Comments on: The Four Forces That Will Reshape Nursing

By: Kathryn Wilson

Kathryn Wilson — Fri, 30 Sep 2016 02:22:00 +0000

Indeed, there is an existing nursing shortage in the US that is forecasted to worsen in the years to come. In addition to the points made above, Johnson and Johnson states that the percentage of nurses in the workforce under the age of forty has been declining; approximately half what the percentage was in 1980. The company also predicts that by 2018, registered nurses are expected to account for 3.2 million jobs in the US and that “by 2020 the US will face a shortage of 800,000 nurses”, a far higher number than years past. (Nursing Now, n.d.). Coupled with the prospect of having an increase of need for nurses, especially among the retiring population, this disparity is especially concerning.

That being said, there is a widespread motivation to close this gap. One method is by encouraging the education of more nurses. Johnson and Johnson currently have a Campaign for Nursing’s Future, which promotes nursing as a profession, provides facts regarding the issues at hand, and helps in directing students and others toward pursuing the career. The campaign’s goal is to increase the number of nurses entering the workforce.

States are also taking legislative initiatives in order to address the shortage. One barrier to bringing more nurses into the workforce is a shortage of nurse educators available to teach them. More and more states are allocating funds to support an increase in nursing school faculty, allowing them to enroll more students. Other states are focusing their efforts on recruitment of new students into nursing programs. If they have the capabilities to educate more students, a rise in recruitment rates should lead to more graduates. By making these changes their schools are able to increase student capacity and therefore aid in increasing nursing capacity. (AACN, 2006)

Another issue mentioned in this article is that as a high percentage of nurses retire, the average level of experience in the field will decline. Johnson and Johnson shares that a higher percentage of new nurses are graduating with a higher level of education. This means that entry level nurses in the years to come will be generally more academically qualified than those in the past. Ideally, this will help to ease the potential gap in quality of care.

With rising RN retirement rates and an increased need for qualified caregivers in the field, nursing is currently the fastest growing occupation in the US (Nursing Now, n.d.). In order to maintain and satisfy this demand, educating new nurses is imperative. Fortunately, the focus is present. The American Association of Colleges of Nursing (AACN) identifies multiple strategies to resolve the shortage including strategies to boost enrollment, accelerated nursing programs, grant-funded initiatives, and various campaigns. (AACN, n.d.). Provided we continue to move forward and produce well prepared and competent nurses, facing the challenges that nursing does will be possible.

American Association of Colleges of Nursing. (2006). Leading Initiatives: State Legislative Initiatives to Address the Nursing Shortage. Retrieved from http://www.aacn.nche.edu/aacn-publications/issue-bulletin/state-legislative

Nursing Now. (n.d.). In Johnson and Johnson; The Campaign for Nursing’s Future. Retrieved from https://www.discovernursing.com/nursing-now#fact-3.

American Association of Colleges of Nursing. (n.d.). In Media Relations: Strategies to Resolve the Shortage. Retrieved from http://www.aacn.nche.edu/media-relations/nursing-shortage-resources/strategies

By: Abigail Wall

Abigail Wall — Wed, 28 Sep 2016 20:10:00 +0000

The nursing shortage is one that many people, especially those involved in healthcare fields, are well aware of. Buerhaus acknowledges this shortage as being one of knowledge rather than bodies. While this may be a large part of it, I think that no matter how educated our new nurses are, it cannot compensate for the increasing percentage of our older population. When asked, “What competencies are most important for nurses going forward?”, during the QA-style interview with Hospital & Health Networks, Buerhaus stressed knowledge and preparation (Larson, 2016). These are great things to enforce. The movement of requiring nurses to receive a BSN is a great start. However, there is so much to say for clinical experience. Buerhaus acknowledges that “Experienced nurses are retiring, so we have more people, but less long-term experience” (Larson, 2016). Yet, he only briefly mentions one way of improving the lack experience aspect, which is to have hospitals and nursing schools develop better communication to ensure the correct skills are being taught. As a current nursing student, I think that he is missing the mark a little bit in his answers. Yes, knowledge will help tremendously in helping to better prepare the nursing staff. However, a student can be incredibly book smart and have no clinical skills. I do not think that improving communication between hospitals and schools is the answer to this. First of all, a student can practice something a million times in clinical, but it will still be an enormous transition to his/her first time job where more is expected of them and they do not have their clinical instructor to lean on. Therefore, I think two things need to be addressed here. Firstly, technology can be incredibly useful in cutting down on an individual’s workload and should be implemented when this is the case. I believe it will be a great tool to help manage the shortage of nurses in the future. Secondly, I feel that the clinical experience of the nursing student needs to be changed. From my experience, we go to clinical for 6-7 hours and are assigned one patient. As a level three in an accelerated program, I cannot understand why this is the case. Yes, we need clinical supervision, but this is a major flaw that prevents us from gaining more real-life clinical experience. In not setting will a nurse have one patient, and therefore in order to prepare for the nursing shortage, students need to be graduating with more real-life clinical skills in order to ease the transition.

