VISION FOR THE FUTURE OF NURSING In many ways this is a time of chaos within health care systems around the world. The economic downturn in the global society has impacted on health care. In many places services have been cut and access to services reduced. In addition, new diseases such as AIDS, SARS and the threat of bio-terrorism have entered our lives. New technologies and treatments occur rapidly, but are often expensive, and financing these advances can be difficult. Patients are moved out of hospital rapidly, and those that remain are more acutely ill than they have been in the past. Those discharged patients often need more assistance at home and in the community than in previous years, and those services can also be expensive. Nurses are a vital part of the health care scene, but nursing shortages have appeared in many areas, the nursing profession needs to begin to recognize new trends and patterns that are emerging in health care. 1. Rapid changes in health care technology and therapies likely mean continued lowered acute care stays. Driving forces include increasingly sophisticated surgical technologies that are less invasive and promote quicker healing. New therapies may reduce sick time, hopefully even in areas such as cancer, HIV/AIDS and genetic disorders. However, as those technologies have prolonged the lifespan, reduced mortality has changed fatal illness into more chronic illness, which may still require care and control. The growth of telemedicine, tele-nursing, and tele-health will also change the way we function, and have great potential and challenges for the development of new nursing roles. With lowered acute care stays, many more people will require care in their own communities. Nurses need to be better prepared to work within this area; financial issues of care provision need to be addressed and nurses need to be better prepared to work with chronic care needs. 2. Demographic trends, epidemiological trends, and health care statistics these help us recognize health care needs for society and give information for future planning of cost effective services. Increasing lifespan is a driving force for the development of improved services for the elderly. End of life care has received more attention over the last few years, but nursing research into this area needs to be further developed and findings disseminated. In many societies

immigrant issues have created the need for better cultural understanding of health care needs and require resourcesp for care. 3. Flow of resources. Where is the money going and where is it likely to go? Money flowing into health care in the community will be a driving force for changes in that area, but a blocked flow will be are straining force to preventive health care services. Nursing input and political power can impact that flow to provide effective health care program and services. 4.Supply of man power and competition manpower shortages or surpluses in health care professions impact the utilization of nurses and advanced practice nurses. Who are our competitors for delivery of services and resources? This is a particularly important area in times of nursing shortage to be sure that less qualified health care workers are not used to substitute for the sake of expedience and reduced costs. How can we develop competitive and marketing strategies? How can we form coalitions to reduce competition? At the same time we need to explore whether more collaborative programs of care can be developed effectively, so that we are not holding on to outmoded ideas of the profession but can develop newer modes, such as advanced practice nursing, to work in interdisciplinary collaboration. Collaborative rather than competitive strategies can strengthen quality of care by better utilizing the expertise of each participant. 5. Role delineation, role confusion. Are the jobs keeping up with the expectations of nurses and with advanced practice nursing? How are supports worker jobs defined? How do professional standards interact with reality? How many people are required to do the job? Can one person realistically do the job? How can job satisfaction be increased in this era of high stress in the workplace?

6. Public opinion. Nurses need to be aware of the public perception of their role. Development of coalitions and supporters within communities and media can be a driving force for advanced nursing practice. Consumer or professional opposition can provide barriers to practice, and be a restraining force. 7. Global trends. We are a global economy and health care services face similar problems Internationally. We can learn and benefit from contacts in other countries, and we can offer our services when appropriate to improve overall

healthcare in both developing and industrial countries. Global terrorism needs to be addressed, and nurses need to be well prepared to deal with the aftermath and to document its effects on those we care for. Nurse educators need to incorporate disaster training and stress counseling into the curriculum and to provide workshops in this area for nurses already in practice. It is essential that nurses participate in the political process to reduce this threat.

