Introduction
The current healthcare provision encounters a high uncertainty in terms of delivering healthcare and due to the rapidly evolving field of health. The changes in the health field have resulted in different changes in the professionals in the healthcare industry, including nurses. The nursing profession, which is one of the essential health professions, has been experiencing changes in the past two decades. The changes have had a significant impact on both the performance of the nurses and the number of applicants enrolling for nursing training. This paper provides a comprehensive analysis of the nursing profession. The paper covers significant changes encountered in the nursing profession in the current healthcare industry, including the development of physician-nurses, emerging nursing identity, and the driving forces for changes such as uncertainties, risks, technology, and working conditions.
Changes in the Nursing Profession
The current nursing profession is experiencing changes in care delivery, the expectation of patients increasing, the advancement in technologies, and the roles of nurses as healthcare professionals growing and evolving to include more responsibilities. The trends require nursing professionals to adjust to the latest aspects in the healthcare field, including knowledge, skills, and attitudes to effectively carry out their mandate to the patients. This section evaluates different changes that nursing professionals are experiencing in terms of healthcare delivery, roles, opportunities, including education, technology, and practice.
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Care Delivery
Changes in nursing care delivery are marked by a unique breed of nurses that has emerged in the United States market. The new breed is the physician-nurses who are a physician that undergo retraining as nurses. The new identity being acquired by nurses comprises of a set of physical, mental, behavioral, and personal traits that make the nurses unique in terms of care delivery than before. The physician-nurses in the US comprise a large number of foreigners since they migrate to the United States as physicians but forced to integrate into the nursing sector to explore opportunities that continue to grow (Reyes, 2019). The increasing job opportunities in healthcare has played a significant role in influencing the care delivery role of nurses. For instance, facilities such as ambulatory surgery centers and retail clinics have expanded their care to include serving patients outside their hospital settings, thus creating more job opportunities for nurses. Nursing integration into the community offers physician-nurses the chance to explore both their physician and nursing skills provided in-home care and nursing homes. Another trend in care delivery that is changing the nursing profession is preventive care (Rosa, Upvall, Beck, & Dossey, 2019). Preventive care is currently on the rise with medical communities and health insurance providers pushing for a healthier lifestyle among people to prevent an increase in health issues. Preventive care, which mostly involves healthcare professionals such as nutritionists, psychologists, and physical therapists, now requires nurses to enhance "well care" demand. The coordination of nurses and other healthcare professionals offers nurses the opportunity to make decisions in different aspects regarding patient's healthcare.
Roles
The current roles of the nursing profession are changing based on the healthcare reforms and the demands for a quality, safe, accessible, patient-centered, and a healthcare system that is affordable. For the outcomes to be delivered, nursing roles have been integrated to accommodate skills for wellness, patient-centered care, care coordination, skills for analyzing data, and skills to provide quality improvement.
The wellness-focused care unit approach being utilized in nursing practice today means that the nurses have to shift their roles to prioritize wellness and prevention. Nurses conduct the evaluation role in wellness through different forms of programs such as educational, environmental, and social care programs. Performing the wellness role requires professional nurses to think about the patients beyond their current conditions to make a decision on what should be done to improve or ensure the wellness of the patient. For nurses to make effective decisions about patient wellness, they should possess the critical and creative aspects essential for decision making (Salmond & Echevarria, 2017). Another factor that influences the changes in nursing roles is the patient-and family-centered care as part of the current transformed healthcare system. Instead of provider-centric care, the current healthcare system uses patient-and family-centered care, which applies self-management responsibility for patients and families. However, self-management responsibility is conducted through a partnership with health providers, patient, and their families to ensure the decision made are best in achieving patient wellness. Nurses are one of the major parties in the patient-and family-centered care due to their ability to provide care that is holistic, inclusive of the patient, family, and communities and respecting patient's needs and preferences.
Another role that the current healthcare system offers played by nurses is care coordination through an integrated care continuum. The health system uses the care continuum as a strategy to achieve better quality, services, and lower cost per unit of service. The integrated care continuum also involves managing and delivering health services to patients based on their needs and across different levels of the health system. The care continuum holds all health services that one requires from birth to death. For the care continuum to be effective, the care coordination role should be conducted efficiently through communication and mobilization of resources and people. In the current healthcare system, the nursing profession has proved to provide skills required in the care coordination of the care continuum (Salmond & Echevarria, 2017). Nursing offers skills that help in promoting self-management among patients, enhancing patient-and family-centered communication, and foster communication among health providers. Nurses' unique skills have placed them in the best position to lead, manage, and participate in the care coordination roles.
Today healthcare provision depends on data for decision making. Data provides the more detailed information required to understand particular health issues within a population or the patient is facing. Data collection has forced nurses to play a role in data gathering and tracking clinical and financial information across the health organization. The role of data analytics conducted by nurses focuses on the patients' outcome and improvement through tracking key metrics such as treatments, functionality, health status, and quality of life.
Opportunities
Opportunities as a factor of change in the nursing profession include advanced education, technology, and practicing nursing. The new trends in the healthcare system are considered the main reason for the development of the nursing education system, which has allowed many nurses to continue their education. The advancement in nurse training is also occurring through the integration of other courses into nursing. The evolving healthcare system requires nurses to conduct additional functions, which means adding more education programs. Education programs that are being integrated n the nursing profession include management, information technology, statistics, and environmental-related applications. The current nursing education structure also allows individuals who have studied other medical, educational programs to retrain as nurses, which has led to a new breed of physician-nurses mostly experienced in the US.
