Chapter 16: Nursing

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Chapter 16 Nursings Future Challenges

• Bonnie M. Wivell, MS, RN, CNS

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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

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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

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Societal Challenges Contd

• 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 Alzheimers
• Euthanasia/assisted suicide Netherlands and
  Belgium legalized it
• End of life care/palliative care

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Societal Challenges Contd

• Poverty
• Working poor basic needs not met has grown since
  reform of 1996
• Medically indigent dont 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

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Societal Challenges Contd

• 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

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More Societal Challenges

• Environment gradual deterioration of the worlds
  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

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More Societal Challenges Contd.

• Bioterrorism refers to use of biological or
  chemical agent as a weapon
• Keep up with emerging information to be prepared
• See CDCs 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

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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 nursings quest for
  professionalism
• Differentiated practice can only be realized if
  we give up the notion that a nurse is a nurse is
  a nurse

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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

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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

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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 nations demographics
• Maintaining Health Work Environment needle
  sticks, latex allergy, shift work, risk of
  violence in workplace, bloodborne diseases, back
  injuries

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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

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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

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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)

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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 Nursings 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