CC BY
14Articles
J Health Dev 2018; 2(27) Supplement:15-19
NURSES OF THE FUTURE: WHAT WILL THEY LOOK LIKE?
Primeau M.S.
University of Alabama in Huntsville, College of Nursing, Coordinator of Global Health and Medical Mission Program, USA
Abstract
Globally, we are in the midst of dynamic shifts in healthcare needs and resources. Increased diversity in populations, increased longevity, rising numbers of non-communicable diseases, and decreased resources are just a few of the healthcare challenges we must address in the coming years.
he article presents discussions about the future of nursing care: educational issues, policy, interprofessional cooperation etc. Key words: nursing care perspectives, education in nursing care.
Болашацтыц мешргерлерг. Ыз оларды цандай децгейде квргiмiз келедi?
Тужырымдама
%a3ipai тацда адамзат медициналы% %ызмет сапасы мен ресурстарыныц заманауи api жылдам дамуын талап emedi. Халы^тыц саны мен вмip CYpy уза^тыгыныц ecyi, щкралы емес аурулардыц жиi кeздeсуi жане вмip CYpy ресурстарыныц mвмeндeyi денсаулы% са%тау саласыньщ 6i3 жа%ын болаша%та шешуае тшс маселелердщ тек аз бвл'г'! гана.
Цолжазбада мeйipaepлiк irnin болашагы, оныц iшiндe б^м беру, саясат, маманаралы% ынтыма%тасты% жане тагы бас%а квптеаен маселелер талкышанады.
Krnmmi свздер: мeйipaepлiк ютщ болашагы, мeйipaepлiк iсmeai б^м беру.
Медицинские сестры будущего: Какими мы их хотим видеть?
Резюме
На сегодняшний день человечество требует динамичных перемен в сфере медицинского обслуживания и ресурсов. Увеличение численности населения, продолжительности жизни, увеличение числа неинфекционных заболеваний, а также уменьшение ресурсов в жизнедеятельности представляют лишь малую часть проблем в сфере общественного здравоохранения, которые мы должны решить в ближайшие годы.
В статье представлены рассуждения о будущем сестринского дела: вопросы образования, политики, межпрофессионального сотрудничества и многое другое.
Ключевые слова: перспективы сестринского дела, образование в сестринском деле.
УДК 61:001.12/.18
Recieved: 14.06.2018 Accepted: 17.06.2018
Corresponding author: Marlena Primeau, DNP, FNP-BC, NHDP-BC, BSHECS, Clinical Associate Professor Coordinator, Global Health and Medical Mission Program University of Alabama in Huntsville, College of Nursing, USA
Address: 301 Sparkman Drive. NB 321. Huntsville, Alabama USA 35899 Phone: + 01 (256) 824-2449 E-mail: Marlena.Primeau@uah.edu
Introduction
To look into the future of nursing, close your eyes
for a moment and think about the year 2050......what will
nurses look like then? What do you imagine? What do you WANT nurses to look like then? Will we wear different clothing; have different jobs, different leadership positions, or will we stay pretty much as we are? The truth is, the
future of nursing is what we make it.......we decide the
future through what we do as individuals, what we do as team members, and what we do as a profession. It really is up to us.
That is both an awesome responsibility and an incredible opportunity. How many times have we thought, «I wish I could CHANGE that!? ». Well, now is our chance! We are in the midst of a tremendous transformation in professional roles, expectations, and practices in both nursing and healthcare. Nurses, though, have to take ownership of those changes. We have to have the knowledge, the determination, and the willingness to step out of our comfort zones and become healthcare leaders. To gain a true picture of what nurses in the future will look like, we need to see it from two perspectives: the opinions of the experts, and the opinions of current and future nurses themselves.
Issues for Nursing's Future
Globally, we are in the midst of dynamic shifts in healthcare needs and resources. Increased diversity in populations, increased longevity, rising numbers of non-communicable diseases, and decreased resources are just a few of the healthcare challenges we must address in the coming years.
