Where is Nursing Headed???

  1. What do you envision nursing in the US will be like 10 or 15 years from now? Do you think the changes will be positive or negative? How do you think the demographic shifts nursing is experiencing (aging staff nurses plus baby boomers entering their senior years) will affect our profession in the year 2015?
    I personally think misguided legislators, hospital executives, and doctors will use this "nursing shortage turned crisis" as a handy excuse to "deskill" our profession (take people off the street and train them in 6 weeks to do vital parts of our professional duties). Already, in NC, it is my understanding (please correct me if I am wrong) that legislation has been passed to allow "medication aides" to pass medications in acute care facilities (with the blessing of the NC BON!!! ). I also think most immigration restrictions on foreign nurses (especially from huge population centers such as India) will be waived.
    Am I being pessimistic or realistic and what can we do NOW to save control over our profession?
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  2. 13 Comments

  3. by   suzanne4
    The restrictions on foreign nurses coming over has actually gotten tighter over the past few years. Before, with an H1-B visa, the temporary work permit for nurses, all you needed was to pass NCLEX and just have TOEFL.
    Now, if they ever become availalbe again, which I highly doubt for nurses, the nurse will have to have documented English skills equivalent to those of a native speaker, as well as complete the Visa Screen process. Most states are now requiring fingerprints, etc.

    It is also a big misconception by many people that every nurse in India and the Philippines is 100% fluent in English and can pass the English exams the first time. This definitely isn't so. Sure they speak English in both of those countries, but usually the nurses will speak their native dialect when at home, or even at work. The way that some words are pronounced are quite different than what you are used to hearing. Personally, I think that the rules may even get tougher. All states may actually require the CGFNS exam in the future.

    But of course, this is just my two cents worth, but I watch the developments on a daily basis and have been doing so for quite awhile.
  4. by   Hodge
    Due to pressure to keep healthcare costs in check and exploding demand for healthcare (i.e. aging population) the demand for nurses and the scope of their job will likely increase. You will see more pressure for nurses to take over responsibilites that MDs used to do. This will increase the need for additional nursing education and put nurese that have that education in great demand.
  5. by   Dayray
    I think there are factors pushing nursing in different directions. Nursing is smack in the middle of the health care system by this I mean we are right in between the consumer and upper management.

    nurses are thought of in terms of quantity rather then quality. The suites in there executive offices don't know a damn thing about what nursing is nor do they care to find out. They think of us as a cost of doing business and therefore more and more attempts to lower this cost are in the makings. I can defiantly see a push toward de-skilling nursing. administration would love to have low cost low educated people take the place of expensive Rn's and they would make Rn's responsible for the care delivered by them. heck if one RN loses their license due to these workers they would just find another one and still get to enjoy the savings.

    On the other hand someone brought up the fact that nurses will be doing more MD tasks then they ever had before. I agree with this but I don't think we will receive any acknowledgment of this or that they will be official expansions in nursing scope of practice. I recently took a continuing education class and realized how many of the things I do and am expected to do are in a gray area of the scope of nursing practice.

    I don't feel uncomfortable making the decisions I do for patients but I realize that many of them are considered MD areas of practice. I just do them and later ask the MD to sign the order. These are simple things like folyes IV's and some other point of care type things but I was a bit taken back when I considered what would happen if the MD chose not to back me up on these decisions. Of course if I refused to make these decisions and called the MD at 2 am I would be seen as incompetent.

    Also as an L&D nurse I observe pateints and call the doc to ask for orders when I want to discharge a patient, I also have to call the doc if I think they need to come in. Thats all fine and well but what if I call a doc and then exacute their orders and then soemthing happens? All the doc would have to say is that I did'nt tell them something and becuse of this they made a bad call. Then guess who gets to go work at McDonalds?

    We are in the middle and because of our lack of cohesiveness as a profession, I fear we will have little to do with path nursing takes in the next few years.

