Over the last decade, the nursing profession in the U.S. has been evolving at unprecedented rates, and the healthcare industry is experiencing unique challenges, and the nurse practitioners working on the front-lines of patient-centered care will take the mantle in achieving the purpose of healthcare (Murray, 2019) . Over the last 15 years, the age, education, and the size of the nursing workforce have considerably changed (Murray, 2019) . There has been a steady rise in the number of RNs (registered nurses) with a bachelor's degree surpassed with an associate degree in 2011. The number of RNs older than 50 years increased by 600,000 in the year 2000, and they currently account for more than 40 percent of RNS working in both hospital and non-hospital settings (Murray, 2019) . In addition to these changes, the beginning of the new millennium resulted in a shortage of more than 100,000 nurses that persisted until 2003, the recession of 2001/2008, and the growth and spread of value-based care (Hassmiller, 2019) . The nursing profession is facing four main challenges, and the include the aging baby boomer generation, the retirement of registered nurses, increased physician shortages, and a new era of health care reforms and implementation in the U.S (Hassmiller, 2019) . The educational training of RNs that is being advocated for by the Institute of Medicine (IOM) in increasing the nursing workforce establishes the underpinnings that can keep up with the nursing profession as it experiences new and unprecedented challenges that America will face in the next 30 years.
In the last decade, there has been a growing recognition that the healthcare delivery system in the United States is responsible for keeping Americans healthy and safe (Hassmiller, 2019) . However, interventions that lie outside that the healthcare system are yet to be recognized in ways that are more than likely to affect the health and well-being of individuals other than the care that is rendered within healthcare institutions (Hassmiller, 2019) . Disparities such as the burden of illness and premature deaths primarily affect destitute populations, and these differences are contained in the environmental conditions and contexts that people reside in. Many, at times, are shaped by economic and political forces, the distribution of wealth, and cultural norms (Hassmiller, 2019) . Despite the historical underpinnings, nursing programs are yet to be developed founded on community-based interventions and experiences that integrate the social determinants of health into the educational programs at the graduate and undergraduate levels.
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The IOM advocates for nursing knowledge that will "prepare them to administer patient-centered, safe, impartial and high-quality healthcare services, the collaboration between clinicians and other healthcare professionals in ensuring the delivery of effective and professional care as well as assume leadership roles that will redesign healthcare systems (Smith, 2019) ." Thus, the recommendations by the IOM are a reflection on the ability of RNs to help eliminate the disparities between coverage and access, the coordination of increasingly multifaceted care, and to realize the value of their contributions across healthcare settings. These recommendations intersect between the demands of disparate populations across different lifespans and the remedies to be taken by the nursing workforce (Smith, 2019) . This necessitates the U.S. to work on educating the nursing workforce so that they can tend to the complex requirements of health care and create a patient-centered system.
In nursing, professional organizations and associations play an integral responsibility in the generation of energy, ideas, and active work that promotes the needs of both patients and nurses (Catallo et al., 2014) . Since its inception, the nursing profession has been built on advocacy. Nurses are responsible for advocating for the needs of the patients and the profession. Nursing organizations and associations provide essential information on the nursing profession, where it is at, and changes that may occur in the future in addition to opportunities and educational resources (Catallo et al., 2014) . The National League of Nursing was the first professional organization to formed in 1893 in the United States (Catallo et al., 2014) . The other organization was formed in 1896 and was known as the Associated Alumnae of Trained Nurses of the United States and Canada that was later renamed to The American Nurses Association. These historic nursing organizations were later joined by more than 200 professional nursing associations that advocated for the "voice of nursing" clinical, political, educational, and regulatory matters. (Catallo et al., 2014)
The three most influencing professional nursing organizations include the American Nurses Association (ANA) that advocates for the welfare of nurses in the workplace, influencing the American government for changes in nursing and health issues (Catallo et al., 2014) . The Royal College of Nursing (RCN) headquartered in the United Kingdom that seeks to improve the quality of patient outcomes by lobbying the government and The American Board of Nursing Specialties (ABNS) that seeks to promote the lifelong career development and learning of nurses as a way of enhancing improved patient and healthcare outcomes (Catallo et al., 2014) . ANA is the professional nursing organization I would most likely want to join through membership from the nursing associations in my state. My healthcare philosophy is centered on the ability of an individual to heal themselves (Smith, 2019) . The philosophy works on the premise that the nursing profession should empower and encourage people to be responsible for their health. The ANA supports this vision through its efforts in promoting access to healthcare for diverse groups, suitable compensation for healthcare services, and appropriate staffing ratios. Through its other programs such as the Healthy Nurse and the Healthy Nation, the ANA supports this philosophy by advocating for healthy habits such as managing stress, getting enough sleep, regular exercise, and getting screenings for nurses (Smith, 2019) .