8. Nursing practice and theory. Nursing research and theory development need to be supported and findings disseminated to continue to build our nursing science and incorporate the results into practice. We need to increase our core of nurses who have met high academic standards for carrying out research and provide resources for their activities. Nursing research and theory also have the potential to contribute to the body of knowledge of other disciplines in the same way that we have borrowed from other theorists to use in our practice. The role of advanced practice nursing has been growing and has demonstrated effectiveness in the health care system. These nurses are now able to provide medical expertise in diagnosing and treating specific conditions, but are not mini-doctors. The medical portion of their practice is only one tool within their whole tool box of nursing competencies for use in providing holistic nursing care and health education. 9. Leadership within the profession Leadership within the profession also influences the trends in nursing. Nursing is moving towards professionalism due to the untiring efforts of nurses who have been dedicated to achieve the aim. 10. Working conditions Working conditions for nurses are also changing. There is a gradual change towards shorter and more convenient hours of duty, better accommodations and higher salaries 11. Patient¶s Bill of Rights After the development of the ³Patients Bill of Rights´, the nurses are also accountable for patients care and have legal responsibilities for the patient. FUTURE OF NURSING CAREER Predictions are that in 10 or 20 years, it will look nothing like it does today! With new technologies and drugs, changes in insurance and health care policies, and the shortage in nurses, the profession will have to reinvest itself. Many

nursing functions will be automated. For example, documentation and updating patient records, smart beds to monitor vital signs, bar codes, and automatic medicine carts could reduce the time and errors in dispensing medications, and voice-activated technology would eliminate the need to constantly write things down. Other nursing task such as serving meals will be taken over by aides. This would give nurses more time to provide a human touch to their patients. As a result of nursing shortages, healthcare facilities will be forced to use their nurses judiciously. Nurses will spend more time at the bedside as educators and care coordinators to refocus on the patient. With the lengths of patient stays shortening, nurses will have to make the best use of a shrinking amount of time hospital stays. Nurses will also spend more time in administration and supervision positions. They will need to know how to access knowledge and transfer it to the patient and their loved ones. NURSES FUTURE CHALLENGE The change in health care delivery systems has also afforded nurses a wider range of functionality. Although independence have been cultivated through expanded roles. Trends towards downsizing and the current nursing shortage have increased the use of non-licensed personnel in many healthcare arenas. This will continue to force the nursing profession to identify, clarify, and communicate its scope of practice. Advances in Technology: The explosive growth of technology will continue to have an impact on health care delivery. The advancements in telemedicine will link clinicians with patients across great distances. The growth of this technology will change the way nurses function, and lead to the development of new nursing roles. Electronic medical records are expected to replace conventional modes of documentation. X-ray films will be a thing of the past; x-ray images will be transmitted by computers and saved on floppy disc for retrieval and reviewing. As consumers become more educated about health promotion, there will be an elevated demand for alternative and complementary health care choices. The promotion of advanced directives, organ donation, and comfort measures for the terminally ill will lead to elevation in hospice care providers. Care modalities which include pain management, spirituality assessment and bereavement counseling will be incorporated into health care organizations and nursing education curriculums. Nursing research will greatly contribute in developing and implementing these therapy options.

Work Environments: Nursing's dissatisfaction with the workplace environment is another issue that must be faced when considering the profession's future. This dissatisfaction was multifaceted and included issues such as workplace violence, inability to attend continuing education programs due to heavy workloads, exhaustion, and inability to provide safe patient care. Mee and Robinson (2003) state that "nurses need work environments with strong professional practice models that value their work and recognize their impact on patient outcomes. Nursing Shortage : According to Wieck (2004), "nursing education is probably the most inflexible 'one size fits all' environment that exists today". More campaigns such as Johnson and Johnson's Campaign for Nursing's Future and the Oregon Center for Nursing's campaign, Are You Man Enough to be a Nurse, will need to be launched to bring more men and minorities into the profession. Other recruitment trends will be lower educational costs, greater access to federal loans and grants, and new educational methods including shortening the time required to become a registered nurse (Buerhaus, Staiger, & Auerbach, 2001). Globalization: Factors contributing to globalization include advances in information technology and communications, international travel and commerce, the growth of multinational corporations. Future nurses will face the challenge of maintaining a holistic approach to client care in an environment of growing specialization. Focus on health promotion, maintenance, and revitalization will continue to grow.