    Doctors and hospital managment love this about nursing. They get all the protections and profits well nurses do all the work for meager hourly wages and then take the fall when their is a problem.

    As a perfect example look at advanced practice nursing. The potential of NP's and CNM's is wonderful they are well trained and experienced practitioners yet they are severely limited in what they are by law allowed to do. Why? because they will forever (until steps are take to remedy it) live in the shadow of the medical profession. Care by an MD is seen as the standard of care and The AMA is a huge powerful lobbying force that will keep it that way. Until this is changed Nurses will still be seen as "under the phsican" we will continue to take the brunt of the responsiblity with very littel aknolewgment of what we do.

    I love nursing and see it as the most dynamic and powerful force in health care. However, we cant even educate the public on what it is we do as nurses. Nor can we pull together enough to have a national professional organization (with any real political/legal power). How can we possibly hope to have a say in what our profession becomes in the near future?

    I'm not poitning any fingers at anyone. I got into nursing becuse I wanted to work as a nurse. I have no interest in becoming political or trying to get recognition for nurses. I think most of us are the same in that respect we like being with patients and don't want to spend our lives in offices. Thats why Doctors and Healthcare groups will continue to shape nursing into what ever they want it to be.
    Last edit by Dayray on May 15, '04
  6. by   BBFRN
    Here's 1 possible scenario: We could all be forced to get our BSNs, not get paid very much more for that, plus be mandated to work overtime without overtime pay. But that's just the pessimist in me.
  7. by   mattsmom81
    Quote from lgflamini
    Here's 1 possible scenario: We could all be forced to get our BSNs, not get paid very much more for that, plus be mandated to work overtime without overtime pay. But that's just the pessimist in me.
    :angryfire Some days I get so pizzed off thinking of how we are manipulated. What kind of a dysfunctional profession have I gotten myself into...LOL!!

    Also agree with Dayray's post regarding the eagerness of everybody else to control us...because we have not seen fit to define our own (nursing's) destiny.

    Perhaps mandating BSN is a good move for the profession...but 'making' ADN's and diploma grads get that BSN (like NYS is considering) doesn't sit well with me at all. But...that's another thread...LOL!
  8. by   Gldngrl
    Quote from Dayray
    I love nursing and see it as the most dynamic and powerful force in health care. However, we cant even educate the public on what it is we do as nurses. Nor can we pull together enough to have a national professional organization (with any real political/legal power). How can we possibly hope to have a say in what our profession becomes in the near future?

    I'm not poitning any fingers at anyone. I got into nursing becuse I wanted to work as a nurse. I have no interest in becoming political or trying to get recognition for nurses. I think most of us are the same in that respect we like being with patients and don't want to spend our lives in offices. Thats why Doctors and Healthcare groups will continue to shape nursing into what ever they want it to be.
    I'm confused by your comments...if you have no political interest or desire to promote nursing advocacy, how do you think change will be effectuated?
  9. by   Hellllllo Nurse
    Quote from Dayray

    We are in the middle, and because of our lack of cohesiveness as a profession, I fear we will have little to do with path nursing takes in the next few years.

    Doctors and hospital managment love this about nursing. They get all the protections and profits while nurses do all the work for meager hourly wages, and then take the fall when there is a problem.

    .
    Dayray, I agree w/ your entire post, but especially the above excerpt.
  10. by   Granted Fal
    As a brand new LPN that is continuing for ADN to be followed by BSN, this is all very disconcerting. I remember working in a adolescent long-term care unit as a counselor prior to my nursing program and the counselors were "med-certified" and still passed meds they should have been "monitoring." This was concerning to say the least because, why couldn't any monkey pass meds that way.

    What crosses my mind are those clientele that are on numerous meds that could interact, and if some 6-week-trained gimp is going to pass meds w/out knowledge of the interactions and risks, I don't want to be responsible and it Seems too risky to me. I don't want to be fodder for some organization saving money at my expense.