When we look at the profession of nursing, we also see dynamic shifts and increasing challenges in the coming years and decades. Currently, there is a worldwide shortage of 7.2 million healthcare workers; by 2035, that number is expected to be 12.9 million [1]. This has not happened overnight; periodic nursing shortages have occurred since World War II [2]. More than a decade ago, the International Council of Nurses (ICN) reported that there are huge variations and instability in nurse to patient ratios worldwide, which in turn directly affects health outcomes [3]. Health care tourism and the ability to practice across national borders are and will continue to critically impact the profession of nursing and healthcare in general. There is an escalating global demand for competent and professional nurses, while at the same time the nursing workforce is aging [4]. Nurses are crossing national borders to practice, often for higher wages and a more positive working environment, but that often leads to critical nursing shortages in the home country [5]. The need for ever more complex nursing care can be overwhelming, and nursing educators often struggle to ensure that students are adequately prepared for an ever-moving target.
The good news is that there is a growing worldwide awareness of this problem, and increasingly, at least a beginning consensus on what needs to be done to mitigate challenges and strengthen the global nursing workforce.
The World Health Organization (2015) [6] notes the key role that nurses play in the success of the Sustainable Development Goals, and in particular Goal #3, which is focused on health and wellbeing. Several decades ago, the word 'Glocal' was coined and is becoming a watchword of global nursing and healthcare [7]. It encompasses the concept that global and local considerations occur together, are interconnected and equally important, and must be addressed at the same time [8]. In other words, think globally, act locally.
Perspectives from the Experts
As noted earlier, we are beginning to see a worldwide agreement on ways to address the global nursing challenges, or at least identify the topics that must be addressed to produce competent and professional nurses in the future.
In a 2004 landmark publication, the ICN [9] suggested that one root cause of the nursing shortage is a poor professional image of nursing as well as gender equality issues, so addressing those core concerns is part of our professional responsibilities individually and as a profession. There are several key concepts on the future of nursing that are repeatedly addressed in organizations from the World Health Organization to international nursing associations to national expert groups such as the US Institute of Medicine. Although there are numerous important concepts suggested by each organization (Table 1), the key categories that appear to be consistently addressed are nursing education, nursing leadership, policy concerns, interprofessional collaboration, workforce issues, and care outcome quality [10,11,12].
Nursing education: The problem in nursing education appears to betwo-fold; there is a worldwide shortage of nurses, but an even larger shortage of academically qualified nursing faculty. The nursing faculty shortage has occurred due to a variety of factors, including financial disincentives and a devaluation of nursing faculty by academic programs [13]. In addition, nursing programs often lag behind practice essentials in the workplace. Nursing education must provide responsive and adaptable programs, global evidence - based knowledge and competencies must be structured into nursing curricula, and skills that empower critical thinking and enhance professional skills needed in the future must be included [8]. Nurse residencies, professional portfolio development, and lifelong learning need to be incorporated into licensure and certification requirements [11], especially for internationally educated nurses. If the transnational nursing trend continues, standardized educational curricula and licensure/certification requirements become even more crucial. Global healthcare and cultural competencies should be a required part of all nursing curricula at every level [7,14].
Nursing leadership: Nursing, unfortunately, has rarely put an adequate emphasis on developing nursing leaders. If we want to have the ability to create sustainable change, nursing as a profession must advocate for strong
Тезис
nurse leaders at every level....from local hospitals and community clinics to national and international organizations. To develop a generation of nursing leaders, educational programs must identify how best to prepare students for this role and include it in the curricula [15]. Every nurse must discover the leader within themselves, and work toward and accept leadership positions as they occur. As a profession, we must also acknowledge that we need to support and encourage the nurses who strive to be leaders, rather than focus on internal power struggles and territorial issues. We must not only acknowledge the need, but act on it.
Policy concerns: Traditionally, nurses have not been involved in decision making, are often not invited to the policy table, and therefore, often have no voice in decisions made about nursing practice. Part of the problem is that nursing students and practicing nurses are often not educated on effective ways to become involved in policy processes and decisions, and are rarely mentored in these procedures [16]. Nurses often forget that we are the largest single group of healthcare professionals in the world, and we have the potential to influence policy and politics, from local issues to global concerns. We do, however, have to have the determination to assist in making those changes. Ways that nurses can become involved is first to obtaining training on policy development and the negotiation process, then join professional nursing organizations, and volunteer with local policy or social services organizations.
Interprofessional collaboration: Too often, nurses continue to stay isolated from other healthcare professionals, and rarely collaborate with other disciplines and groups, including non-medical ones. Interprofessional collaboration has been identified as a key strategy in
improving healthcare is well supported in the literature [17]. To address critical healthcare and workforce needs, nursing programs need to include interprofessional teamwork training and practice. Nurses should also take the lead in becoming members of interprofessional healthcare teams at their place of work, join and support nursing organizations, and interact with other nurses and healthcare professionals around the world.
