40 million Americans are currently without healthcare insurance seems overwhelming and presents cultural and ethical considerations. Proponents of healthcare rationing as a solution to controlling mushrooming costs exist among all levels of care providers. The nursing profession will need to be prepared to accept the familiar role of patient advocate as the tapestry of decision-making becomes ever so complex. Additionally, the orchestrated shift from acute care to population-focused outcomes by third party payers will over the next 5-10 years result in communities becoming the arena for managing recurring illnesses. This will result in an expanded need for more nurses with population-level assessment, management, and evaluation skills (Stanhope & Lancaster, 2000). The burden of cost control is no longer limited to those in the accounting office but should be shouldered as a collaborative effort of all involved disciplines with nursing playing an integral role.

Health Care Complexity

The comprehensive health care needs of individuals and communities will require a plethora of knowledge and skills provided in an effective and efficient manner (Heller, Oros, & Durney-Crowley, 2000). This will require greater degrees of team based collaboration among health care professionals. Nursing education programs must therefore incorporate interdisciplinary education and collaborative practice to prepare tomorrow's nurses.