    I just have this uneasy feeling as I'm new in my career and the proverbial carpet is going to be yanked before I'm even in my prime?!

    We nurses should form a coalition, dare I say become unionized, to protect our profession and use our pull as a group to control the SBON's from screwing us out of what we were trained and worked so hard to do.

    How does a grass-roots movement begin, when are nurses passionate enough about this to actually do something about it?

    concerns of a newbie.... :uhoh21:
  11. by   oramar
    There seems to be two totally different trends in nursing at the same time both brought on my demographic forces. One is an increasing awareness by public and nurses themselves of the importance of their role brought on my nursing shortage. This is resulting in a larger voice for nurses which translates into improved image which is being followed by improvements in wages and benefits as well as working conditions. One he other hand, there is an ever increasing negative pressure from all directions (improvements in technology that has produced exploding elderly and sick populations even while there are less people to care for them), that causes ever increasing need for cost controls. These negative pressures are causing every increasing pressure on medical establishments to look at deskilling and increase work loads as a real possibility. I don't know how this is going to all play out. What I do know is that in 15 years I will be seventy(God willing) and be one of those most vulnerable to the choices and policies we make now. Myself I hope there is a large and well educated force of highly skilled nurses out there to deal with me and my fellow bay boomers as we age.
    Last edit by oramar on May 22, '04
  12. by   live4today
    I don't know about nursing ten or fifteen years from now, but from what I can demise from my own professional nursing experience today, armed security guards are now needed to protect the staff caring for the general public these days. :stone

    Some educational facilities and other businesses have armed guards due to the brutality employers and employees potentially and actually face day to day, and hospitals NEED to be next on the list of employers and employees to protect while on duty.

    What good is having more education and the "PTB" delegating MD tasks to nurses if we're all being threatened and/or assaulted while on duty by those patients in our care, or those who visit the patients we care for if our FIRST priority is to protect ourselves against violence while on duty? I rest my case!!! :angryfire
    Last edit by live4today on May 16, '04 : Reason: missing letters
  13. by   Dayray
    I'm not sure how grass roots movements begin. I could see it happening though. I know there are some people out there who would want to fight this battle, I also know its not me.

    Someone asked how I could see things changing if I don't want to become political. Thats a very fair question. How can I complain if I'm not willing to do something about it? I don't have a good answer other then that it's not what I want to do with my life. I love what i do now and want to become better at it. I want to learn and grow more and at some point effect positive change in my particular field of nursing.

    In order to empower nursing as a profession and to give nursing a voice in the way things turn out, someone or more likely many someones will have to first get us to all stop fighting amoung each other. ADN vs BSN vs Diploma vs med surge vs ICU vs ER vs l&D vs PP vs ICN vs vs vs........

    Nurses are not a cohesive group. Think about how many petty arguments we have between our selves. Last week I called report to a nurse on another floor, it ended up a spiteful battle over who was responsible for what and disagreement over how much detail needed to be in a report. There is animosity between departments all over the hospital. I'm often embarrassed when a patient asks me about a nurse on post partum or nursery. I have to admit that I don't know them. I don't know them because we don't want to know each other. They don't like me and while I don't dislike them I don't make any effort to get to know them.

    Once that cohesiveness is achieved that person or group of persons would then have use our new nursing organization to make the public understand what it is we do. Some people understand what nurses do and respect us for it but the majority are confused.

    Most people only know what they see on TV. On TV nurses are submissive to doctors and run out of the room when the doctor says "nurse go get me a scalpel!" they empty bed pans and are all sexy young women in short white skirts. I don't know how many times I've had people ask me how I stand my job and then tell me that emptying bed pans all day would drive them crazy. The funny thing is that I haven't emptied a pan in like 3 years.