Workforce issues: An important barrier to accurately identifying workplace and workforce concerns is that there is no standardized way of comparing issues and data across very diverse conditions in dissimilar countries. Working environments for nurses, unfortunately, are often professionally lacking [18]. Environments conducive to recruitment and retention of nursing should include a supportive work environment, respect and collegiality from other healthcare professionals, and a management organization that is respectful of nursing knowledge and expertise [19].
Care and outcome quality: Every day, nurses around the world do many things to improve patient care and outcomes. As a profession, though, we are often deficient in documenting and, especially, publishing nursing findings and outcomes. As the World Health Organization (2016) [12] notes, data is critically needed on various aspects of nursing, including numbers, competencies, practice locations, and patient outcomes. Developing an infrastructure to sustainably document information on current nursing roles and practices will empower nurses to have confidence as change agents and speak with an effective voice to influence patient care and outcomes in the future.
Table 1 - Key Concepts on the Future of Nursing
Selected Global Organizations
Key Concepts on the Future of Nursing
WHO SDG #3 [6]
WHO Global Strategy on Human
Resources for Health [6]
Needed focus on people-centeredness; nurses have particularly important role
Increased political and technical leadership to support long-term human resource development efforts.
Collection of reliable data on nursing from local to international levels - numbers, competencies, practice locations, outcomes. Documentation on role and work of nursing is critical
Maximizing the role of mid-level and community health workers to provide
accessible and acceptable primary care.
Better geographic distribution and retention of health workers.
Nurses play a key role at the policy table.
Provide mechanisms for the voice of health workers in developing and implementing policies and strategies towards universal health coverage.
WHO Global Strategic
Directions for Strengthening Nursing and Midwifery [12]
International Council of Nursing
Global Nursing Review Initiative [20]
Sigma Global
Advisory Panel
on the Future of
Nursing
[GAPFON]
[10]
Institute of Medicine [US] [11]
Ethical action
Relevance and Quality
Ownership, Leadership, Governance
Collaborative Partnerships
Evidence-Based Nursing
Workforce Education and Development
Importance of strong positive relations internationally
Recruitment and retention of nurses, including in-country maldistribution and outmigration
Comprehensive standards on policy, regulations, research, management, and practice
Address health sector funding policies
Positive practice environments and organizational performance
Professional practice and regulation
Nursing leadership.
Leadership - collaborative nursing leaders Policy - participate and influence health policy
Workforce - work to full capacity, ensure adequate numbers and skill levels,
collaborative teamwork
Practice - focus on health promotion
Education: reform educational curricula, increase lifelong learning Research - document contribution of nursing, research informed practice Implications for global nursing (esp. WHO SDG #3) Nursing Residency programs Lifelong Learning
Leading Change - curricular changes, mentorships
Infrastructure for Interprofessional care - national tracking, Include nursing as viable resource in all environments
Perspectives of Practicing Nurses and Nursing Students
An informal survey of local nursing students and practicing nurses provided an intriguing look at how nurses may see the future of our own profession. The identified themes were surprisingly similar to expert opinions on what nursing will need to become in the future. These themes included:
• A more global nursing perspective for all nurses;
• ncreased proficiency in cultural competence;
• Active participation in interprofessional teams;
• Continued advocacy for underserved populations and health concerns;
• Continued emphasis on lifelong learning and education;
• Facilitation and encouragement of nursing research;
• Facilitation of nursing leadership roles;
• Importance of preventative care and primary prevention;
• Increased nursing presence at policy tables and in politics;
• Nursing knowledge and input requested and valued;
• The need for technological proficiency as well as traditional nursing skills.
Conclusion
Globalization appears to be a truly critical and motivating dynamic in the new millennium. Along with other factors, it is shaping society and, in particular, the healthcare arena.
The reason we have the ability to change or
improve our future is that nursing is truly at the core of healthcare. Although interprofessional teams are critical to quality care, nurses are the hands-on people, the ones who provide the necessary day to day care and teaching that is so important to our patients. In the US, we call people doing the on-site, essential work in any situation the 'boots on the ground' people. They are the ones who truly know what is occurring with patients and staff on a daily basis. For healthcare, those 'boots on the ground' people are usually nurses.
