Nurses in America: Where They’re Going, Where They’ve Been


The field of nursing is at a critical juncture. Greater access to health insurance, an aging population and decreases in the number of primary care physicians mean more patients and less support in a rapidly changing environment. At the same time, nurses are also standing on the cusp of new possibilities thanks to advances in health research and greater access to technology.

Nurses in America

Nursing is in demand. The Bureau of Labor Statistics expects nursing positions to grow faster than average over the next decade. The field also has a proud history; Florence Nightingale and Clara Barton are household names (click here to see a timeline of nursing in America). To enable nurses to perform at their best, healthcare providers, universities and government agencies need to keep four best practices in mind: freedom to practice, better education, improved occupational care and access to technology.

Giving Nurses Freedom to Practice

Outdated regulations often prohibit nurses from practicing at the apex of their skills. For instance, each state has different regulations governing whether advanced practice nurses can examine patients, order and review lab tests, admit patients into hospitals or prescribe medications. More medical students gravitate toward specialized fields rather than general care, and this places a heavier workload on nurses in many environments. In many cases, nurses could take on more responsibilities to help their patients, but federal and state regulations limit their roles.

According to the journal Nursing Economics, limited access to nurse practitioners (NP) costs the American health care system an average of $9 billion per year.The congressional Office of Technology Assessment estimates that NPs could perform 80 percent of adult primary care duties and 90 percent of primary pediatric care duties. NPs tend to receive higher patient satisfaction scores, and they’re less likely to prescribe medication for minor problems. In fact, giving NPs full freedom to practice can fill primary care physician shortages in inner cities and rural areas, and NPs can take care of patients at a lower cost with higher patient satisfaction.

Providing Better Education

To take on more responsibilities, nurses need more extensive education. However, only 50 percent of nurses have a bachelor’s degree, and even fewer nurses have masters and doctoral degrees. The Robert Wood Johnson Foundation’s Initiative on the future of nursing suggests four ways to improve nursing education:

  • By 2020, 80 percent of nurses should have baccalaureate degrees. Academic institutions need to explore funding and partner with accreditation agencies to expand access to these programs.
  • Double the number of nurses with a doctoral degree by 2020. Advanced degrees would give nurses a presence in academia and expand opportunities for research and leadership.
  • Establish nurse residency programs.Nurseswho complete pre-licensure programs, earn advanced practice degrees or transition into new specialties should complete residency programs for supervised on-the-job experience.
  • Encourage continuing education. Nurses, nursing students and nursing faculty should be expected to earn meaningful continuing education credits.

Improved Occupational Care

Nurses are increasingly vulnerable to on-the-job stress and workplace injuries. Needlestick injuries, followed by sprains and strains, are the top causes of missed workdays. However, only 34 percent of nurses report work-related lower back pain, although 12 percent of nurses have thought of leaving the profession because of lower back pain.

Stressors related to shift work, work overloads and staffing patterns not only affect nurses’ mental health but also contribute to a high incidence of workplace injuries. In addition, nurses and nursing assistants are vulnerable to injury from patient attacks. Losing nurses to injury affects quality of care and costs hospitals millions of dollars each year. For these reasons, health care providers need to reexamine scheduling, and they need to improve the physical work environment.

Greater Access to Technology

Better technology can improve patient care and decrease nursing workloads. For example, using cloud-based Web messaging or text messaging for medication reminders can significantly cut patient readmissions. Technologies like telemedicine are allowing advanced practice nurses to provide consultations for patients who can’t make it to the physician’s office. Giving nurses access to patient data can help them make better clinical decisions. Providing technology sums up the message behind all four of these best practices: give nurses the training and the tools to do what the job demands.

About the author: Carol Tucker is a retired nurse, but she stays involved in the profession by giving workshops and by blogging.

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Category: Nursing Careers

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