The role of nurses is one that is undergoing constant redesign as the profession seeks to deal with various challenges emerging due to the changing healthcare landscape and patients’ needs. Currently, graduate training has enabled nurses to go beyond their historical job description of assisting physicians without adding their input to now being able to independently assess, diagnose, and manage problems affecting their patients. However, various policy-makers have currently limited the ability of nurses to practice to the full scope of their training. Nevertheless, increased advocacy and demand for medical practitioners may enable nurses to obtain the privileges they need. Another key issue in nursing is the absence of nurses in policy-making despite the fact that they are the best advocates for patient needs. Consequently, the lack of a patient-centered approach that nurses could have provided has led to hospitals being business-oriented leading to care being compromised to some extent. As a result, there is a need for nurses to ascend into leadership positions that will enable them to engage in policymaking. Finally, the lack of a streamlined education pathway to entering the field as a nurse has led to nurses generally lacking competencies that would enable them to deal with current challenges. There is a need for the education system to be updated to ensure nurses are equipped with essential competencies that will contribute to their delivery of evidence-based care.
Three of the Most Important Issues in the Profession of Nursing Today
- Changing health care landscapes and patient needs have continually created challenges that have necessitated the nursing profession to evolve continually since its inception. Currently, there are various challenges facing nurses in health care such as the need to keep abreast with emerging technologies and evidence-based practices for patient care. Furthermore, improvements in nursing education have expanded the traditional scopes of practice for nurses. With patient numbers expected to rise in the coming decades due to an aging population and increasing prevalence of lifestyle disorders, this expanded scope of practice may help alleviate some of the pressure from the physicians who may be unable to cope with the numbers. However, there are challenges which currently inhibit nurses’ abilities to effectively undertake their roles. These include; barriers to nurses practicing to the full extent of their training, lack of nurses in health care policy-making, and an educational system that fails to prepare nurses to tackle emerging challenges in the field. Various researchers and institutions such as the Institute of Medicine (IOM) not that removing scope of practice barriers, empowering more nurses to seek leadership positions, and improving the education system for nurses will enable the nursing field to effectively respond to current and upcoming challenges in the healthcare industry.
Removing Scope-of-Practice Barriers
The Institute of Medicine (2011) noted that there are a number of barriers which are limiting the ability of nurses to practice to the full extent of their training and, consequently, their potential is not being tapped into by the healthcare industry. It recognized that should such barriers be eradicated, nurses will be able to improve the health care system by leading innovative strategies.
Advanced Practice Registered Nurses (APRNs), particularly Nurse Practitioners (NPs), are registered nurses who have acquired a postgraduate education that prepares and certifies them to assess, diagnose, and manage problems affecting their patients. To do so, they are enabled to order tests and prescribe medications. However, despite this training which enables them to perform some of the services traditionally attributed to physicians, many are unable to perform to the full scope of their training due to various barriers. They include Medicare requirements for physicians to exclusively conduct a history and physical, various state laws which prohibit NPs from gaining hospital privileges, and various hospitals which enact bylaws denying their APRNs privileges and credentials (Brassard & Smolenski, 2011). Consequently, NPs are required to refer their patients to physicians to be treated for conditions the nurses could have effectively treated and this is detrimental to the healthcare industry as the resources of the already limited physicians are further stretched.
The current state of this policy results from a differing opinion in the medical community. Oliver, Pennington, Revelle, and Rantz (2014) noted that there is an opinion in the medical community that it is not safe to reduce APRN practice regulation. This opinion occurs despite evidence showing that the quality of care between APRNs and physicians is comparable.
Currently, there are concerns that should the status quo be maintained, the healthcare industry will be faced with a crisis as the physician numbers will be unable to cope with an increase in patients resulting from an aging population and increasing prevalence of lifestyle disorders (Oliver et al., 2014). The Institute of Medicine (2011) also recognized that professional resistance from physicians will play a significant role in preventing APRNs from practicing to their full scope of training. Consequently, this will contribute to the healthcare industry being strained in future.
Effective Nurse Leadership
The IOM recognized the need for empowering nurses to create a future where they are leaders. It called for the creation of full partnerships between nurses and other health professionals in the redesign of healthcare in the country (Institute of Medicine, 2011). This need was necessitated by the historical view of nurses by the public, administrators, and policymakers as being workers who are meant to carry out instructions given by physicians rather than the strategic thinker who can act independently and make informed decisions. Due to the nature of their work, nurses are more aware of patient needs and act as their advocates but their limited influence in policy-making limits their ability to influence policies to improve patient care from their perspective. Huston (2014) noted that current challenges in healthcare have resulted from the absence of nurses in policy-making and the vast influence of government, pharmaceutical manufacturers, and insurance in making policies. Consequently, the autonomy of health providers to offer care has been reduced due to the proliferation of managed care and this need to reduce health care costs has negatively impacted the quality of care patients get.