Costs control challenge : In 1970s, 1980s, and 1990 governmental budget deficits reached all time high. Government spends re money on health care system. Societies poor, homeless, elderly, substance abuse, AIDS and mentally ill patients are increased into country. The major question yet to be answered is ³How can we pay for health

care for these people and the numbers are expected to be increased? The central and state governments are seeking to answer that question. The next decades will see hospital closing is record numbers, pressures continuing to mount from business community forcing changes in financial health Care reforms.

NURSING AND HIGHER EDUCATION Most professions provide a single route for the educational preparation of its practitioners. However the development of nursing as a profession has resulted in major educational routes that prepare graduates to write the National Council Licensure Examination (NCLEX) for registered nurses. Nursing Assistant: Individuals called nursing assistant provide care to the patient in hospitals and long-term care facilities. Certified Nursing Assistant (CNA) works under the directions of RN or licensed Practical nurse. The training course may conduct at many settings-high schools, long term care facilities, hospitals, community colleges, and privately operated hospitals.

Practical Nurse Education: The practical nurse or vocational nurse no new comes into the health care delivery system. They could perform basic nursing procedure at home itself. The general curriculum for these people to take 7 years to complete. They have educational preparations at high schools, technical schools, hospitals, junior or community colleges, universities or independent agencies.

Diploma Education: Diploma program administered by hospitals and also referred to as hospital based programs. The programs vary in length from 24-36 months. They are affiliated with a college or universities. Associate degree education:

The movement toward in 1972, today associate degree nursing program prepare more graduate for licensure as RN¶s than do any other program. Baccalaureate Education: This program that occur in 4.5 years in colleges or universities. The program existed as a quasi autonomous branch of the university¶s school of medicine. In recent years the nature of baccalaureate education has changed they permit a degree of specialization at the same level . Masters program: After baccalaureate degree students are granted Masters Degree in nursing after completion of 2 years program .The research-based Master of Science in Nursing (MSc N) program provides the basis for leadership in professional Nursing and the foundation for doctoral studies. M.Phil: This program is of 1 year (full time) or 2 years (part time) after the completion of M.Sc. nursing. Doctoral programs: Nurses with doctoral degrees are expected to have tremendous job demand over the next ten years. These programs prepare nurses for careers in health administration (a PhD is the preferred degree for nursing executives), clinical research, and advanced clinical practice. The programs take from four to six years to complete, so they represent a significant commitment on your part. In a doctoral program everyone receives training in research methods (including statistics and data analysis), the historys and philosophy of nursing science, and in leadership skills.


The nurses in India are also prepared and more privileged to face the changes and ready to accept the challenging roles and functions of the nurse as perceived in the globe because of the development in the education and training system. The following roles and positions perceived as in the globe are given below. a . Nurse Educator works in schools of nursing, staff development departments. They provide the educational program for student¶s nurses and nurses, teach clients about the self-care and home care. b. Clinical nurse specialist specializes in managing specific diseases and they function as clinicians, educators, managers, consultants and researchers. c. Nurse practitioners are certified to provide health care to clients in outpatient or community settings. d . Certified nurse-midwife are certified by the American College of NurseMidwives to provide independent care for women during normal pregnancy, labor and delivery. e . Nurse anesthetist , having advance training in anesthesiology, provides surgical anesthesia to the client under the supervision of an anesthesiologist during minor surgery with baccalaureate degrees or master¶s degree. f. Nurse administrators manage client care within the healthcare agencies in a middle level or upper level management position. g . Nurse researcher with Doctoral degree investigate nursing problem to improve care and to define and expand the scope of nursing practice. Advancements in science increase health needs of the society and thereby expect changes in the role of nurses and thus increases improvement. NURSING IN THE 21ST CENTURY With the focus of clinical practice on evidence-based medicine, the relationship between nursing and the patient has become treatment-centered. Amidst the organizations and policy initiatives, the ever-changing technology, and the focus on healthcare costs, the nurse practitioner is faced with the need to find faster, simpler ways to provide care. Furthermore, many nurse practitioners practice in settings driven exclusively by the medical model and leave little room for

