Nursing in the next 10 years

[linguine]

Experienced nurses, new grads, retired nurses,

What do you think nursing will be like in 10 years in terms of education, work environment or professional developement?

Nursing is going through changes and advancements in different directions very quickly. Wondering what is going to be required of a nurse in 10 years to practice successfully.

Nothing special sparked this discussion.. just going through some thoughts (and some anxiety) about what being a nurse may be like in the next decade.

[SnowRox]

I'm sorry, but all this doom-saying strikes me as rather myopic, driven primarily by an excessive focus on a comparatively depressing near-term future at the expense of larger trends that loom in the longer term. Absent the technology to create truly viable robot-RNs (which is, on current evidence, centuries off at the earliest for a civilization that can't even design effective clean-energy engines or offer economically viable supersonic air transport), RNs are quite safe from technological obsolescence. Legal history and precedent also suggests that the recent health care reform legislation is likely to withstand an inevitable assault from those who think the existing badly broken and grossly inequitable but highly profitable pay-to-play model is A-OK -- which, combined with the huge generation of Baby Boomers nearing retirement and expected to have increasingly complex care needs, as well as an economic recovery that, while still sluggish, is clearly gathering steam, portends sharply increased demand for health-care services in the coming years. Then, we have the increasing shortage of primary-care physicians, lured away by the massive salaries of specialization, to contend with, which will increase demand for the midlevel providers (including and especially APRNs) who will be needed to fill the gap. The evidence therefore paints a rosier picture than some would have you believe. RNs will be in demand again in the coming years, and the demand will likely be high enough that RNs will not be required to obtain a BSN merely to earn licensure, nor to obtain a DNP to be credentialed for advanced practice. A few deep breaths and a little patience will go a surprisingly long way, folks -- have a little perspective and marshal the facts here!

[Househead4life]

This is NOT even funny (so sad)

[Mona77]

Want to tell another story, during the last decade 20% of German nursing schools were closed, due to an oversupply and increased costs, DRGs, less governmental funding, lobbying physicians. More than 50 000 nursing jobs were cut down.

Now we can't find competent and skilled nurses to fill in acute care jobs - we have 3 job postings open since 10/2009!

On a med/surg. floor the patient/nurse ratio is 15:1, sometimes 20:1 (morning shift) and we don't have Techs, CNAs or LPNs. We have only nursing students and service aides working 4 hours a day.

Due to that working conditions many nurses now work in Austria and Switzerland or somewhere else or switched to a BSN program to become a nurse educator or to climb up to a management position.

Therefore many hospitals and nursing homes try to recruit nurses from Eastern European countries - so how will the future be like? In ten years maybe 30 - 40% of the workforce will be imported from different countries - which doesn't really matter main point - they work, hope they will be able to speak German properly!

About 20% will retire during the next decade - and in Germany they will retire due to our social insurances including a pension plan. Don't forget about the ading population.

So we will be facing a great nursing shortage in Germany, since the skilled and experienced nurses will continue to leave Germany and everyone knows that, but the only governmental point of interest is to cut the exploding cost of our health care system by boosting premiums (every german citizen and resident has a right to receive medical care if he is insured or not and even if not insured high quality care is demanded) but without the courage to stop Pharmas expanding gains (Meds in Germany cost twice the amount than in Northern America).

The next decade will be very interesting, we recently had a change of paradigm - leading to a reformation of the nursing education - more scientific approach, more professionalism - so that we can compete internationally, having now trouble to implement knowledge and skills into the hospital setting due to understaffing - maybe in some years care will be provided like in Turkey - where patients are bathed, turned and transfered by relatives, meals are prepared at home and brought to the hospital.......

[OCNRN63, RN]

I feel like we will be "scripted" to death. Our jobs will be so customer service related we'll forget we're even nurses. I already have days like that.

I look back on what things were like 25 years ago when I first graduated, and it makes me sad. I am nowhere near the ideals that were instilled in me by my instructors. Nursing isn't what it used to be.

I wish I could say the future of nursing excited me. In reality, it scares me.

[evolvingrn, BSN, RN]

I feel like we will be "scripted" to death. Our jobs will be so customer service related we'll forget we're even nurses. I already have days like that.

I look back on what things were like 25 years ago when I first graduated, and it makes me sad. I am nowhere near the ideals that were instilled in me by my instructors. Nursing isn't what it used to be.

I wish I could say the future of nursing excited me. In reality, it scares me.

a healthcare path that supports pt autonomy and respect..............oh my how nursing has fallen. Im very proud of pt centered care at our facility and im also proud of working in an area where nurses are treated with respect and have an active role in helping guide pt care. Im excited for the future.

