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Submitted to

Submitted by:
Mr.Ramdhan Gilla Manu
M.Sc(N) 1










+isin ,r the ,uture , nursin!
-uture , Nursin! careers
Nursin!.s ,uture challen!es
Nursin! and hi!her educatin
Chan!in! rle and ,unctins , nurse
Nursin! in the "1
-uture directins ,r nursin!
Cntinuin! /ducatin ,r "1
Methds , 0tainin! nursin!
Cntinuin! /ducatin
1urnal re,erence
5n many 6ays this is a time , chas 6ithin health care systems arund
the 6rld. The ecnmic d6nturn in the !l0al sciety has im3acted
n health care. 5n many 3laces ser7ices ha7e 0een cut and access t
ser7ices reduced. 5n additin, ne6 diseases
Such as 85DS, S8RS and the threat , 0i4terrrism ha7e entered ur
li7es. Ne6 technl!ies and treatments ccur ra3idly, 0ut are ,ten
e93ensi7e, and :nancin! these ad7ances can 0e di;cult. <atients are
m7ed ut , hs3ital ra3idly, and thse that remain are mre acutely
ill than they ha7e 0een in the 3ast. Thse dischar!ed 3atients ,ten
need mre assistance at hme and in the cmmunity than in 3re7ius
years, and thse ser7ices can als 0e e93ensi7e. Nurses are a 7ital 3art
, the health care scene, 0ut nursin! shrta!es ha7e a33eared in many
The nursin! 3r,essin needs t 0e!in t rec!ni=e ne6 trends and
3atterns that are emer!in! in health care
. Rapid changes in health care technology and therapies li>ely
mean cntinued l6ered acute care stays. Dri7in! ,rces include
increasin!ly s3histicated sur!ical technl!ies that are less in7asi7e
and 3rmte ?uic>er healin!. Ne6 thera3ies may reduce sic> time,
h3e,ully e7en in areas such as cancer, @5+A85DS and !enetic
disrders. @6e7er, as thse technl!ies ha7e 3rln!ed the li,e
s3an, reduced mrtality has chan!ed ,atal illness int mre chrnic
illness, 6hich may still re?uire care and cntrl. The !r6th ,
telemedicine, telenursin!, and telehealth 6ill als chan!e the 6ay 6e
,unctin, and ha7e !reat 3tential and challen!es ,r the de7el3ment
, ne6 nursin! rles. Bith l6ered acute care stays, many mre 3e3le
6ill re?uire care in their 6n cmmunities. Nurses need t 0e 0etter
3re3ared t 6r> 6ithin this areaC :nancial issues , care 3r7isin
need t 0e addressed and nurses need t 0e 0etter 3re3ared t 6r>
6ith chrnic care needs.
!. Demographic trends, epidemiological trends, and health
care statistics
These help us rec!ni=e health care needs ,r sciety and !i7e
in,rmatin ,r ,uture 3lannin! , cst eDecti7e ser7ices. 5ncreasin! li,e
s3an is a dri7in! ,rce ,r the de7el3ment , im3r7ed ser7ices ,r
the elderly. /nd , li,e care has recei7ed mre attentin 7er the last
,e6 years, 0ut nursin! research int this area needs t 0e ,urther
de7el3ed and :ndin!s disseminated. 5n many scieties immi!rant
issues ha7e created the need ,r 0etter cultural understandin! ,
health care needs and re?uire resurces ,r care.
". Flow of resources. Bhere is the mney !in! and 6here is it li>ely
t !E Mney F6in! int health care in the cmmunity 6ill 0e a
dri7in! ,rce ,r chan!es in that area, 0ut a 0lc>ed F6 6ill 0e a
restrainin! ,rce t 3re7enti7e health care ser7ices. Nursin! in3ut and
3litical 36er can im3act that F6 t 3r7ide eDecti7e health care
3r!rams and ser7ices.
#. Supply of manpower and competition.