According to a study led by the American Association of Pediatrics, there is an acute shortage of home care nurses in the U.S. that has prolonged the stay of children in hospitals ( Foster et al., 2019) . Pediatric home care health services are understaffed, and hence they are unable to fulfill the healthcare needs of both patients and families ( Foster et al., 2019) . Advancements in healthcare have made it possible for children to survive medical conditions that were deemed unresponsive to treatment decades ago. Due to medical advancements, hospitals have been able to manage previously fatal conditions that are yet to be matched with the community- and home-based medical care that has left parents struggling to administer intricate medical care for their children at home (Simpser & Hudak, 2017) . The prevailing challenge that pediatric home health care is experiencing is the lack of an adequately trained and compensated workforce that can satisfy the needs of families and their children. Not only does the shortage of pediatric home care nurses does affect not only pediatric patients' health but also causes emotional, financial, and social hardships for families (Millefoglie, 2015) . Although home-based care is often associated with the elderly, technological advancements and techniques have made it possible for children with medically complex conditions to stay at home and be part of the community.
Children with chronic illnesses represent less than five percent of the total pediatric population, but their care exceeds the numbers of other pediatric patients (Millefoglie, 2015) . The lack of sufficient home care nurses to meet the current demand is negatively impacting patients and their nurses. This presents an opportunity for advanced nurses with their educational background that is focused on healthcare education and promotion to reduce this disparity with cost-effective care. The incorporation of advanced nurse practitioners at each stage in the care of children can improve their quality of life and that of their families, decrease costs associated with care, and increase family satisfaction.
References
Catallo, C., Spalding, K., & Haghiri-Vijeh, R. (2014). Nursing Professional Organizations. SAGE Open , 4 (4), 215824401456053. https://doi.org/10.1177/2158244014560534
Foster, C., Agrawal, R., & Davis, M. (2019). Home Health Care for Children with Medical Complexity: Workforce Gaps, Policy, And Future Directions. Health Affairs , 38 (6), 987-993. https://doi.org/10.1377/hlthaff.2018.05531
Hassmiller, S. (2019). A New Future of Nursing Report. AJN, American Journal of Nursing , 119 (7), 7. https://doi.org/10.1097/01.naj.0000569348.73400.fe
Millefoglie, M. (2015). A Day in the Life of a Pediatric Home Care Nurse. Home Healthcare Now , 33 (3), 173-174. https://doi.org/10.1097/nhh.0000000000000207
Murray, T. (2019). The Future of Nursing 2020–2030: Educating the Workforce. Journal of Nursing Education , 58 (9), 499-500. https://doi.org/10.3928/01484834-20190819-01
Simpser, E., & Hudak, M. (2017). Financing of Pediatric Home Health Care. Pediatrics , 139 (3), e20164202. https://doi.org/10.1542/peds.2016-4202
Smith, K. (2019). Facing history for the future of nursing. Journal of Clinical Nursing , 29 (9-10), 1429-1431. https://doi.org/10.1111/jocn.15065