[chuckster, ADN, BSN, RN, EMT-B]

Want to tell another story, during the last decade 20% of German nursing schools were closed, due to an oversupply and increased costs, DRGs, less governmental funding, lobbying physicians. More than 50 000 nursing jobs were cut down.

This is exactly the reverse of the situation in the US, where the nursing student population has increased significantly and continues to do so.

Now we can't find competent and skilled nurses to fill in acute care jobs - we have 3 job postings open since 10/2009!

This is way different than the US where there would be many qualified applicants for those postings - at least in many parts of the country.

On a med/surg. floor the patient/nurse ratio is 15:1, sometimes 20:1 (morning shift) and we don't have Techs, CNAs or LPNs. We have only nursing students and service aides working 4 hours a day.

This seems to be occuring in the US but not because there is not a sufficient supply of qualified nurses. In the US, it is increased pressure to reduce costs (if you're a non-profit) or increase profits (if you're one of the many for-profit hospitals) that is driving the nurse/patient ratio upward. Thankfully, the US is not at those levels - yet - but it seems to be increasingly common for med/surg nurses to have patient loads up 7, 8 or more. There are few states that are willing to take on the special interests and regulate ratios (California is one, not sure how many there are overall). Unions have also been successful in contractually demanding reasonable nusre/patient ratios but the power of unions is waning and will decline even further as the US electorate sends ever larger numbers of conservative legislators to Washington.

At some point, especially with a growing elderly population, there will be an increased demand in the US for all medical personnel, particularly nurses. I suspect strongly however that the supply will be there, given that there is no indication that the supply of nurses is or will be declining.

[Trinitas2010RN]

This is NOT even funny (so sad)

While these pictures were a response to a funny post earlier in the tread.

The Robots in these pictures are for real and may become common in the work place.

RIBA robot nurse bear ::: Pink Tentacle

Grand Rounds: New and Innovative! // Emergiblog

Kiwi Researchers Develop Robo Docs To Treat Patients - Gizmo Watch

[pbstrums]

I have been a nurse since 1971. Regarding the BSN, back in the day this was something you aspired to if you wanted to be in leadership or management. So I chose to be an AD RN. My interest was and is bedside hands on patient care. I understand the rationale of having the BS degree, and for new entry programs would encourage it. However, is there anyone advocating for the AD nurse with over 35 yrs of dedication, strong work ethics and dependability etc? It saddens me, that as a AD RN I am made to feel almost worthless because I do not have a BSN.

I worked hard for my AD, 3 jobs plus raising my 2 children by myself. The stress was so intense that when I finished school I could not put my children thru that for another 2 yrs. Then they went to college and I am still paying for it (so are they). So, it is not like I can just say sure I will go back to school because financially I can not and there is no way I can work OT and go to school. Though the hospital would help financially they only cover a certain percentage. At 59 I do not want any more loans. So I am hoping that someone will advocate for the AD nurse, and the fact that we never stop learning just because we are out of school. In order to maintain our license there are requirements that must be filled, competencies etc.

The general public is made to believe that AD RN's are substandard and do not realize that we are constantly learning thru conferences, courses, certifications etc.

Regarding the robot RN. Yes it is sad but this is something that is actually in process in Japan at Toyota Memorial Hospital. Look it up if you have the time.

Thank you

[organichombre, ADN, BSN, MSN, LPN, RN]

Except for the LPN's who were already onboard, hospitals will be staffed with RN's and some sort of nursing assistant. Our patient to staff ratios will fluctuate greatly dependent upon who you work for; Federal government (better ratios but more rules), private (more patients, less independence), general hospitals (more patients, more paperwork). Unions may or may not help us out depending upon how many nurses embrace this representation. Nurse pratitioners and clinical nurse leaders will be on the floor in ICU's and the floor to guide care since MD's will be seen less and less in the acute setting. Nursing schools will continue to be overwhelmed with prospective students but these new fly by night schools will finally start to be held accountable and accredited. With more research and best practice scenarios, MD's and Nurses will reach a point where standing orders are more common, alleviating the need to call docs for everything. A national Chief Nurse position will be created and appointed by the President and the first one will be a past president of the ANA. Will nursing care improve???I'm not convinced but as I approach retirement I'm hoping so!

[Guest717236]

However, is there anyone advocating for the AD nurse with over 35 yrs of dedication, strong work ethics and dependability etc? It saddens me, that as a AD RN I am made to feel almost worthless because I do not have a BSN.

