Presentation
The role of nursing has shifted significantly in the last decades, enabling nurses to become critical and leading professionals in the community and healthcare systems. There is an increasing need for highly trained and well-educated nurses with critical thinking skills. They must be able to manage complex health issues in a modern day and provide quality in service delivery using the latest technology and methods to provide treatment. In turn, the future trend of nursing is to provide treatment outside acute care environments as technology becomes more mobile and capable of fulfilling required functions in the community (Johnson, 2015). The move of healthcare into the community transforms how nurses can use their specialized skills. A primary trend is a preventive care which encourages healthier lifestyles and maintaining of health that can be done without presence in an acute healthcare setting. Communication technologies allow collaboration amongst health professionals to create a care delivery team with various specializations (Evans-Agnew, Reyes, Primomo, Meyer, & Matlock-Hightower, 2016).
Statistics indicate that 23% of new nurses are more often finding jobs in non-acute healthcare environments such as nursing homes, home care, and ambulatory care (Hussung, 2016). It is a trend which continues to grow due to policy such as the Affordable Care Act that has increased access to healthcare in the nation. This has led to an evolution of patient interactions due to the increasing age of the general population and better consumer education. The expanding and versatile roles of the nursing profession require more in-depth and continued education. Often, a basic RN degree is unable to prepare a nurse for all the challenges, and a well-educated workforce is essential to address the demands of the healthcare system. Policymakers and national organizations are actively pushing for continued education as nurses engage in learning while continuing to practice (Jeffries, 2015).
As nurses achieve higher levels of education, there will be more leaders and effective managers able to produce high quality of care and maintain oversight over healthcare facilities. The future models of healthcare systems focusing on home health and community-based care provide opportunities for nurses to expand their traditional roles. A recent rise in facilities such as accountable care organizations, medical homes, and nurse-managed health clinics require structure and care coordination that is managed by nursing staff. Care coordination (also known as the continuum of care) is the organization of patient activities between various participants (specialists) and seeks to guide and track their progress so that appropriate health services are delivered (Aronson, Bautista, & Covinsky, 2015).
Although the continuum of care is currently being practiced at the primary care level, expanding it to home and community-based care brings with it additional tasks and unique perspectives. In the future, it will be important to implement transitional care where the setting and treatment of the patient will change depending on their condition. However, the focus is to shift away from acute care settings into community-based environments where the nursing staff can provide a more holistic approach. Furthermore, home care allows nurses to better connect with patients, being aware of unique issues, social support, and home environments that may serve as healthcare factors (Essey, 2011). These aspects are critical to the change management, patient interaction, and quality of care that will occur as the nursing role in healthcare begins to shift.
Opinions
Licensed Practical Nurse
The interviewee is a licensed practical nurse, who is studying to become a registered nurse. After being presented with the research, she agrees that the nursing practice is rapidly evolving to become critical support for the United States health system. She mentions that the transformation that the nursing profession has undergone, even in the last 20 years, is what motivated her to enter the field. Nurses can diagnose patients, prescribe medications, engage in research, and manage whole departments and clinics.
The burden of disease has changed as more people are suffering from a variety of conditions, particularly preventable ones. Different populations require various needs that a traditional healthcare setting cannot always provide. She views home and community-based medicine as the way forward as patients will be more comfortable in these environments. This is likely to increase instances of a nurse-patient connection and improve outcomes. However, it is a long and complex process which will require difficult conversations to be had. It is likely that policies and standards will change and become more difficult to attain since the home and community-based care carries various risks as well.
Nurse Manager
The interviewee is a nurse manager at an emergency department of the major metropolitan hospital. She believes that the future of nursing lies in competent education. She notes that many nurses come into the job significantly underprepared for the tasks and pressure. It is critical for nurses to improve education and training in order to achieve the full potential of their practice and talents. The complex nursing roles and responsibilities which will only continue to expand require competencies at the higher level from every nursing position. The best solution to this issue would be to reform the education system that promotes progression and practical applications.
The nurse manager indicated that the shift to home care is more an ideological aspect than practical. Although recent healthcare policies have made it easier to form ACO’s and other medical facilities, many organizations do not have the necessary infrastructure or systems in place to conduct telehealth or home-based care. Community health is limited to public interventions and walk-in clinics. The home healthcare agency system will require significant structural reform to create patient-centric medical homes and other types of medical facilities.
Nurses in their current capacity are unlikely to succeed in home healthcare in a manner that is done currently. It requires specialized training and education that will increase a nurse’s ability to perform high-level assessments and highly skilled interventions in addition to improved communication and care coordination. Home healthcare is definitely the future of nursing but requires significant research, input, and development before being implemented. The benefits of home healthcare are the ability to maintain a firsthand perspective and have “feet on the ground”. It will be able to address the complexities of treatment and a patient-centered approach that are impossible in primary care settings.
Nurse Practitioner
The interviewee was a registered nurse practitioner with four years of experience, working in a pediatric unit of a local hospital. She had mixed reactions after reading the presentations. Although she remains optimistic about nursing expanding its roles and becoming a leading profession to provide healthcare, she believes the realities are significantly different. Despite nursing education and public policy promoting nurses as leaders, innovators, and managers, in reality, most nurses remain as the ones doing the busy work. Nurses engage with patients but have limited time and opportunity to engage in patient-centered care. There are significant pressure and overload on nurses, causing burnout and apathy. Furthermore, many decisions about policies and practice guidelines are made without consultation with the nursing staff, despite the widespread belief that nurses are included in the conversation.
The nurse practitioner sees the possibility of home care and other non-acute facilities and standards mentioned in the research. Many patients have expressed a desire for the wider availability of such treatment options, particularly for pediatric and geriatric care in order to avoid the risks associated with acute healthcare environments. It was also expressed that most likely the standards of care and competencies will continue to improve and increase as demanded by social, legal, and lifestyle norms. The complexity of healthcare delivery will only improve if nurses are provided with greater opportunities for training and development with up-to-date technology and methods. Overall, education should begin to shift away from theoretical perspectives towards practical applications which would promote continuity of care and expand the horizons of nursing.
Comparison
The findings from the interviews were mostly consistent with the conducted research on the evolution of nursing practice. All the nurses seem to believe that home and community-based care is the future of nursing. However, it will require a restructuring of the existing standards and systems of care. Furthermore, the task and responsibilities placed upon nurses in such scenarios would increase, requiring better training, education, and skill to ensure competency. As the system shifts away from traditional approaches to patient treatment, it will be focused on transitional and continuum of care to provide for the needs and demands of the population.
References
Aronson, L., Bautista, C. A., & Covinsky, K. (2015). Medicare and care coordination. JAMA, 313(8), 797-798. Web.
Essey, M. (2011). ACOs, medical homes, and home health: A collaborative model. Web.
Evans-Agnew, R., Reyes, D., Primomo, J., Meyer, K., & Matlock-Hightower, C. (2016). Community health needs assessments: Expanding the boundaries of nursing education in population health. Public Health Nursing, 34(1), 69-77. Web.
Hussung, T. (2016). The future of nursing: How changes in the healthcare industry affect clinical practice. Web.
Jeffries, P. R. (2015). The evolving health care system: The need for nursing education reform. Journal of Professional Nursing, 31(6), 441-443. Web.
Johnson, S. (2015). How has nursing changed and what does the future hold? The Guardian. Web.