Summary: Changes In Nursing Practice

A study was done at a 1,300 bed urban facility over a 13-week period. The purpose of the study was to describe the causes of inpatient falls in hospitals (Hitcho, et al., 2004). All falls were reported except falls in the psychiatry service and during physical therapy sessions. During the 13-week period, a total of 183 patients at an average age of 63.4 years old fell. Of the total number of falls 79% were unassisted, 85% happened in the patient room, 59% occurred during the evening or overnight shift, 19% were while walking, and 50% were elimination related (p. 732). In this study it was identified that many patients did not use their call bell before getting up because they did not believe they needed assistance. It was stated that, “perhaps patients need to be better educated on the effects that a new environment, decreased activity, medications, tests, and treatments can have on patients’ energy and ability to ambulate safely” (p. 737). The findings of this study showed that falls not only happen in the elderly, but in the younger population as well. Patients that fall in hospitals are often unaided and are due to elimination needs. To prevent falls and decrease injury rates, more studies need to be done.

Multiple studies have linked professionalism with high amounts of education (Blaney 1986, Jacobs and Bishop 1998, Hess 1996). Other professions such as lawyers, physicians, architects, etc. maintain a high-standardized level of education in which nursing fails to do so. The American Nurse Association (ANA) committee published a position paper that compared nursing to other professions and recommended that the ADN is not sufficient for this profession (Jacobs and Bishop 1998). Jacobs and Bishop (1998) made a point by stating that “the education of professional nurses must take place in institutions of higher learning with a bachelor of science in nursing degree required for beginning professional practice as they should be socialized with philosophic and value system that is compatible with this role” (p. 226). Nursing is an evolving profession where they must be able to utilize their critical thinking skills in order to “assess, diagnose, intervene, evaluate, be a leader, deliver evidence-based care and know how to research and interpret that evidence. These competencies are only achievable through higher education with the baccalaureate level being the launching point” (Tollick, 2013, p. 4).

Healthcare systems and the way safe, quality health care is delivered are continually changing to better serve patients and communities. Professional nursing practice is a large component in the healthcare system today. Back in the 1960s, professional nursing leaders tried to adopt the bachelor degree programs as the only educational track to become a registered nurse (Creasia & Friberg, 2011). Due to nursing shortages and demands this motive did not hold fast. Individuals entering the nursing profession today must first decide which educational pathway to take to become a Registered Nurse (RN).

Transitioning from nursing school to working in a hospital setting can be a challenging time for a new graduate. Due to the nursing shortage, new graduate nurses are being hired with little to no experience. This is overwhelming for new nurses, especially when they are not getting adequate support or training from the hospital. The amount of stress, pressure, and lack of training is leading to a high turnover rate for new graduate nurses. With patient acuity on the rise, new graduate nurses that are filling these vacancies in the hospitals, need to be competent nurses to provide proper and safe care to the patients.

With an ever-increasing body of knowledge in the field of nursing, more education is being required to enter the field of nursing. Many healthcare institutions are raising the educational requirements in order to become employed or maintain employment in their facilities. Healthcare organizations are transitioning to hiring registered nurses (RN) who have a higher level of education, such as, a graduate from a Baccalaureate Degree Nursing (BSN) program. The goal of these institutions is to have nurses with a broader array of skills that can meet the growing demands of our patient population. BSN prepared nurses are recognized for their well-rounded skills in critical thinking, management, case management and health promotion versus Associate Degree nurses (ADN)/Diploma nurses that focus on direct patient care.