creative, caring approaches to practice Healthcare systems suffer from a lack of access and fragmented, costly care; there is also an overemphasis on technologic approaches to treatment. Not enough time is spent on health maintenance and disease prevention. In addition, there is little to no attention paid to the patient's emotional and social needs, nor to their particular pain and struggle. Troubled by this emerging paradigm for practice, nurse practitioners are challenged to envision how holistic, caring practices can change both the way that care is provided and the relationship between the patient and nurse practitioner -creating a partnership. The call is out to advanced practice nurses to imagine the possibilities for enhancing their caring practices in the 21st century. FUTURE DIRECTIONS FOR NURSING RESEARCH Nursing research continue to develop at a rapid pace and will undoubtedly flourish in the21st century .The priority of nursing research in the future will be promotion of excellence in the nursing science. Towards this end nurse researchers and practicing nurses will be sharpening their research skills and using the skills those skills to address emerging issues of importance to profession and its client. High focus on EBP: Concerted efforts to use research findings in practice are sure to continue and nurses at all levels are encouraged to engage in evidencebased patient care. In turn improvements will be needed both in quality of nursing studies and in nurses skills in locating, understanding, critiquing and using relevant study results. Development of stronger Evidence base through rigorous methods and multiple, confirmatory strategies: Practicing nurses are unlikely to adopt an innovation based on weakly designed or isolated studies. Strong designs are essential and confirmation is usually needed through replication (i.e. intentional repeating) of studies with different clients in different clinical settings and at different times to ensure that findings are robust. Expanded local Research in health care settings: In current evidence based environment there is likely to be an increase of small and localized research designed to solve immediate problems. It ensures that evidence from these small projects become available to other with similar problems.

CONTINUING EDUCATIONFOR 21ST CENTURY One need only scan a newspaper or read a weekly magazine to be astounded by the number of stories about new medical breakthroughs, disease processes, emerging threats of disease, or innovations in medical and health care technology. The World Health Organization warns us to prepare for a potential worldwide Bird Flu epidemic, terrorists threaten us with chemical, biological and nuclear weapons, and new protocols for ACLS are released. How is a working nurse to keep up? Nursing education provides the basic building blocks of medical, scientific, and nursing knowledge, but competence in the nursing profession requires an ongoing process of continuing education. Continuing education for nurses is necessary for the nurse to remain up to date with the latest practice issues and it is necessary for patient¶s safety as well. Some states have made continuing education for nurses mandatory and require a certain number of course credit hours be attained before license renewal, or require certain mandatory course subjects, while other states leave it to the nursing professional themselves to accept a personal responsibility for their own continued learning. Regardless of whether nursing continuing education, or Nursing. Methods of obtaining nursing continuing education hours and the pros and cons of each: 1. Professional Journals: Most professional nursing journals offer an article for continuing education credit. Some offer a partial credit hour or one credit hour to readers who fill out a post test after reading the article and mail it in. While some journals offer the credit for free, others charge 10 or more and in addition to the inconvenience of needing to tear out a post test form and mail it in the nurse has no official record of having taken and passed the course. Obtaining continuing education hours through professional journals is costly and inefficient in that the cost of the journal itself must be taken into consideration along with the cost of the course if there is one, and the time and expense of mailing in addition to the lack of official record of completion and lack of central maintenance of all credits accumulated by the nurse. 2. Seminars: Professional development programs and seminars that offer accredited continuing education hours for nurses are frequently offered at various locations in every state, in some foreign countries, and even on cruises. Employers frequently pay the registration fees for nurses to attend local

seminars of short duration such as one day, but nurses still have to sacrifice their precious day off to attend them or lose time from work to do so. In addition nurses who attend seminars away from home have to pay their own travel expenses, hotel bills, and costs of meals. Needless to say cruises and foreign travel are an appealing avenue, but obtaining one's continuing education by that metho is not something every working nurse can afford to do. 3. Online Nursing : The internet provides nurses access to extremely affordable and high quality accredited continuing education courses covering a plethora of professional nursing topics. Online nursing courses are the gateway to nursing continuing education for the 21st century! Nurses who take advantage of online courses are not restricted by geographical barriers, financial hardships, or the inconvenience of taking time from work or family in order to attend courses. Online nursing continuing education courses are readily available for both mandatory state required subjects, courses in one's own nursing specialty, and courses that all nurses regardless of practice specialty need to be familiarized with so nurses have access to a much broader choice of subject matters than they ever had before when restricted primarily to journals or seminars. In addition to those benefits, substantial as they are, online nursing courses are inexpensive, up to date with changing trends, can be taken from the comfort of one¶s own home, generally allow nurses who take them to keep an official record of courses completed and credit hours earned online with the course provider, and allow nurses who complete a course to print the course certificate immediately upon completion. In order to stay professional and to safeguard the wellbeing of the public nurses need to continue their education over the course of their career through a variety of means including taking continuing education courses. The most convenient and most cost effective method of nursing continuing education is by taking online Nursing courses.

