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?
May 15, '04
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
May 16, '04
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
May 16, '04
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