Nurturing the Next Generation of Nurses
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Citing a recent report that concluded that nurses must become equal partners in the health care industry, along with doctors and other health care professionals, University of Miami President Donna E. Shalala declared, “The era of having a hierarchical system is over.” Shalala made her remarks at a panel titled “Meeting the Global Health Care Challenge: The Role of Nursing,” at the University of Miami Global Business Forum, held Jan. 12–14, 2011.The report, “The Future of Nursing: Leading Change, Advancing Health,” was published in October 2010 following a two-year project by a committee convened by the Robert Wood Johnson Foundation and the Institute of Medicine, and chaired by Shalala, a former U.S. Secretary of Health and Human Services. (Click here for the full report.) Its primary goal was to address the barriers that may prevent nurses from leading and responding to changes in the health care system.
Among the report’s recommendations: Nurses must be allowed to practice to the full extent of their training, including writing prescriptions and seeing patients without physician supervision — which most states do not permit. Rosemary Bryant, president of the International Council of Nursing, would welcome such advances. “That is one of the major challenges we have,” she said. “Nurses are educated to perform certain roles, but they are not able to do so because of structural barriers.”
Although it clearly outlined the importance of nurses to the future of health care, the report also noted a major challenge: They continue to be overworked and in short supply, especially in the U.S. They require higher levels of education to respond to increasing demands as well. A four-year degree “has to be the norm in nursing,” insisted Shalala, who advocated for “pathways” that would make education more accessible to prospective nursing students.
Many more nurses will have to enter the field to keep up with demand. In Bryant’s native Australia, for example, there are 109 nurses for every 10,000 people. In the United States it is 98 nurses for every 10,000. And in places such as Sierra Leone and Bhutan, there are just two nurses per 10,000 residents.
In other parts of the world, though, the global financial crisis has cost many nurses their jobs. “In the U.K., Spain, Portugal and Greece, nurses were laid off in large numbers or forced to take a 10 or 20 percent pay cut,” Bryant noted. In Fiji, the government decreed that all nurses older than 55 were to retire immediately. And in Haiti, the free labor provided by aid workers has left large numbers of nurses unemployed.
Unfortunately, attracting new nurses is not easy, especially because the profession is often undervalued. Alaf Meleis, dean of the University of Pennsylvania School of Nursing, said that part of the reason nurses are taken for granted is that the majority of them are female. “Societies do not pay for caring, and women do most of the caring — and they do it for free. They do it in families or they volunteer,” Meleis said.
The work is challenging too, and there are few residency programs to transition nurses from school to job. Only in nursing, Meleis said, is someone expected to work at her or his “highest capacity level” the first day on the job. Throughout their careers, nurses are often left without proper guidance to fully utilize their skills, added Linda Burns Bolton, vice president and chief nursing officer of Cedars-Sinai Health System in Los Angeles. “We recognize that three million nurses in the United States and across the world are focused on doing good but often lack the leadership to make it happen,” she said.
Indeed, Bolton continued, nurses are vital to disease prevention and patient wellness efforts, and they play a key role in decreasing potentially costly adverse events such as falls.
So how can nurses raise their stature in the medical community? Meleis said they must do a better job of speaking out about the work they do and its importance.
Despite these challenges, the panelists were optimistic about nursing’s future. Bryant noted that in spite of recent employment “blips,” the increase in chronic diseases creates more need for nurses. “I think the future for nursing is fantastic,” she said.
Meleis also thinks this is “the most exciting time for nursing,” partly because she perceives a growing awareness of the importance of nurses’ input in improving health care. “We need to keep our mind on quality of care,” she said. “It is not merely about nursing.”
Bolton warned that without input from nurses, health care won’t evolve: “Our knowledge, ability and skills will lead the way to an improved health care system.”
By Erik Bojnansky