References:

Larson, L. (2016, September 8). The 4 forces that will reshape nursing. Retrieved from Hospitals and Health Networks website: http://www.hhnmag.com/articles/7522-the-4-forces-that-will-reshape-nursing

Gold, J. (2016, September 20). The 4 Forces that Will Reshape Nursing. Retrieved September 28, 2016, from http://www.hhnmag.com/articles/7522-the-4-forces-that-will-reshape-nursing

By: Alexa Breslin

Alexa Breslin — Wed, 28 Sep 2016 01:03:00 +0000

According to health care economist and professor of nursing at Montana State University, Peter Buerhaus, PhD, RN, the U.S. is in the midst of a knowledge shortage, not a nursing shortage, when it comes to health care. Buerhaus attributes the knowledge shortage to the fact that one-third of the nursing workforce will be retiring over the next 10 years. Additionally, he attributes the knowledge shortage to the retirement of 70 million baby boomers, the health care reform, and a physician shortage (Larson 2016).

Moreover, in regards to the believed nursing shortage the U.S. is in, Buerhaus doesn’t necessarily see this as true, except for states like California and Colorado where nurses are retiring sooner than expected (Larson 2016). Because so many experienced nurses are retiring, more unexperienced nurses are being hired to fill the gap.

Buerhaus sees a resolution to the knowledge shortage that starts in nursing school. “The nursing profession needs to make sure that the nurses coming out of school are savvy about health care reform and understand value-based care. Without knowledge, I worry that the workforce will not be as prepared as it needs to be,” Buerhaus said in a QA-style interview with Hospital & Health Networks (Larson 2016).

In my opinion, there should not be a knowledge shortage when it comes to nursing. Every RN should be equipped with the necessary knowledge that is pertinent to the job. Ensuring that all graduating nurses are equipped with this knowledge comes two-fold. First, nursing schools need to ensure that the appropriate curriculum being offered. Second, the NCLEX examination needs to test students on their critical thinking skills.

I think the problem lies in the fact that some students are able to simply memorize content and then test well on that content. However, the NCLEX is now formatted to test prospective RNs on how to apply critical thinking skills using the curriculum they learned in nursing school, rather than answering questions about specific content learned. I believe that this approach should have an impact on what Buerhaus refers to as the knowledge shortage, and I look forward to helping to fill the knowledge shortage gap when I graduate from nursing school in 2017.

With that being said, no amount of content learned in school can replace the invaluable resource that is experienced nurses. We need experienced nurses to pass on their knowledge to those below them, and so on, and so forth. This is critical when it comes to knowledge.

As a student nurse, I have experienced several different types of nurses during clinicals. Some of the nurses I have shadowed immediately took me under their wings, quizzing me along the way, and taking time out of their incessantly busy days to show me an extra thing or two. Yes, this probably meant that they would have to stay a little later than normal to catch up on charting or one of the several hundred other tasks nurses do during the day, but they understand the importance of teaching the new crop of nurses everything they know.

I’ve also shadowed another type of nurse. This type of nurse was immediately annoyed by my presence alone. This nurse ignored me when I introduced myself and volunteered any sort of help or service I could provide. This nurse had no interest whatsoever in showing me the ropes of nursing. This nurse did not help me in my nursing career.