Man36er shrta!es r sur3luses in health care 3r,essins im3act the
utili=atin , nurses and ad7anced 3ractice nurses. Bh are ur
cm3etitrs ,r deli7ery , ser7ices and resurcesE This is a
3articularly im3rtant area in times , nursin! shrta!e t 0e sure that
less ?uali:ed health care 6r>ers are nt used t su0stitute ,r the
sa>e , e93edience and reduced csts. @6 can 6e de7el3
cm3etiti7e and mar>etin! strate!iesE @6 can 6e ,rm calitins t
reduce cm3etitinE 8t the same time 6e need t e93lre 6hether
mre clla0rati7e 3r!rams , care can 0e de7el3ed eDecti7ely, s
that 6e are nt hldin! n t utmded ideas , the 3r,essin 0ut can
de7el3 ne6er mdes, such as ad7anced 3ractice nursin!, t 6r> in
interdisci3linary clla0ratin. Clla0rati7e rather than cm3etiti7e
strate!ies can stren!then ?uality , care 0y 0etter utili=in! the
e93ertise , each 3artici3ant.
$. Role delineation, role confusion. 8re the G0s >ee3in! u3 6ith
the e93ectatins , nurses and 6ith ad7anced 3ractice nursin!E @6
are su33rts 6r>er G0s de:nedE @6 d 3r,essinal standards
interact 6ith realityE @6 many 3e3le are re?uired t d the G0E Can
ne 3ersn realistically d the G0E @6 can G0 satis,actin 0e
increased in this era , hi!h stress in the 6r>3laceE
%. Public opinion. Nurses need t 0e a6are , the 3u0lic 3erce3tin ,
their rle. De7el3ment , calitins and su33rters 6ithin
cmmunities and media can 0e a dri7in! ,rce ,r ad7anced nursin!
3ractice. Cnsumer r 3r,essinal 33sitin can 3r7ide 0arriers t
3ractice, and 0e a restrainin! ,rce.
&. Global trends. Be are a !l0al ecnmy and health care ser7ices
,ace similar 3r0lems
5nternatinally. Be can learn and 0ene:t ,rm cntacts in ther
cuntries, and 6e can Der ur ser7ices 6hen a33r3riate t im3r7e
7erall healthcare in 0th de7el3in! and industrial cuntries. Gl0al
terrrism needs t 0e addressed, and nurses need t 0e 6ell 3re3ared
t deal 6ith the a,termath and t dcument its eDects n thse 6e
care ,r. Nurse educatrs need t incr3rate disaster trainin! and
stress cunselin! int the curriculum and t 3r7ide 6r>sh3s in this
area ,r nurses already in 3ractice. 5t is essential that nurses
3artici3ate in the 3litical 3rcess t reduce this threat.
'. Nursing practice and theory. Nursin! research and thery
de7el3ment need t 0e
Su33rted and :ndin!s disseminated t cntinue t 0uild ur nursin!
science and incr3rate the results int 3ractice. Be need t increase
ur cre , nurses 6h ha7e met hi!h academic standards ,r carryin!
ut research and 3r7ide resurces ,r their acti7ities. Nursin!
research and thery als ha7e the 3tential t cntri0ute t the 0dy
, >n6led!e , ther disci3lines in the same 6ay that 6e ha7e
0rr6ed ,rm ther therists t use in ur 3ractice. The rle ,
ad7anced 3ractice nursin! has 0een !r6in! and has demnstrated
eDecti7eness in the health care system. These nurses are n6 a0le t
3r7ide medical e93ertise in dia!nsin! and treatin! s3eci:c
cnditins, 0ut are nt mini4dctrs. The medical 3rtin , their
3ractice is nly ne tl 6ithin their 6hole
tool box of nursing competencies for use in providing holistic nursing care and health.
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. Patients Bill of Rights
fter the development of the !"atients #ill of $ights%, the nurses are also accountable for
patients care and have legal responsibilities for the patient.
Future of Nursing Careers
"redictions are that in &' or (' 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.
*any nursing functions will be automated. +or 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. -ther 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.
s a result of nursing shortages, healthcare facilities will be forced to use their nurses
.udiciously. 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.

Nursing’s Future Challenges
The change in health care delivery systems has also afforded nurses a wider range of
functionality. lthough independence have been cultivated through expanded roles.
Trends towards downsi/ing 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 0
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. 1,ray films will be a thing of the past2 x,ray
images will be transmitted by computers and saved on floppy disc for retrieval and
reviewing. s 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. 3are modalities which
include pain management, spirituality assessment and bereavement counseling will be
incorporated into health care organi/ations and nursing education curriculums. Nursing
research will greatly contribute in developing and implementing these therapy options.
Work Environments:
Nursing4s dissatisfaction with the workplace environment is another issue that must be
faced when considering the profession4s 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.
