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					Nursing in the 21st Century

          NUR 210
Nursing as an ART

w   “Nursing…its very essence lies in the
    creative imagination, the sensitive spirit,
    and the intelligent understanding that
    provides the very foundation for effective
    nursing care”. Donahue(1985)
Nursing as a SCIENCE
w Nightingale identified nursing as a scientific
  discipline separate from medicine
w Educational foundation and basic college
  credit in scientific disciplines R/T nursing
w   1950’s                     w   1960’s
    • Code of Ethics (ANA)         • Post BSN programs
    • 1st CNS programs               increase
    • Nursing Research first       • Nursing researchers
      published (1952)               pioneer clinical
                                   • International Nursing
                                     Index categorizes
                                     worldwide nursing
Highlights                       w   1980’s
                                     • MS and Doctorate
w   1970’s                             programs increase
    • NP in expanded roles           • Prof. Nursing journals
      gain national visibility         increase
    • Nurses Coalition for           • More nurses are
      Action in Politics               nationally “certified”
      formed                           in 17 specialty areas
    • ANA creates AAN to             • STTI increases its
      honor outstanding                membership
      nurses                         • NIH has a National
    • Nurse theorist come              Center for Nrsg. Res.
      into national spotlight
Nursing Professionalism
  at a Crossroad
w   Briefer professional hx than the traditional

w   Has been and continues to be primarily a
    women’s occupation
w autonomy and independent decision making
w career commitment
w collegial relationships
w professional worth or rewards
Contemporary Nursing Issues
    • extended and expanded role for nurses

       • Role: a pattern of behavior associated with a
         distinctive social position

       • Extended role: a role lengthened in a unilateral
         manner (PA)

       • Role expansion: multidirectional spreading out (NP)
What services should nurses
w   The profession with help from society it
    serves should decide what services to offer?
    •   Managed care
    •   Professional competition
    •   Chronic conditions
    •   Aging population
How should nurses be educated?
w Half of RN’s are ADN
w Need for master’s prepared nurses as
  clinicians, managers, administrators, and
w Doctoral-prepared are needed as leaders in
  all specialty areas, including education and
What payment should nurses
receive for their services?
w Retrospective reimbursement
w Prospective prepayment
w Managed care = managed cost
w Better paying positions requires advanced
What will be the influence of
nursing on health care policy?
w   Viewed as colleagues of other health
    professions rather than as extensions

w   Other professions has issues about unique
    services, educational preparation, and
    payment of services.
Changing Images
w Diversity: most nurses are white and
  female, great need for multicultural
  diversity, as well as more men
w Specialty areas:
    • Clinical: age groups, illnesses, abilities or
      disabilities, and locales

    • Functional: management/administration,
      research, and teaching
Traditional vs. Nontraditional
Career Options
w   More practice options are possible

w   Trend toward more advance preparation

w   External barriers to practice options are
    presently decreasing, but have the potential
    to go either way
w   More attempts are being made at
    collaborative practice

w   Move toward primary care and community
    and home health care

w   Increasing emphasis on wellness programs
    in schools, residential living communities,
    and industry
Nursing Options
w Nurse-practitioner
w Clinical Nurse Specialist
w Nurse-midwife
w Nurse anesthetist
w Case manager/clinical manager
Future of Practice Options
w   Must take leadership roles

w   Need to find or generate job opportunities
    that allow them to practice as prepared and
    grow to their full potential
Nursing Functions
w   Dependent: performed under delegated
    medical supervision or prior routines

w   Independent/autonomous: initiated as a
    result of own knowledge and skills

w   Interdependent: overlapping functions
    shared between nursing and medicine
Educational Requirements
w ADN: 2 years (minimal to be RN)
w Move to see the BSN as eligibility to
  receive professional licensure
w Prepare for generalist, entry-level staff
  nurse positions
w MN, MS, MA
w DNS, PhD, DN, JD, EdD, DPH
Nursing Education: Future
w Changing Student Profile
w Educational Mobility
w Shortage of Qualified Nursing Faculty
w Technology and Education
w Changing Health Care Settings
w The Aging Population
Research and Theory
w Clinical trials, intervention research, or
  experiments conducted in the real world of
w Theory development is needed to guide
  research and increase nursing’s scientific
w “New science” with much uncharted
Manage or Administer Health
Care Organizations
w   Skills related to management, leadership,
    and fiscal responsibilities