In conclusion, I feel very, very, very strongly about hands-on experience and what it lends to nursing students. I believe it is up to the current experienced nurses to prepare future nurses for their careers. No one knows the field, or floor, better than an experienced nurse.

Larson, L. (2016, September 8). The 4 Forces that Will Reshape Nursing. Retrieved September
25, 2016, from http://www.hhnmag.com/articles/7522-the-4-forces-that-will-reshape-nursing

By: Jessica Stambelu

Jessica Stambelu — Wed, 28 Sep 2016 00:33:00 +0000

The first sentence of this article really captured my attention by acknowledging that “America has a knowledge shortage, not a nursing shortage”. For years we have been told there is a nursing shortage and it is just going to get worse over the next ten to fifteen years. Baby boomers are retiring and getting older. With age, comes more chronic conditions that will need to be taken care of. “Experienced nurses are retiring, so we have more people, but less long-term experience” (Buerhaus). Many of the retiring nurses have been nurses for 20-30 years at least. These nurses have experience that no new nursing graduate will ever be able to have and this poses a serious problem for the American health care system.
The new health care reform has allowed and will continue to allow more and more people to need doctors and nurses to care for them. An overwhelming amount of people will seek care and not enough health care providers will be able to care for them. “The Affordable Care Act breaks the promises of access and quality of care for all Americans by escalating the shortage and increasing the burden and stress on the already fragile system” (Anderson). Therefore, yes the ACA will increase coverage for millions of individuals but it will also reduce the quality of health care tremendously. When there are too many patients cared for by one nurse, the nurse can not possibly care to her full potential. Soon the seasoned nurses with years of experience will retire and brand new nurses will have to fill some pretty big shoes. These nurses will be fresh out of a associate/BSN program with little clinical experience, making caring for multiple patients pretty difficult. While I agree with Buerhaus when he states that nursing graduates need to get the knowledge up to speed with upcoming retirement of 1 million nurses over the next decade, I think this may be very difficult to do. We are frequently told in nursing school how important clinical skills and patient advocacy and care are. I feel that even with all of the knowledge of learning how to become a great nurse, the nursing graduates will lack the experience. The nursing and health care provider knowledge shortage will effect patient care more than anything else.
In addition, I agree with the importance of nurse practitioners. “Nurse practitioners are 10 to 30 percent less expensive to employ than physicians” (Buerhaus). They are indeed cheaper to employ and they also have the bedside manner that physicians sometimes lack. The scope-of-practice laws for NP’s should have less restrictions in order to provide the highest care that they can. All in all, I found this article very interesting and it opens up for much conversation about what is going on with health care today.

References:

Anderson, A., DNP, RN, NE. (n.d.). The Impact of the Affordable Care Act on the Health Care Workforce. Retrieved September 27, 2016, from http://www.heritage.org/research/reports/2014/03/the-impact-of-the-affordable-care-act-on-the-health-care-workforce

By: laurette235

laurette235 — Wed, 28 Sep 2016 00:14:00 +0000

As healthcare is changing and the nursing field is shifting towards a new direction, new graduate nurses will have to assume much more responsibility than ever before. Healthcare is now combining both the patient and the population as one equal entity. New nurses will have to be well versed in providing education, leadership tools, and advocacy for their patients when entering the workforce. The shifting of the old nurse paradigm which consisted of nurses following orders and strictly providing bedside care is switching.
Peter Buerhaus touches on an important message in the role of the nurses moving forward in stating that “nurses will play a greater role in preventive care, patient education and [working with] the social determinants of health care”(Larson, 2016). As a student nurse, I know that the shift in nursing is heading toward engaging the patient in his/her own care, making health services more accessible for convienincy and efficiency, and encouraging the collaborations of healthcare practitioners. This is so individual patients and communities overall will be able to receive safer and better care. We are also shifting towards a view of analyzing patient care and population health as one in the same. Understanding that our patients are a direct reflection of the communities we serve and the resources readily available to them.
An article published by John Hopkins Nursing suggested four themes that would transend new nurses into becoming exceptional healthcare providers with an expanding older patient population and shift in healthcare service. These themes include increasing and improving nursing education, supporting nurses to practice under the full scope of their education, creating a culture where interprofessional collaborations are encouraged, and collecting better workforce data. It is refreshing that the future of nursing is pointing upwards. Nurses will be expected to be critical thinkers, community advocates, and team leaders, all while performing the incredible duty of individual and community patient care. (K. Brooks, 2011).
This shift in the future of nursing makes me think of what being a nurse will mean for me. Now, opening positions for nurses will be looking for new graduates who are confident in their skills, eager to learn and advance in practice, and focused on making patients live healthy lives through prevention and management and not only treatment.