1. The Shortage: In the early years of 2000 the true nursing shortage had begun. With

The national shortage of Registered Nurses (RNs) has helped generate formidable interest in the nursing profession among people entering the workforce and those pursuing a career change. According to a report issued by the U.S. Department of Health and Human Service in 2002, the national population is continuing to grow and age and medical services continue to advance, so the need for nurses will continue to increase. They report from 2000 to 2020 the predicted shortage of nurses is expected to grow to 29 percent, compared to a 6 percent shortage in 2000. With the projected supply, demand, and shortage of registered nurses and nursing salaries ever-increasing, the nursing profession can offer countless opportunities. But first one must

For years now it has been well know and documented that there is a brutal disconnect between what school prepares NGRN for and the reality they find once they begin working.(Duchscher, 2009) This stark difference found between school and reality sets new graduates (NG) up for a hard fall and the disillusionment they are under when entering the professional practice can lead them to exit nursing altogether.(Duchscher, 2009) The problem then of course becomes recruitment and retention, and the cost of training new nurses back in 2007 was recorded to be as much as 82,000 to 88,000 each.(Ulrich et al., 2010)

In 2010, the Patient Protection and Affordable Care Act, or PPACA gave many Americans the opportunity to have health care coverage that previously may have not been available to them. The reform is primarily aimed at decreasing the number of uninsured and underinsured Americans. The landscape of health care is changing and nursing is evolving alongside it. This health care overhaul gives nurses a vital role in leading the reform revolution. With more than three million strong, nursing is the biggest sector of the nation’s health care labor

214) “The ACA and the need for APRNs, nurse faculty, and nurse researchers would have increased dramatically under any scenario.” (L R Cronenwett [RWJF Iniative on the Future of Nursing], 2010, table 1). “Not only must schools of nursing build their capacity to prepare more students. Nursing need to focus on fundamental improvements in the delivery of nursing care to improve patient safety and quality is key.” (IOM, 2010, p. 208)

There needs to be more emphasis on community health, long-term care, and coordination of care. In addition, the curriculum should include more leadership, systems thinking, and quality improvement. The IOM also recommends having incentives for nurses who wish to achieve higher levels of education such as tuition reimbursement, expansion of grants and loans, and more scholarships. As the number of students is expected to increase, educational institutions need to hire and retain faculty by creating competitive salaries and benefits. The IOM suggests doubling doctoral level nurses by 2020 (Institute of Medicine, 2010). The committee further encourages life long learning in order for nurses to practice to their fullest potential. The emphasis of improving the education system will produce a highly educated, well-rounded workforce who is equipped to effectively meet the health care needs of Americans today.

“Throughout the last decade, policymakers and practice leaders have recognized that education makes a difference” (Impact of Education, n.d.). Hospitals are also trending towards preferred hiring of bachelors prepared nurses for their workforce. Even national organizations are jumping on the bandwagon requiring “all nurse managers and nurse leaders to hold a baccalaureate or graduate degree in nursing by 2013” (Impact of Education, n.d.), likewise the Institute of Medicine has also recommended that all hospitals have at least 80% of their nursing staff with a BSN or higher by the year 2020 (Impact of Education, n.d.).

Furthermore, licensing and accreditation standards must be heightened to insure the quality of the nurses that enter the workforce. Certifying organizations must therefore mandate the proper demonstration of core competencies and skills prior to endowing students with the nursing title. The nursing profession, according to the IOM report, must undergo fundamental changes within the overall education of nurses. In many respects the basic

There have been many changes (major and minor) in the nursing profession and the medical field, as a whole, over the years. Some of these changes include changing demographics and increasing diversity, technological explosion, the cost of health care, and significant advances in nursing science and research. Major socioeconomic changes created this drive to make transformations in nursing and institutions. These institutions are the ones that are responsible for educating the next generation of nurses, such as West Coast University.

There is no doubt that the health care system is constantly changing and working to improve its flaws, to the best of its ability. Whether nurses like it or not we are a part of the ever changing health care system. “With more than 3 million members, the nursing profession is the largest segment of the nation’s health care workforce” (Institute of Medicine [IOM], 2010, p. 1). The Institute of Medicine believes that nurses should be active in transforming the profession of nursing, along with the health care system. Regardless, of backgrounds, race, and age all nurses can contribute to the future of the nursing profession. The following paper will discuss the Institute of Medicine’s nursing expectations and recommendations, as well as the opportunity to becoming a clinical nurse instructor.