*ee and $obinson 5(''67 state that 8nurses need work environments with strong
professional practice models that value their work and recogni/e their impact on patient
Nursing Shortage 0
ccording to Wieck 5(''97, 8nursing education is probably the most inflexible 4one si/e
fits all4 environment that exists today8. *ore campaigns such as :ohnson and :ohnson4s
3ampaign for Nursing4s +uture and the -regon 3enter for Nursing4s campaign, re ;ou
*an Enough to be a Nurse, will need to be launched to bring more men and minorities
into the profession. -ther recruitment trends will be lower educational costs, greater
access to federal loans and grants, and new educational methods including shortening the
time re<uired to become a registered nurse 5#uerhaus, =taiger, > uerbach, (''&7.
+actors contributing to globali/ation include advances in information technology and
communications, international travel and commerce, the growth of multinational
corporations. +uture nurses will face the challenge of maintaining a holistic approach to
client care in an environment of growing speciali/ation. +ocus on health promotion,
maintenance, and revitali/ation will continue to grow.
Costs control challenge 0
?n &@A's, &@B's, and &@@' governmental budget deficits reached all time high.
Covernment spends re money on health care system.
=ocieties poor, homeless, elderly, substance abuse, ?D= and mentally ill patients are
increased into country. The ma.or <uestion yet to be answered is !Eow can we pay for
health care for these people and the numbers are expected to be increasedF
The central and state governments are seeking to answer that <uestion. The next decades
will see hospital closing is record numbers, pressures continuing to mount from business
community forcing changes in financial health 3are reforms.
Nursing and "igher education
*ost professions provide a single route for the educational preparation of its
practitioners. Eowever the development of nursing as a profession has resulted in ma.or
educational routes that prepare graduates to write the National 3ouncil Licensure
Examination 5N3LE17 for registered nurses.
Nursing Assistant: ?ndividuals called nursing assistant provide care to the patient in
hospitals and long,term care facilities. 3ertified Nursing ssistant 53N7 works under
the directions of $N or licensed "ractical nurse. The training course may conduct at many
settings,high schools, long term care facilities, hospitals, community colleges, and
privately operated hospitals.
#ractical 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 A years to complete. They have
educational preparations at high schools, technical schools, hospitals, .unior or
community colleges, universities or independent agencies.
Diploma Education0 diploma program administered by hospitals and also referred to as
hospital based programs. The programs vary in length from (9,6G months. They are
affiliated with a college or universities.
Associate degree education: The movement toward in &@A(, today associate degree
nursing program prepare more graduate for licensure as $NHs than do any other program.
$accalaureate Education: This program that occur in 9.I years in colleges or
universities. The program existed as a <uasi autonomous branch of the universityHs school
of medicine. ?n recent years the nature of baccalaureate education has changed they
permit a degree of speciali/ation at the same level .
%asters &rogram: fter baccalaureate degree students are granted *asters Degree in
nursing after completion of ( years program .The research,based *aster of =cience in
Nursing 5*=cN7 program provides the basis for leadership in professional Nursing and
the foundation for doctoral studies.
*."hil0 This program is of & year 5full time7 or ( years 5part time7 after the completion of
*.=c. nursing.
Doctoral programs0 Nurses with doctoral degrees are expected to have tremendous .ob
demand over the next ten years. These programs prepare nurses for careers in health
administration 5a "hD is the preferred degree for nursing executives7, 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. ?n a doctoral programᄃ everyone
receives training in research methods 5including statistics and data analysis7, the history
and philosophy of nursing science, and in leadership skills.
Changing roles and functions of the nurse as &erceived in the gloe'
The nurses in ?ndia 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 programme for studentHs nurses and nurses, teach clients
about the self,care and home care.
' Clinical nurse s&ecialist speciali/es in managing specific diseases and they function
as clinicians, educators, managers, consultants and researchers.
c' Nurse &ractitioners are certified to provide health care to clients in out,patient or
community settings.
d . Certified nurse(mid)ife are certified by the merican 3ollege of Nurse,*idwives 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 masterHs 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. dvancements in science increase
health needs of the society and thereby expect changes in the role of nurses and thus
Nursing in the *+
With the focus of clinical practice on evidence,based medicine, the relationship between
nursing and the patient has become treatment,centered. midst the organi/ations 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.