w   BSN provide these courses
Teach Consumers or
w   Teaching self-care and resolution of
    responses to pathology

w   Opportunities to teach outside the hospital:
    shorter stays and increased severity of

w   Need for nurse educators
w a contractor and also someone who
  undertakes projects requiring
  unconventional activity and some risk
w 20th century: private-duty nurses
w screening, counseling, and instruction
  before same-day surgery
w home health care planning and coordination
w alternative birthing arrangements
New Wave of Technology
w implants, genetic therapies, imaging devices
w medical artificial intelligence such as
  computer-assisted surgery, ECG and fetal
  monitoring interpretation, clinical dx., and
  genetic counseling
w telemedicine
w devices for home use
Computer Skills
w NIC/NOC: computerized interventions and
w Word processing, file management,
  accessing information
w Data management for staffing and
  scheduling, accessing expert practice
  consultants, finding appropriate educational
  material for client-patient use
Nurse Informatics
w 1994 ANA recognized the field of nursing
  informatics (NI)
w integrates nursing science, computer
  science, and information science in
  identifying, collecting, processing, and
  managing data and information to support
  nursing services
w certification available
Sports Health and Physical
w Interest in prevention
w Lifetime individual sports offer potential
  involvement of an entire society
w Physical fitness of children
w Fitness facilities in the workplace
Pioneer in Space Health
w Expert care and sensitive communication
  will be basic to prolonged confinement
w New information: weightlessness, sleep,
  nutrition, exercise, and mobility, stress,
Create Dual Careers
w   Artistic or Analytic
    • music, art, drama (pediatrics, mental health)
    • verbal skills, writers, high tech, people persons
w   Law and business
w 1983: 1st major article about AIDS for
  general public was published
    •   difficult disease to catch
    •   CDC Universal Precautions
    •   OSHA is enforcing CDC guidelines
    •   Care required by AIDS clients in not unique
Health Care of the Elderly
w Isolated by: early retirement, trend away
  from extended families and the trend toward
  segregated retirement communities
w Most pervasive security need derives from a
  common fear of neglect
w Changes in Medicare, Medicaid
w 2010: >40 million > 65
Similarities of Care
w Misunderstood and ostracized by society
w Decreased functional abilities and
  increasing dependency on others for
w Susceptibility to infection
w Nurses can be caregivers, respectors of
  personhood, advocates and teachers
w   Continue Professionalism of Nursing

w   Extend Practice through Research

w   Increase Public Awareness of Nursing’s
    Contribution to Health Care

w   Increase Nursing Influence on Health Care
    Policy and Delivery
w   Become More Globally Aware

w   Increase the Number of Nurses in Health
    Care Leadership and Administrative Roles

w   Achieve Cultural Diversity and Gender
    Balance in Nursing
w   Need to learn about health care beliefs and
    practices of other cultures

w   International nursing forums

w   Nursing and health care products,
    publications and methods and the expanding
    nursing knowledge will find new
    possibilities in a global economy
Social Change
w   “Three driving forces--aging, technology,
    and costs--will reshape health in the future”

w   1.6 million new jobs are projected in the
    health care industry from 2000 to 2010. RN
    account for more than a third of these jobs.

w   A shortage of more than 1 million nurses by
    the end of this decade.
Medicine and the Public Eye
w   15,000 Web sites that offer some form of
    medical advice

w   Nurses are a resource for consumers
    regarding how to find and evaluate medical
    information via the Internet.
Quality of Care
w Health care as a “purchase”
w Nurses in a position to offer the best
  services for the best prices (role of NP)
w Health care will be a focus on the value of
  the product
w Quality measures will direct our activities at
  work and require us to constantly maintain a
  level of excellence
National Health Expenditure
w   1.5 billion in 2000, 2.2 billion in 2005

w   move from inpatient to ambulatory services

w   outpatient and home health care costs grow
    at 10% per year.

w   Hospital spending grew at < 3% per year.
“IMAGE” of Nursing
w   Directly related to what the profession
    offers society and the value placed on that

w   “Nightingales” TV program d/c due to
    public outcry from nurses

w   “Pearl Harbor”, “ER”, Desert Storm

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