Resources:
Brooks, K. (2011). The future of nursing. John Hopkins School of Nursing,14(2). Retrieved from http://magazine.nursing.jhu.edu/2011/04/future-of-nursing/

By: diana chau

diana chau — Tue, 27 Sep 2016 23:14:00 +0000

This article raises an important issue that the health care is going through right now. There is definitely “a knowledge shortage, not a nursing shortage” when we talk about about the amount of nurses that will be retiring in the next few years. Because these people have worked for so long in the nursing field, they have lots of knowledge, skills, and experience that we are losing for the new upcoming nurses. Bureaus stated that “the retirement of one-third of the nursing workforce over the next 10 years, which has never happened before and is going to take a lot of knowledge and know-how out of the workforce.” As a student nurse myself, I find myself learning best during clinicals when I have more hands on experience with patients. But that is only if I have a great instructor to teach me. When I graduate and enter the workforce working with a bunch of new nurses, we would not get the chance to learn about all the different skills and knowledge that we could have obtained if we were to work with an older nurse who has been in this field for years. Because of the shortage of experienced nurses, there will be a shortage of knowledge that won’t be there to guide new nurses and student nurses. New nurses will also have a hard time teaching student nurses, and so on. This issue will have a domino effect, as more and more nurses retire in the future. Also, because of the shortage of nurses, there won’t be enough clinical instructors for current and future students. Therefore, clinical instructors are either forced to take on more students that they can handle, or more students will get turned down for schools. Sometimes these clinical instructors are not ready to be instructors yet, but are forced to take on these roles because of the shortages.  

Shortage of nurses not only affect nursing students, but also effects patients care. Since patients’ life is on the line, nurses have to be extra careful when providing care to their patients. They already have a stressful day with their long list of responsibilities, and if we continue to not have enough nurses, they would be forced to take on more patients and responsibilities. Because of that, the quality of patient care will decrease, and can possibly put someone’s life in danger. By providing more incentives such as loan forgiveness program will help this shortage. However, the health care field should be prepare for when the shortage hits, so current and future nurses are not hit with surprise and stress later on.  

However, a pro to having more new nurses is that they will be more tech savvy since our generation depends on technology so much. But having more advanced technology will also help take some work of the nurses’ hands. Burhaus stated that “Nurses will play a greater role in preventive care, patient education, and [working with] the social determinants of health care – they will be more affected by that as access to care expands.” By providing lots of education on preventative care will help this shortage problem as well.

By: April Cutrofello

April Cutrofello — Tue, 27 Sep 2016 22:55:00 +0000

This article challenges my opinion about a recently-discussed topic in class: “Should the Bachelor of Science degree be the entry-level degree for all nurses?” Initially, I believed that although BSNs hold more knowledge-base in preparation for a career as an RN, ultimately ADNs and Bachelor-holders are equally qualified to take the state licensure examinations, and upon passing, each holds equal licensure to practice within his or her jurisdiction. The BSNs would have opportune advantages over the ADNs in their future career paths, sure– if not to be elected to managerial/administrative positions, then to be paid a higher salaries as practicing nurses. Instituting Bachelor degrees as the new nursing minimum requirement would devalue what is actually (ideally) an equal clinical skill set and core-knowledge base that is an ADN in comparison to a BSN. The change would be unnecessary.

