The Future of Nursing Practice

Although many segments of society have been untouched by the pandemic, it would be hard to argue that few have been impacted more than health care.

While Covid-19 placed many challenges on the healthcare system, nurses were thrust into the spotlight. Hospitals were inundated with very sick patients, raising their profile as they worked under the toughest of conditions to care for their communities. Seemingly overnight, they became “health care heroes” – applauded, praised, and honored for their work during the pandemic.

What’s Ahead for Nursing?

Despite the spotlight that the pandemic shined on the nursing profession, looking ahead, there’s still work to be done. According to a report from BMC Health Services Research, “the COVID-19 pandemic brought some positive changes in the nursing practice environment, but more efforts are needed to solve those nagging and important problems, such as staff shortages and low participation. Nursing managers and hospital leaders were encouraged to listen to nurses’ concerns and value this suitable opportunity for changing and improving to achieve better health services and coping ability to deal with emergency events going forward.”

Just as so much of the world changed irreversibly because of the pandemic, nursing will need to adapt accordingly.

A Technological Shift

An editorial in BMJ Journals called “COVID-19: reflections on its impact on nursing,” notes that “the rapid shift to technology-mediated healthcare, such as virtual primary care consultations, will require nurses to ensure that they possess not only the technological skills required to manage these new approaches to providing care, but also the communication skills necessary to assess and support patients via different media (e.g., videoconferencing; telephone). Critically, nurses must also be aware of the potential risk that certain groups of the population, such as older people or those facing digital poverty, may be uncomfortable with — or excluded by — the move to technology – mediated care. As advocates for their patients, nurses must ensure that not only is the care they deliver person-centered but that the modality through which care is provided is adapted according to the patient’s characteristics, abilities, and preferences.”

Nursing Shortages

Long before the pandemic, supply was not keeping pace with demand. This trend has only been exacerbated by COVID-19, and it accelerated retirements and delayed opportunities for education and clinical rotation.

According to the Bureau of Labor Statistics’ Employment Projections 2021-2031, the registered nursing (RN) workforce is expected to grow by 6% over the next decade – from 3.1 million in 2021 to 3.3 million in 2031, an increase of 195,400 nurses. The Bureau also projects 203,200 openings for RNs each year through 2031 when nurse retirements and workforce exits are factored into the number of nurses needed in the U.S.

The American Association of Colleges of Nursing is making efforts to address this growing problem, including:

  • Advocating for federal legislation and increased funding for nursing education
  • Promoting a post-baccalaureate nurse residency program to aid in nurse retention; encouraging innovation in nursing programs, including the development of fast-track programs (second-degree BSN and MSN programs; baccalaureate to doctoral)
  • Working with partner organizations to highlight careers in nursing, including those requiring graduate-level preparation
  • Operating the nation’s centralized application service for nursing education programs that prepare nurses for entry-level and advanced roles. This is designed to ensure that all vacant seats in schools of nursing are filled to meet the nation’s need for RNs better, advanced practice registered nurses, and nurse faculty

The Gig Economy

As it turns out, the gig economy isn’t just for Uber and Lyft drivers. A significant shift in the way people work and how they work can be seen in the healthcare industry as well.

“The COVID-19 pandemic accelerated the spread of the gig economy into the caregiver workforce, and it’s here to stay,” Susan Pasley, MS, BSN, RN, VP of clinical solutions at CareRev, said in this article in HealthLeaders.

In regards to nursing specifically, Pasley said, “During the pandemic, the mass exodus of nurses from the profession — due to stress, burnout, and lack of work-life balance — was unlike anything we’ve experienced. It has been a real game-changer for health systems. As we approach the endemic phase of the pandemic, the gig economy offers alternative, flexible options to retain nurses in the profession while eliminating budget-draining travel contracts. Other dynamics are also changing the nursing world and how we think about career paths, workforce planning, and development strategies. For example, younger professionals are demanding workplace cultural changes such as more time to focus on their personal life and priorities. There is a pattern of younger nurses who want to cycle on and off of work every few months while others seek to work more hours to achieve financial independence and early retirement. The gig economy allows nurses to work where they want when they want. Without the healthcare gig economy, we risk losing more nurses to more flexible industries and professions.”

