Even compared with other jobs in healthcare — an industry that made it through the heart of the recession rather gracefully — the job outlook for registered nurses is strong, with the number of jobs growing at an above-average rate.
But nursing schools are slow to change, and in order to graduate successful nurses who are prepared to enter the rapidly changing digital world of healthcare, there needs to be some changes in how nurses are trained and transitioned, says Beth Ulrich, Ed.D., R.N., FACHE, FAAN.
Ulrich is the editor of Nephrology Nursing Journal and a national thought leader on nursing education and workforce issues. Her new book, Mastering Precepting: A Nurse’s Handbook for Success, was published by the Honor Society of Nursing, Sigma Theta Tau International (STTI), out of Indianapolis, Indiana late last year.
When Investment Rhymes with Canada
Canada has a proud history of achievement in the areas of science and technology, and the field of biomanufacturing and life sciences is no exception.
She offered up her thoughts on the current nursing shortage, how healthcare reform is changing the field and what the rise of digital health will mean for the future of nursing.
We’ve heard a lot about a current nursing shortage — is there one, isn’t there one? What’s the deal?
There are two different things when we talk about a nursing shortage: a shortage of nurses and a shortage of nurses in hospitals. Over 40 percent of nurses don’t work in hospitals. There are nurses disguised in a lot of other job titles at insurance companies, pharmaceutical companies, nursing homes, etc. Most often when we’re talking about a nursing shortage, it’s in hospitals because it’s a very hard job with a lot of strange hours and it’s very intense.
I think we will need more nurses. What we’ve seen is that anytime unemployment goes up, nurses come back to hospitals. So a number of new grads haven’t been able to find jobs because more experienced nurses lost their jobs and went back to hospitals. Nurses who came back into hospitals during the recession are likely to leave as national employment goes up.
How is the supposed shortage being addressed?
Hospitals that are really foresighted are putting new graduate nurses through a residency program with a preceptor. It’s hard to get over the gap between nursing school and working in a hospital, and we were losing a lot of new nurses when hospitals weren’t doing that. Increasing numbers of hospitals have the residency program and the National Council of State Boards of Nursing has done research showing that “transition to practice” slows down turnover and gets them engaged.
It seems that more specialized-care nurses are in higher demand these days. Why is that?
With accountable care organizations, the concept is different than that you only take care of the patient when they’re in the hospital. Now you have to worry about them more before they come in and when they go home — there has to be continuity of care, which means more nurses with different sets of skills. Home health nurses, visiting nurses and public health nurses are becoming more needed.
At the same time, patients are sicker. As reimbursement has decreased, you’ve tried to make the patient’s stay as short as possible, so you’ve compressed their care. With ACOs, they can go home sooner, but that’s going to compress it yet again. So a higher severity of sickness means even more specialized nurses.
With schools of nursing, it takes them a while to change their curriculum. I don’t think a lot of the stuff that we need for ACOs these days is being taught in nursing schools. It’s one of those things where you teach them when they get to the hospital. That’s what the residency is for.
What challenges to electronic medical records pose for nurses?
There are a number of schools that are starting to do some simulation of EMRs. If they’re in a hospital with EMRs, they have “plays pace” where you can document things, but it doesn’t really go into the chart. Some of the schools use human-patient simulators that can be connected to EMRs.
How has the role of the nurse changed as hospitals integrate more digital health measures?
Nurses have to have a broader knowledge base because they can’t just know about acute care nursing. The place where we have the most problems with communication is in hand offs, from different units or home. And it works from both sides — it’s also how you take the patient from the community. That’s why there’s the big push to get everyone on EMRs, so that everyone has the same information.
The insurance companies have really stepped up — when data comes in with drugs that shouldn’t be taken with each other, they say ‘no, no’. Some of the pharmacies have gotten better, too, but that assumes that you go to the same place every time. Those are the kinds of things where there’s no real captain of the ship
I think nurses are very well positioned to do that. They’re very holistic; they’re taught to take care of the whole patient. That knowledge base is a very good foundation for all the changes that are going on in healthcare.
[Photo from Flickr user salforduniversity]