To reach our goal of respected, trained professional nurses in adequate numbers, we need to be mindful of the key concepts identified as crucial to our sustainability as a profession:
• Nursing education programs that are responsive and adaptable to provide the skills necessary for future needs;
• Nurses who are in leadership positions, and who encourage, support, and mentor other nurses who are new to leadership roles;
References
1. World Health Organization. Global health workforce shortage to reach 12.9 million in coming decades, 2018. Web site. Retrieved 06.01.2018. Available: http://www.who.int/.
2. Grando VT. Making do with fewer nurses in the United States, 1945-1965. Journal of Nursing Scholarship. 1998; 30 (2): 147149.
3. International Council of Nurses. The global shortage of registered nurses: Priority Areas for Intervention, 2006. Web site. Retrieved 06.01.2018. Available: http://www.icn.ch/.
4. International Council of Nurses. Nurses and the Ageing Workforce, 2015. Web site. Retrieved 06.01.2018. Available: http://www.icn.ch/.
5. Nichols BL, Davis CR, Richardson DR. An integrative review of global nursing workforce issues Annual Review of Nursing Research. 2010; 28: 113.
6. World Health Organization. Consultation on the Global Strategy on Human Resources for Health, 2015. Web site. Retrieved 06.01.2018. Available: http://www.icn.ch/.
7. Wilson L., Mendes IAC, Klopper H, Catrambone C, et al. 'Global health' and 'global nursing': Proposed definitions from The Global Advisory Panel on the Future of Nursing. Journal of advanced nursing. 2016; 72 (7): 1529-1540.
8. Holmgren J. Global nursing: educating future nurses for tomorrow's nursing care needs. Nordic Journal of Nursing Research2017; 37(3): 172-174.
9. International Council of Nurses. Socio-economic Welfare of Nurses, 2004. Web site. Retrieved 06.01.2018. Available: http://www.icn.ch/.
10. Klopper HC, Hill M. Global advisory panel on the future of nursing (GAPFON) and global health Journal of nursing
• Nurses who are involved in policy decisions that affect the nursing profession and patient care;
• Nurses who are involved in interprofessional collaborative teams at all academic and clinical levels;
• Workplace settings that are positive environments and are supportive of recruitment and retention of nurses;
• Infrastructure for documentation and analysis of nursing numbers, competencies, practice locations, and patient outcomes.
So what will the nurses of the future look like? Whatever we want, and whatever we are willing to work for! Whether at the bedside, in the community, in government, or in space, nursing's focus on health, wellness and quality patient care remains the fundamental and primary principle on which we base our practice. However, we need to remember that, to provide excellent care, we must also care for ourselves and empower our professional lives.
scholarship. 2015; 47(1): 3-4.
11. Shaffer FA, Davis CR, To Dutka J. et al. The future of nursing: Domestic agenda, global implications. Journal of Transcultural Nursing. 2014; 25(4): 388-394.
12. World Health Organization. Global strategic directions for strengthening nursing and midwifery 2016-2020, 2016. Web site. Retrieved 06.01.2018. Available: http://www.who.int/.
13. Nardi DA, Gyurko CC. The global nursing faculty shortage: Status and solutions for change. Journal of Nursing Scholarship. 2013; 45(3): 317-326.
14. Visovsky C, McGhee S, Jordan E, Dominic S. et al. Planning and executing a global health experience for undergraduate nursing students: a comprehensive guide to creating global citizens. Nurse education today. 2016; 40: 29-32.
15. Sverdlik B. Who will be our nursing leaders in the future? The role of succession planning. Journal of Nursing Administration. 2012; 42(7/8): 383-385.
16. Wallis L. The Global Advisory Panel on the Future of Nursing. AJN The American Journal of Nursing. 2016; 116 (4): 18-19.
17. Goldsberry JW. Advanced practice nurses leading the way: Interprofessional collaboration. Nurse Education Today. 2018; 65: 1-3.
18. Douglas M. Opportunities and challenges facing the future global nursing and midwifery workforce. Journal of nursing management. 2011; 19 (6): 695-699.
19. Kraft M, Kastel A, Eriksson H, Hedman AMR. Global Nursing - a literature review in the field of education and practice. Nursing open. 2017; 4(3): 122-133.
20. International Council of Nurses. The Global Nursing Review Initiative, 2010. Web site. Retrieved 06.01.2018. Available: http://www.icn.ch/.