+urthermore, many nurse practitioners practice in settings driven exclusively by the
medical model and leave little room for creative, caring approaches to practice.
Eealthcare systems suffer from a lack of access and fragmented, costly care2 there is also
an overemphasis on technologic approaches to treatment. Not enough time is spent on
health maintenance and disease prevention. ?n addition, there is little to no attention paid
to the patient4s 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 (&st century.
Future directions for nursing ,esearch
Nursing research continue to develop at a rapid pace and will undoubtedly flourish in the
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.
Eigh focus on E#"0 3oncerted efforts to use research findings in practice are sure to
continue and nurses at all levels are encouraged to engage in evidence,based patient care.
?n turn improvements will be needed both in <uality of nursing studies and in nurses
skills in locating,understanding,criti<uing and using relevant study results.
Development of stronger Evidence base through rigorous methods and multiple,
confirmatory strategies0 "racticing nurses are unlikely to adopt an innovation based on
weakly designed or isolated studies. =trong designs are essential and confirmation is
usually needed through replication 5i.e. intentional repeating7 of studies with different
clients in different clinical settings and at different times to ensure that findings are
Expanded local $esearch in health care settings0 ?n current evidence based environment
there is likely to be an increase of small and locali/ed research designed to solve
immediate problems. ?t ensures that evidence from these small pro.ects become available
to other with similar problems.
Continuing education for *+
-ne need only scan a newspaper or read a weekly maga/ine 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 Eealth
-rgani/ation warns us to prepare for a potential worldwide #ird +lu epidemic, terrorists
threaten us with chemical, biological and nuclear weapons, and new protocols for 3L=
are released. Eow is a working nurse to keep upF
Nursing education provides the basic building blocks of medical, scientific, and nursing
knowledge, but competence in the nursing profession re<uires an ongoing process of
continuing education. 3ontinuing education for nurses is necessary for the nurse to
remain up to date with the latest practice issues and it is necessary for patientHs safety as
well. =ome states have made continuing education for nurses mandatory and re<uire a
certain number of course credit hours be attained before license renewal, or re<uire
certain mandatory course sub.ects, while other states leave it to the nursing professional
themselves to accept a personal responsibility for their own continued learning.
$egardless of whether nursing continuing education, or Nursing

%ethods of otaining nursing continuing education hours and the &ros and cons of
&. "rofessional :ournals0 *ost professional nursing .ournals offer an article for
continuing education credit. =ome 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 .ournals offer
the credit for free, others charge &' 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. -btaining continuing education hours through
professional .ournals is costly and inefficient in that the cost of the .ournal 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.
(. =eminars0 "rofessional development programs and seminars that offer accredited
continuing education hours for nurses are fre<uently offered at various locations in every
state, in some foreign countries, and even on cruises. Employers fre<uently 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. ?n 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 one4s continuing education by that method is not
something every working nurse can afford to do.
6. -nline Nursing 0 The internet provides nurses access to extremely affordable and high
<uality accredited continuing education courses covering a plethora of professional
nursing topics. -nline nursing courses are the gateway to nursing continuing education
for the (&st 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. -nline nursing continuing education courses are
readily available for both mandatory state re<uired sub.ects, courses in one4s own nursing
specialty, and courses that all nurses regardless of practice specialty need to be
familiari/ed with so nurses have access to a much broader choice of sub.ect matters than
they ever had before when restricted primarily to .ournals or seminars. ?n 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 ones 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.
?n 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.
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 ma.or impact on the entrant.
!The only thing that is constant is change% Lord Jrishna in the !Ceetha%
+uturistic nursing can be classified in terms of nursing education, nursing "ractice,
nursing $esearch, nursing administration and an amalgamation of all the four
components which might occur in years to come.
oriented >
health care
$enewal of licensure
Nursing services
involvement in
primary health care.
(.:ob description >
.ob specification
-ther groups
?nstitutional lumni
#log groups nursing
Nursing Education
Lpgrding Nsg schools
to colleges. "rogram
*.=c nsg
"h D
Nursing ,esearch
Nsg Administration
"ay scales
• "otter and "erry, +undamentals of Nursing,G
edition,*osby publishers,"p ((,(6
• www.nursing.grMeditorial Lowenstein.pdf
• :hn.sagepub.comMcgiMcontentMabstract
• +indarticles.comMpMarticlesMmiN<a9'@'