    I am actually a bit reluctant to let patients know how much responsibility I have over their care. I've seen some very surprised looks from patients when I explain a plan of care, I have decided on. I can't count how many times I hear "when is the doctor going to come?" They don't realize that the hospital is where nurses coordinate care and the doctor is just a part of that care.

    Changing the publics opinion would be really hard. I Can't even explain to my wife exactly what it is I do. there is so much that goes into nursing the details are hard to communicate. Add to that the fact that nurses are all so different depending on what specialty they are in and dependent on what area of the country they work in. On top of that many of the things we do, we do and then later ask the doctor to give us an order, giveing the impressiton that the doctor was the one who decided to do it.

    A positive public opinion of nursing would do so much for nursings political clout. As it stands now, many people are a little peeved that nurses earn as much as they do because they think we are all just glorified waitresses.

    So It would take a very strong and politically oriented group of people to tackle this job. It would take dedication and a huge portion of their lives to see a tangible change.

    I know that their are people like this out there and I would love to lend some time and money to the cause. I also know that I'm not one of them I want to change things but in a different way.
  14. by   VickyRN
    Quote from Dayray
    I'm not sure how grass roots movements begin. I could see it happening though. I know there are some people out there who would want to fight this battle, I also know its not me.

    Someone asked how I could see things changing if I don't want to become political. Thats a very fair question. How can I complain if I'm not willing to do something about it? I don't have a good answer other then that it's not what I want to do with my life. I love what i do now and want to become better at it. I want to learn and grow more and at some point effect positive change in my particular field of nursing.

    In order to empower nursing as a profession and to give nursing a voice in the way things turn out, someone or more likely many someones will have to first get us to all stop fighting amoung each other. ADN vs BSN vs Diploma vs med surge vs ICU vs ER vs l&D vs PP vs ICN vs vs vs........

    Nurses are not a cohesive group. Think about how many petty arguments we have between our selves. Last week I called report to a nurse on another floor, it ended up a spiteful battle over who was responsible for what and disagreement over how much detail needed to be in a report. There is animosity between departments all over the hospital. I'm often embarrassed when a patient asks me about a nurse on post partum or nursery. I have to admit that I don't know them. I don't know them because we don't want to know each other. They don't like me and while I don't dislike them I don't make any effort to get to know them.

    Once that cohesiveness is achieved that person or group of persons would then have use our new nursing organization to make the public understand what it is we do. Some people understand what nurses do and respect us for it but the majority are confused.

    Most people only know what they see on TV. On TV nurses are submissive to doctors and run out of the room when the doctor says "nurse go get me a scalpel!" they empty bed pans and are all sexy young women in short white skirts. I don't know how many times I've had people ask me how I stand my job and then tell me that emptying bed pans all day would drive them crazy. The funny thing is that I haven't emptied a pan in like 3 years.

    I am actually a bit reluctant to let patients know how much responsibility I have over their care. I've seen some very surprised looks from patients when I explain a plan of care, I have decided on. I can't count how many times I hear "when is the doctor going to come?" They don't realize that the hospital is where nurses coordinate care and the doctor is just a part of that care.

    Changing the publics opinion would be really hard. I Can't even explain to my wife exactly what it is I do. there is so much that goes into nursing the details are hard to communicate. Add to that the fact that nurses are all so different depending on what specialty they are in and dependent on what area of the country they work in. On top of that many of the things we do, we do and then later ask the doctor to give us an order, giveing the impressiton that the doctor was the one who decided to do it.

    A positive public opinion of nursing would do so much for nursings political clout. As it stands now, many people are a little peeved that nurses earn as much as they do because they think we are all just glorified waitresses.

    So It would take a very strong and politically oriented group of people to tackle this job. It would take dedication and a huge portion of their lives to see a tangible change.

    I know that their are people like this out there and I would love to lend some time and money to the cause. I also know that I'm not one of them I want to change things but in a different way.
    Excellent post, Dayray. You share a lot of my frustration and sentiments.

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