Same for diploma RNs. Many of us went to programs where the class consisted of mature second career students who had BS and MSN degrees in other fields. Our program at a major teaching hospital was excellent, in

both theory and clinical.

Why are strong work ethics,dependability, dedication, responsibility and personal career improvement not honored?

I think one problem is the constant change

of requirements and "throwing out" the experienced individuals to soon while they still can contribute to nursing.

Read all the books, take all the tests, but until you have spent time working with nurses like pbstrums who can show you how to manage situations that are not in the textbook your studies are not complete....

To pbstrums-

Please do not feel almost worthless, your license as an RN

and the countless hours of devotion to your patients care is the

nursing we signed up for...and quality care we have given.

[groanup]

In almost 24 years of nursing I've seen all kinds of predictions for

the future. Nurses would form their own companies and contract

with hospitals for services. Nurses would bill patients separately

for services. Nurses would direct care and the all grunt labor would

be done by ancillary staff. The shortage would never end.

Nurses would enjoy higher pay, increased autonomy, and more

respect.

Shortages have come and gone. Nurses' pay has not kept pace

with the real cost of living. And who would have said ten years

ago that we would be turned into waiters and waitresses, more

focused on "customer satisfaction" than on safe care and good

outcomes?

This post has every opinion across the board. The truth is,

no one can say for sure which way things will go, because we still

don't have that much- ballyhooed autonomy. I can predict this,

and I think I'm right- - patients will continue to get fatter, they and

their families will become more demanding, and nurses will be

expected to do more with less.

Incidentally, all you people demanding the almighty BSN

for entry level practice:

I have a nursing diploma. I paid my own way, had a house payment

and car note and couldn't have afforded another two years of school.

Don't talk to me about student loans, Reagan was president and

there were no student loans for anyone.

Since graduating in 1987 I've worked in many different ICUs- -

trauma, cardiac, neurotrauma, closed head injury, open heart,

transplant. I currently work one job in an ICU and another on a

rapid response team. I am ACLS, TNCC (trauma nursing) and ENPC

(emergency pediatrics) certified. I have been in many critical

situations and have done all the amazing things that nurses do.

I consistently receive high marks from managers, co-workers,

patients and their families. At the age of 56 I can generally run

circles around many of my colleagues, regardless of their education

level. They often ask for my help or advice. An advanced degree

is no guarantee of critical thinking, a skill very much needed

at the bedside.Can someone please explain to me why

not having a BSN all these years is a bad thing?

**

* *

[SnowRox]

Same for diploma RNs. Many of us went to programs where the class consisted of mature second career students who had BS and MSN degrees in other fields. Our program at a major teaching hospital was excellent, in

both theory and clinical.

Why are strong work ethics,dependability, dedication, responsibility and personal career improvement not honored?

I think one problem is the constant change

of requirements and "throwing out" the experienced individuals to soon while they still can contribute to nursing.

Read all the books, take all the tests, but until you have spent time working with nurses like pbstrums who can show you how to manage situations that are not in the textbook your studies are not complete....

To pbstrums-

Please do not feel almost worthless, your license as an RN

and the countless hours of devotion to your patients care is the

nursing we signed up for...and quality care we have given.

As regards ADN/diploma RNs, I must concur completely. Vocational skills and professionalism should always be the sole criteria used to judge any nurse's competence, and the vast majority of ADN/diploma RNs amply demonstrate both of these criteria day in and day out on the job. The BSN, at the end of the day, is still just a piece of paper; indeed, there are quite a few sub-baccalaureate nursing programs out there that produce RNs who are as well prepared or better than some BSN programs. My own program (community college) boasts a 98% first-time pass rate on the NCLEX-RN (better than several of the area BSN programs) and enjoys a strong reputation throughout the area for producing high-quality nurses. Being a returning student with BA degrees (both summa cum laude) in English and political science, my analytical and critical-thinking skills should hardly be called into question just because I lack a BSN; in fact, I plan to leverage those BAs into a berth in an MSN program (an option available at some schools), earning and learning on the job while studying part time (goal: NP) once I obtain my ADN and RN license. Clearly, then, the BSN is just not necessary for some RNs -- not only can you practice quite competently without one, you can even aspire to advanced-practice specialties without one!

Education and experience both have value, but there's nothing wrong with having different avenues for entry into practice, whether at entry level or even beyond. The only thing that ultimately matters is whether or not RNs demonstrate competence via the above-mentioned criteria in their practice, not what kind of alphabet soup you've accumulated behind your name or what bits of fancy paper you've got hanging on the wall. If you're good at what you do, you deserve respect -- and you should both demand it from others and show it to fellow professionals, be they neophyte CNAs or veteran physicians.