4.Conference: Many continuing education opportunities involve attending a conference with people. Extroverts generally love the chance to meet people from all over the country, sometimes the world, face to face. The networking they accomplish is a huge benefit of attending conferences. There¶s power beyond learning in meeting peers face to face. Take advantage of all the opportunities your next conference presents. New Ideas: No matter how much we think we¶re at the top of our field, there¶s always room to learn new ideas. People are different in so many ways, and they think and work in many different ways. There can be myriad strategies for approaching . Why reinvent the wheel when you can meet with peers and find

out what they¶ve learned through trial and error, what they have found to be best practice. Networking: Gathering with health care professionals is the most effective way of networking. Opportunities: Opportunities abound at conferences, especially if you network. Every conference-goer has stories about the great opportunities that arose. Inspiration: Conferences usually include keynote speakers chosen not only for their message and their expertise, but for their enthusiasm and ability to inspire. Grab a seat up close in these sessions and listen carefully. Enthusiasm is powerful, and it¶s contagious. Take it back with you. Learn to Love Conferences: A conference can be the highlight of work year if made the most of it. Learn to love conferences, they can provide with all kinds of opportunities and great experiences. Plus, they can make work more enjoyable. 5.Workshops: Change is something the world will continue to experience for eternity. On the same note, it is important to understand that change does not happen selectively. It is across the board. As the world progresses, so do all the industries because of technological advancement. Some ways of doing things are being faced out as other change oriented techniques are adopted. For instance, news skills are imparted in the education institutions daily. For this reason, the syllabus is changing with introduction of new courses. This does not mean that those who went through the previous system are half baked. What these individuals need is refresher training in order to acquire new skills. Therefore, it is important for adults to undertake the continuing education workshops. This entails training sessions for people who hold college or university training. On the same note, this form of training has already been adopted by some professions. Examples of these include nursing, law and teaching. The professionals in these fields enroll in the courses to refresh their skills in their line of specialization. It also helps them beat the competition especially for those who are in private practice. Additionally, since this change is inevitable, it is not strange to find organizations that are enlisting their staff. The characteristics of these classes are different. Some may be in form of seminars, study online programs or even conferences. The duration of the workshops also differs. It can be a one day affair, weeks or months. When a person wants to enroll in the continuing education workshops, it is important to

look for one that fits the profession the individual is in. The person needs to register, meet the requirements and the fee. These three factors depend with the course, the duration, the certification to receive once the workshop is over and the location of the continuing education workshop.

Within the frame of reference, many changes are occurring that will have a dramatic and long term activity. Technology and change are moving at such an accelerated rate that it depends upon the profession to respond approximately. The following are skills and processes which will have special implications for nurses as they begin to expand their frame of reference to incorporate their role that of other health professions is defining health care delivery in the future. 1. Role in Planning Perhaps this is the most significant role for the future for which nurses must be prepared in their responsibility is the planning forum of health care delivery. Much nursing in the past had been of a clinical services. Now the nurse manager is well prepared to assume leadership and take responsibility for making key decisions in groups that are deciding issues of policy and setting direction for the future of healthcare. The opportunities are available, the challenge is to be prepared to recognize and accept them when they arise. 2. Business of healthcare Nurses must recognize that healthcare is more than a service. While service is a major component, it is a fundamentally a business (US). It will require nursing practice in the future to be aware of cost constraints and to be become more efficient and reduce expenditure. The proliferation of collegiate nursing and to the development of conceptual thinking to guide in practice of nursing. 3. Cost Accounting for Nursing Nursing has not been looked in the content of its value and contribution to the institution as a whole. The non-revenue related approach to the costing of nursing services to the disadvantages of hospitals over the long time as to the fundamental value, contribution and cost characteristics of such services. Without addressing that particular issue, hospital viability in relation to its primary practitioner has always been questionable. This will no longer be true in the future. Mechanisms are being developed to identify the cost characteristics of nursing. Time and its value to the delivery of services will be the cornerstone of the costing system. Time is what a nurse offers just as does any other professional. This cost-based on

