4. Removal of scope of practice barriers
All the advanced degrees and residency training in the world won’t change nursing much or help us meet the growing demands for care unless we eliminate the regulatory obstacles that currently hinder nurses from practicing fully according to their educational capabilities. Do you know of any other profession where professionals are not allowed to practice to the full extent of their skills, abilities and education? Advanced practice nurses must be allowed to act as full partners in health assessment, treatment and care of patients. This is the top recommendation of the Institute of Medicine Report on the Future of Nursing, and should be supported fully by all schools of nursing, nursing organizations, nursing students and other coalitions. States must reform scope of practice regulations to ensure that advanced practice nurses are defined as primary care providers and are thus eligible for clinical and admitting privileges, are accessible to patients through the new state health insurance exchanges (launching in 2014) and are eligible for payment with private health plans as well as Medicare and Medicaid. Now is the time for this to happen, as physician shortages, an aging population and demand for more and better services strain our healthcare system. Nurse practitioners and other specialty care nurses are the answer to this growing concern, but only if they are freed of existing scope of practice limitations and able to act in accordance with the demand and their capabilities.
5. Putting science into practice
Evidence-based practice has been recognized as the "gold standard" of care by the healthcare community, as it attempts to combine the best available evidentiary research with the most appropriate care for the patient’s individual needs. However, nurses have been challenged to implement such practice by barriers due to lack of time, lack of access to the most appropriate research, failure of organizations to adopt a culture conducive to evidence-based care, and lack of nursing autonomy. Hospitals and schools of nursing must find paths to overcome these barriers and put easy-to-follow steps in place which support evidence-based practice.
At UCLA, for example, the School of Nursing and the Ronald Reagan UCLA Medical Center have collaborated to establish a director of evidence-based practice position, designed to institute a structure to engage staff nurses and other clinicians in the constant process of examining their practices to ensure they are backed by the best available scientific evidence. This includes supporting nurses in original research, bringing the findings of relevant studies to the attention of nurses, and helping nurses institute important research-based practice changes at the hospital. This program has facilitated any number of improvements. For example, based on findings that thoracic surgery patients were not consistently prepared for their post-operative experience, one nurse developed a DVD for patients and their families, greatly relieving post-op anxieties and reducing unnecessary readmissions. Tools like this not only improve patient care, but reduce healthcare costs for everyone and further demonstrate the critical role that nurses can play in our evolving healthcare system.
6. Shortage of nursing school faculty
Faculty shortages at nursing schools are limiting student capacity at a time when the demand for nurses is skyrocketing. U.S. nursing schools turned away more than 67,000 qualified applicants from baccalaureate and graduate nursing programs in 2010 due to an insufficient number of faculty, clinical sites, classroom space and budgetary and other constraints. While the American Association of Colleges of Nursing is leveraging its resources to address this issue through focused media attention, data collection and the procurement of federal funding for faculty training programs, we must all focus attention on this crisis by making sure our nurse faculties have the appropriate support and resources they need to not only prevent job burnout, but to encourage potential retirees to stay on the job longer. And, we must continue lobbying policy makers and the Federal government to act swiftly to help fund new faculty recruitment and training.
These challenges nurses face are not for the faint-of-heart, or for those without conviction. Since, there are no other profession more capable of meeting tough challenges than nursing. Our specialty was built by individuals who have broad shoulders, a strong back and perseverance. Nurses will, as they have done always, continue to transform healthcare in ways that will have an immeasurable impact on the nation’s health.
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