Empowering nurses

One way to encourage people to enter the field – and stay there – is to make them part of the decision-making process. Rebecca Love, chief clinical officer at IntelyCare, was quoted during a recent discussion, “Nurses have a tremendous amount of responsibility, but not a lot of authority to drive those changes of the tremendous amount of tasks that they have.”

She also believes that healthcare organizations should have nurses on their C-suite teams. This will position nurses to find tech solutions that are actually relevant to the job.

“I think it is time that nurses say, ‘I’m not buying products or using products that don’t have nurses who are adequately involved in that,’” she said.

This sentiment was echoed in a 2011 report on the Future of Nursing from the Institutes of Medicine, which found that strong leadership will be required to transform the U.S. healthcare system. A transformed system will need nurses with the adaptive capacity to take on reconceptualized roles in new settings, educating and re-educating themselves along the way — indispensable characteristics of effective leadership. Whether on the front lines, in education, or in administrative positions and health policy roles, nurses have the well-grounded knowledge base, experience, and perspective needed to serve as full partners in healthcare redesign. Nurses’ unique perspectives are derived from their experiences in providing direct, hands-on patient care, communicating with patients and their families about health status, medications, and care plans, and ensuring the linkage between a prescribed course of treatment and the desired outcome. They must be full partners and given responsibility for identifying problems and areas of waste, devising and implementing a plan for improvement, tracking improvement over time, and making necessary adjustments to realize established goals.

Transforming the Practice

The 2011 report on the Future of Nursing also noted that nurses should practice to the full extent of their education and training to ensure that all Americans have access to needed healthcare services. Advanced Practice Registered Nurses (APRN), who are a vital part of the health care system, are educated with a master’s degree or higher and have hundreds of hours of hands-on clinical experience. They can provide care in all types of practice settings, including healthcare facilities, outpatient clinics, specialty practices, employee health programs, and in rural and urban areas with limited access to care. They will be essential to filling gaps in the system.

Research has repeatedly demonstrated that APRNs provide safe, high-quality care with equivalent outcomes to their physician counterparts. However, in just half of the states and jurisdictions in the U.S., APRNs currently have full practice authority. That means that they can provide care to the full extent of their education — from diagnosing and treating patients to delivering babies, expertly managing life-saving respiratory devices, and more. According to Nursing America, lifting restrictions on APRNs can help avert a healthcare crisis in America that is threatened by a growing shortage of medical providers.

Health Equity

Nurses have seen firsthand Covid-19’s inequitable impact on certain communities. At the same time, nurses are uniquely positioned to play a central role in addressing these inequities across the entire spectrum. For people who have difficulty accessing health care because of distance, lack of providers, lack of insurance, or other reasons, nurses are a lifeline to care that meets them where they are. Nurses work in areas that are underserved by other healthcare providers and serve the uninsured and underinsured. They often engage with and provide care to people in their homes, they work in a variety of clinics, they use telehealth to connect with people, and they establish partnerships and create relationships in schools and communities. Nurses can strengthen their commitment to diversity, equity, and inclusion by leading large-scale efforts to dismantle systemic contributors to inequality and create new norms and competencies within health care.

A report on The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity (2021) found that in primary care, RNs can assume at least four responsibilities:

  1. Engaging patients with chronic conditions in behavior change and adjusting medications according to practitioner-written protocols
  2. Leading teams to improve care and reduce the costs of high-need, high-cost patients
  3. Coordinating the care of chronically ill patients between the primary care home and the surrounding healthcare neighborhood
  4. Promoting population health, including working with communities to create healthier spaces for people to live, work, learn, and play

While it remains to be seen long-term what the future holds for the future of nursing, it will be vital to invest in strategies that reduce barriers to nurses’ work and promote their work enthusiasm.