A major reason for the absence of nurses in policy-making is the perception that they are not revenue generators for hospitals, unlike physicians. Furthermore, the possible patient-centered approach that nurses would approach should they develop policies are likely to impact the financial performance of hospitals negatively. Another reason why nurses are excluded from policy-making is their limited expertise in serving in the role of the trustee which may limit nurse leaders’ understating of their responsibilities such as in fiduciary obligations (Hughes, 2017). As a result of these views, the penetration of nurses into leadership roles has been severely limited.
Hughes (2017) noted several concerns that are inhibiting nurses from becoming leaders. These include the unavailability of leadership education for nurses, lack of structured pathways for nurse leaders, and lack of funding for such programs. Consequently, these issues are likely to hamper the development of leadership in future.
Improving the Education System for Nurses
As it currently stands, the nursing profession lacks a streamlined educational pathway to enable one to practice as a registered nurse. Nurses can acquire a license to practice by obtaining a baccalaureate degree (BSN), associate’s degree (AND) or a hospital-based diploma program. The Institute of Medicine (2011) called for the improvement of the education system to promote seamless academic progression so that nurses can achieve higher training and education levels.
This issue stems from the fact that nursing education is based on the same formats that were developed in the previous century yet the current healthcare landscape has changed drastically. There is a greater demand currently placed on nurses that the current education system is struggling to cope with. Due to care environments and patient needs becoming more complex, nurses require new competencies such as health policy, leadership, evidence-based practice, and system improvement among others. The Institute of Medicine (2011) recommended for more nurses to acquire a BSN education as this introduces the students to a wide host of competencies that they require for their practice when compared to the other pathways. It also places a strong emphasis on the need for schools to invest in preparing their students for graduate education as this will enable them to pursue roles in research, teaching, advanced practice, and leadership.
Sebastian, et al. (2017) recognized that hospital-based diploma programs and ANDs offer their students more field practice while BSN students have a stronger emphasis on academia. In my opinion, should BSN programs not be modified to accord their students more practice opportunities to enable them to integrate their academics with practice, then there may be future resistance towards the creation of a streamlined educational pathway for nurses.
The role of nurses in healthcare has been traditionally understood to be that of workers who carry out physicians’ instructions. However, this notion is being challenged by expanding education in nursing that enables graduate nurses to perform tasks that were previously limited to physicians. Despite evidence that APRNs perform comparably to physicians and the need for more practitioners stemming from a shortage of physicians, many APRNs are unable to deliver care to the scope of their training due to various barriers such as state regulations, hospital bylaws, and Medicare regulations. Another challenge nurses face is their lack of inclusion in health care policy-making. Consequently, hospitals have placed more emphasis on financial issues at the expense of patient care. Nurses are most aware of patient needs and their inclusion into leadership positions will enable them to advocate for the patients’ behalves for the implementation of policies that improve patient care. Finally, another challenge facing nurses today is the lack of a streamlined education pathway into the career. Consequently, most nurses are inadequately trained to deal with the current challenges in healthcare and do not possess some crucial competencies to enable them to carry out their roles in the current environment.
There is a need to work towards a future where ARNPs and medical practitioners work together rather than in rivalry if patients are to access affordable and appropriate care. Moreover, the unique perspective of nurses means they are best placed to contribute to developing policies for providing the best care to patients and they should, therefore, venture into leadership. Finally, the growing requirement for new competencies for nurses based on current developments in health care calls for a stronger emphasis on the education system to produce nurses who can deal with the challenges.
Brassard, A., & Smolenski, M. (2011). Removing barriers to advanced practice registered nurse care: hospital privileges. Washington, D.C.: AARP Public Policy Institute.
Hughes, V. (2017). What are the barriers to effective nurse leadership? A review. Athens Journal of Health, X(Y), 1-13.
Huston, C. J. (2014). The nursing profession’s historic struggle to increase its power base. In C. J. Huston, Professional issues in nursing: challenges & opportunities (pp. 310-326). Baltimore, MD; Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Institute of Medicine. (2011). The future of nursing: leading change, advancing health. Washington, D.C.: The National Academies Press.
Oliver, G. M., Pennington, L., Revelle, S., & Rantz, M. (2014). Impact of nurse practitioners on health outcomes of Medicare and Medicaid patients. Nursing Outlook, 62(6), 440-447. Doi: 10.1016/j.outlook.2014.07.004.
Sebastian, J., Breslin, E., Trautman, D., Cary, A., Rosseter, R., & Vlahov, D. (2017). Leadership by collaboration: Nursing’s bold new vision for academic-practice partnerships. Journal of Professional Nursing, Doi: 10.1016/j.profnurs.2017.11.006.