According to the Bureau of Labor Statistics reports, improving the nursing educational programs would be able to attract more individuals to study nursing at high levels, which will feel more than 525,000 nursing vacancies available (Hussung, 2016). The current nursing education programs also offer students with experience in practical skills required to deliver patient-centered care through systems-based practice. The Bureau of Labor Statistics also projects an increase of 283,100 registered nurses employed by the year 2026 if the apprenticeships are achieved (What Nurse Leaders Need to Know, 2019). Apprenticeships in nursing education involve the facilitation of experimental learning programs. In the United States, the department of Labor availed $150 million in 2018 to fund the expansion and development of apprenticeships programs across the nation, which also played a significant role in improving the nursing education system.
Technology is another opportunity that has resulted in changes in the nursing profession. Current and expected technologies to emerge in the future have shaped how nursing education is being provided. Some of the emerging technologies in the practice of nursing include genetics and genomics, 3-D printing, less invasive and more accurate tools for diagnostics and treatment, biometrics, electronic healthcare records (HER), robotics, and computerized physician/provider order; entry (CPOE) and clinical decision support (Huston, 2013). Nurses are required to obtain skill sets that will enhance their ability to work with different technological tools to respond to emerging technologies in their working environment. Nursing skills will include the ability to use technology in facilitating communication, mobility, and relationships through tools like email, video conferencing, 3-dimensional printing, social media networking, and virtual realities (Huston, 2013). Another nursing skill set will comprise of expertise in knowledge information, distribution, and acquisition such as information literacy, clinical decision support, commercially purchased expert networks, and knowledge engineering. The nurse will also have to understand and use genomics, including sequencing, service delivery models, ethical issues, and effective utilization of genetic/genomic data.
Practicing nursing in the current healthcare industry has shifted with more flexibility being applied. The flexibility, especially concerning licensing, has increased the ability of nurses to freely operate in the nation. The complete registration process allows a nurse to obtain a license card that can be used in different states. The license, also known as a multistate license, can be applied when a nurse moves to a new state as a residence, or when changing their primary state. With multistate permission, one is able to move from states to practice nursing while maintaining legal purposes such as state taxation (What Nurse Leaders Need to Know, 2019).
Driving factors for change
Healthcare transformation is a result of driving factors that have impacted the health sector of the United States in terms of operation and performance. The driving factors for change extend to the nursing profession and nursing practice. Cost is one of the driving factors for change in the healthcare system. The cost of care is continuing to increase due to the use of sophisticated medical technology, high charges associated with treatment procedures, and high consumption of drugs. Waste is another contribution to the high cost of care in the United States, with an estimated loss of $750 billion yearly due to poor care delivery, unnecessary services, high costs of administrative, fraud, inflated prices, and prevention failure. The high costs also have an impact on the quality of nurses in care delivery. In the health settings that provide quality infrastructure, clinical information systems, and provider decision-support tools, among other technologies that can support nurses to improve care quality would result in high care prices. However, to ensure care prices are reasonable and still, quality care is achieved, changes such as the use of physician-nurses who have the ability to cover many roles than average nurses are encouraged. Physician-nurses will conduct the nursing role with less support, which will lower the cost associated with care provision, thus reducing the care costs.
The social demographic change includes the high growth rate of people of color in the United States, which calls for changes in terms of healthcare delivery for racial, ethnic minorities. Another social demographic change is the graying of America. In the United States, 14.1% (44.7 million) of its population is over 65 years, with the number set to double to up to 98 million by 2060. The shift has a significant impact on the roles and care delivery associated with nursing. Nurses will be required to work in elderly homes, which are set to increase, participate more in patient-and family-centered care, and work closely with many aging individuals to maintain their wellness.
Another noted change is the diseases-type demographics such as the rise of related chronic diseases including stroke, obesity, heart disease, cancer, type 2 diabetes, and arthritis. Chronic associated disorders as the leading cause of death and disability in the United States, with an estimate of 133 million individuals having been affected. Considering that most chronic diseases are the most common preventable of all health problems, human wellness-focused care is regarded as one of the primary approaches to tackle the diseases (Makridakis, et al. 2019). Therefore, for the healthcare system to manage to prevent chronic diseases, nurses must be included, which means the roles of nurses shift and expands to fit in the healthcare system capable of providing wellness-focused care and educate citizens about a healthy lifestyle.
Conclusion
The nursing profession continues to gain strength among the careers that have a significant impact on the running of the healthcare system. The changes noted in the health system contribute to changes in the nursing profession. Significant changes provided in the paper include changing and expanding roles of nurses in the healthcare system, types of care delivery, technological development, education programs, and the new breed of physician-nurses emerging in the United States. The paper also provides driving factors for change, which comprises costs and demographics, which have an impact on health in different ways forcing changes that include nurses as part of the solutions. Therefore, the nursing profession is bound to experience more changes in the future and more job opportunities for nurses that would be able to take more roles such as the physician-nurses.
References
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Makridakis, S., Kirkham, R., Wakefield, A., Papadaki, M., Kirkham, J., & Long, L. (2019). Forecasting, uncertainty and risk; perspectives on clinical decision-making in preventive and curative medicine. International Journal of Forecasting , 35(2), 659–666. https://doi-org.ezproxy.umuc.edu/10.1016/j.ijforecast.2017.11.003
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Salmond, S. W., & Echevarria, M. (2017). Healthcare Transformation and Changing Roles for Nursing. Orthopedic nursing , 36(1), 12–25. https://doi.org/10.1097/NOR.0000000000000308
What Nurse Leaders Need to Know. (2019). Missouri State Board of Nursing Newsletter , 21(2), 7. Retrieved from https://search-ebscohost-com.ezproxy.umuc.edu/login.aspx?direct=true&db=ccm&AN=136533563&site=eds-live&scope=site