all the nurses offer so that their cost characteristics can be identified clearly in any setting or any time. 4. Business and industry interests The key in the future will be creatively and cost effectiveness. Nurse will utilized in creative and cost effective ways. The challenges for nurses will be provided the industry ways in which they can be utilized in new and creative ways. Historically, nurses have filled roles that have often been prescribed by others for them. While the industry is changing, opportunity exists for nurses to create and develop roles that give evidence of needed services. Areas of wellness, health maintenance, care and counsel of the aged, healthy lifestyle, education from childhood to retirement provide some of the cost effective services. 5. Transitions of Illness to Health In the past nurses have been exposed to patients when illness has occurred already. A major responsibility of nursing in the future will be to focus on preventing illness, maintaining health, and changing those lifestyles conditions that have contributed to illness. But, the significant change in the delivery system is the slow social transformation away from focusing on illness toward focusing on health or wellness. Health obviously is much less expensive than illness. Nurses can play a major role in providing service that maintains health. Participating is that transition will be an important part of the leadership role of nursing is the future. 6. Joint Venture Healthcare Services Joint ventures encourage participating in the risks of delivery and specific health services with the hope of sharing in the result and revenues. They provide opportunities for individuals and groups to invest in a project that can produce value to the users and to the health professionals participating. Joint venturing with physicians, other health professionals or hospitals provides a framework for nurses to offer specific services of value to consumers that can provide rewards to the nursing professionals as well as those with whom they collaborate. Nurses will find almost unlimited opportunities in joint ventures. For example, health and nutritional services, specialists in those fields, health and exercise programs with exercise physiologists and other rehabilitation specialists, psychiatric services with psychiatrists, psychologists and social workers.

CONCLUSION Nursing as it exists today has come a long way, withstanding the ups and downs that social, political, economic religious, cultural, technological changes have put forward. These factors such as religion, economy & culture have a major impact on the entrant. ³The only thing that is constant is change´ Lord Krishna in the ³Geetha´ Futuristic nursing can be classified in terms of nursing education, nursing Practice, nursing Research, nursing administration and an amalgamation of all the four components which might occur in years to come

College of nursing dhamtari



Submitted to: Mrs.S.Victor MSc.Nursing Lecturer College of Nursing Dhamtari

submitted by: Ms.Eudora Blah MSc Nursing 1st yr College of Nursing Dhamtari

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1. McGee Paula, Castledine George Advanced Nursing Practice 2nd Edition 2004 Pp.121-123 2. Rolfe Gary, Fullbrook Paul Advanced Nursing Practice 1998 P.132 3. Barker Anne M,Advanced Nursing Practice:Essential for the Knowledge of Profession, 2009 Pp.232-233 4. Hamric Ann B, Spross Judith A, Hanson Charlene M. Advanced Nursing Practice, An Integrative Approach, 2000 Pp.45-46 5. Advanced Nursing Practice:A National Framework, Canadian Nurses· Association 6. McGee Paula,Advanced Practice in Nursing and the Allied Health Professions, 2009 Pp.90-91 7. Cody William K.Kenny Janet W.Philosophical and Theoretical Perspectives for Advanced Nursing, 4th Edition, 2006 Pp.13-14 8. www.scribd.com 9. Jansen Michaelene P., Zwygart-Stauffacher Mary Advanced Nursing Practice:Core Concepts for Professional Role, 2009 Pp.78-79 10. Schober Madrean, Fadwa A. International Council of Nurses, Pp.23-24

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