However, I have been convinced otherwise upon reading this article. Buerhaus states that the care needed by retirees and baby-boomers in upcoming years will increase in complexity for multiple reasons pertaining to their inevitable diagnoses, which does make sense. He also notes that patients may require the attention of multiple nurses at any given time. This brings attention to two anticipated nursing skills necessary to care for this generation of patients: a thorough medical-knowledge base, and versatility relating to roles and responsibilities within a healthcare setting.

While being a “team player” is not necessarily refined to BSN holders, BSNs do have the advantage of more extensive education and therefore more knowledge about disease processes and related factors than an ADN does. This is extremely important for the anticipated surge in hospital admissions/retiring senior nurses regarding patient safety during treatment and recovery, as is thorough understanding of the presentation of these diseases in older adult and geriatric populations (which may differ from that of a middle-aged adult, as is known). If teamwork is especially essential for the care of incoming thousands upon thousands of retirees, I believe all members of the team should be “on the same page,” if you will, academically. This may also prove effective with Buerhaus’ anticipated physician shortage, which may leave nurses to intervene more actively and extensively over time (and with appropriate training).

With increased educational background of practicing nursing staff teams across the board, we may be able to alleviate the gap in applicable skill level/working knowledge that Buerhaus anticipates will exist once the experienced, baby-boomer-aged nurses begin to retire en masse. Perhaps establishing Bachelor degrees as the new hiring minimum for all incoming RNs would be beneficial for both the upcoming changes in nursing staff quality and the new majority patient population.

By: Samuel Desmond Nathanson

Samuel Desmond Nathanson — Tue, 27 Sep 2016 02:46:00 +0000

This article raises a very interesting point about the coming nursing crisis. It is not necessarily a shortage of quantity, but of quality. The unprecedented growth of nurses since 2002 is certainly heartening to see. I am one of these nurses who will enter the workforce. However, these new nurses can’t bring with them the years of experience that are lost form a retiring nurse. However, I think that the rise of new technologies may make young nurses more desirable as they are fresh from school and ready to learn new technologies.

The point that there won’t be a “new normal” may also improve the utility of new nurses as they are ready to learn new hospital policies which Mr. Buerhaus addresses. I agree that restricting the scope of nurse practitioners is a bad choice. The point that nurse practitioners working in rural areas is a valid one. The Affordable Care Act has taken great strides in expanding access to health care and Mr. Buerhaus emphasizes that they need nurse practitioners. It is heartening that he says that many states are starting to open up the laws.

The physician shortage the article brings up is also concerning and I agree that we need to have nurses step forward to fill the health care gap. The competencies of being nimble and being able to be leaders can’t be emphasized enough. When I am in clinical I see the best nurses and they are strong and able leaders and able to face whatever comes their way. Many times I’ve seen nurses get a new challenge presented to them.

Finally, the four major changes that affect the nurses are interesting. The retiring of one-third of the workforce is disconcerting, but I think by emphasizing the need to be leaders and adaptive then the nurses who remain can work alongside the newcomers to fill the gap. The wave of 70 million baby boomers is concerning as they get older and the strain they will place on the economy and health care is certainly concerning, but I am confident that the nurses I know can rise to the occasion. Health care reform is socially important, but presents many challenges to the health care providers. The last point about the physician shortage brings up a great point that we must focus on preventative care. In all this was a great article with great insights about what we need to keep our eye to in the coming years.

By: Shannon Greger

Shannon Greger — Mon, 26 Sep 2016 17:01:00 +0000

I thought this article was right on when they said that we are facing a “knowledge shortage, not a nursing shortage”. This is true as the retirement of all the older nurses and the nurses of the baby boomer generation occur we are not only losing their bodies in the workforce but their skills and knowledge that they have acquired over their long careers. The nursing profession will be losing one third of their most skilled and experienced workers in the next ten years. Although we will be able to replace their spots in the nursing profession there is no way that new nurses coming out of school will be able to be at the same experience and knowledge level of the nurses that are retiring. Not only will there be the shortage that nurses will have to combat with but they will now be taking on more responsibility and playing a new role for preventative care. It is imperative for nurses to always be striving within their education and taking their knowledge to the next step. Being a nursing student myself currently I know that for where I want to get in my nursing career I will need to further my knowledge and seek a higher degree than a bachelors. I do believe that I am not the only one with this mindset, plenty of my fellow students want to do the same and achieve higher degrees. This attitude and mindset that is being cultivated in nursing school could help with the knowledge shortage that Peter Buerhaus is talking about. One thing that will stand in our way though with getting advanced degrees such as Nurse Practitioners is the Scope of practice laws. Buerhause points out that “Twelve states still restrict scope of practice and 17 more reduce the ability of nurse practitioners to engage in at least one element of their practice, but patient care in a wide range of settings, such as nursing homes, demands that they have broader privileges”. This is crazy and defiantly something that will need to change. Hospitals also need to realize that employing nurse practitioners are now cheaper then employing medical practitioners. The article also touches on how health care reform is another thing that is really going to be a force that will reshape nursing. Buerhause states “We will always need hospitals, but delivery systems are changing; there will be less hospital care, and everyone accepts that they will have greater accountability for cost and quality”. Nursing has already seen some changes in health care reform with shorter hospital stays going from 10 days to now only 48 hours. Care is now focused much more on preventative care and keeping people out of the hospitals. This is a topic that is taught heavily in nursing school and is teaching us to become more adaptive people and to be accepting of change and new ideas. This article is a good stepping stone to show the changes that are going to be coming to nurses and to show the forces and challenges the new nurses entering the field will experience.

By: Amy G. Patel

Amy G. Patel — Sun, 25 Sep 2016 19:20:00 +0000

This article provides great insight on how current challenges within nursing will transform its future as well as how strategies to overcome these obstacles will lead to optimized healthcare.

According to Buerhaus, the retirement of one-third of the nursing workforce over the next 10 years will inevitably lead to a nursing knowledge shortage. “Experienced nurses are retiring, so we have more people, but less long-term experience” (Larson, 2016). With these nurses retiring alongside the growing need for primary care, his point on increasing nursing graduates’ knowledge base to the level of experienced nurses is crucial for maximized patient care. Nursing education has a key role in preparing students for these challenges and supplying them with adequate resources to tackle them. This requires constant communication with hospitals and other workplaces that are being influenced by these changes. It is satisfying to see today’s nurses advance their education to higher levels each year with these ideas and challenges in mind.

Furthermore, in light of increasing integrated care, advanced practice nurses allow for greater impact within healthcare—management, leadership, and healthcare reform towards enhanced affordability, access, and adequacy for patients. As Buerhaus mentions, while their roles are continuing to grow outside of hospitals, they will likely remain “organization-specific” based on the unique needs of each workplace and community.

Moreover, due to the physician shortage, it is imperative to consider that nurse practitioners are more affordable to employ and likely to care for minority populations across the nation at lower costs. With the rise of retirement of the large baby boomers population, there will also be a significant increase in the incidence of chronic and degenerative conditions implying greater need and complexity of care that nurses can facilitate.

To continue, health care reform is leading to changes in delivery. The vision is to increase community-based systems promoting preventative care and education as opposed to hospital care focusing on acute treatment. Greater accountability for lower costs, quality care, enhanced productivity via modern technologies, and tackling disparities are also expected as healthcare expands.

All of this requires developing a collaborative model that is carried out with value-based care and focuses on affordability, access, adequacy, and awareness. This requires two major steps for hospital leaders. The first, as mentioned above, is to stay in communication with nursing schools so that educators can continuously guide students to not only be prepared but also motivated to impact their field on a grand scale. They must also discuss value-based care and adjustment strategies needed to maintain the mission of their organization with experienced nursing leaders (those close to retiring).

The essence of value-based care (in relation to all of the challenges listed above) is based on its equation of quality over cost over time. This is beneficial for patients because they are guaranteed safe, effective, and affordable care with lasting results. For providers, it involves offering evidence-based education and treatments that consider patient preferences on a holistic level. All together, the effect is the basis of successful nursing, the reduction of “complications, hospital-acquired infections, readmissions, etc.” (Dartmouth-Hitchcock, 2016).

References:

What is value-based care? (2016). Retrieved from Dartmouth-Hitchcock website: http://www.dartmouth-hitchcock.org/about_dh/what_is_value_based_care.html