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The Future of Nursing
The Future of Nursing explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system.
At more than 3 million in number, nurses make up the single largest segment of the health care work force. They also spend the greatest amount of time in delivering patient care as a profession. Nurses therefore have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care as envisioned in the Affordable Care Act (ACA) enacted this year.
Nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States. To ensure its members are well-prepared, the profession should institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates. Furthermore, regulatory and institutional obstacles-including limits on nurses' scope of practice-should be removed so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care.
In this book, the Institute of Medicine makes recommendations for an action-oriented blueprint for the future of nursing.
eBook
Advanced Practice Nursing Roles, Regulation, Education, and Practice: A Global Study
Several subgroups of the International Council of Nurses Nurse Practitioner/Advanced Practice Nurse Network (ICN NP/APNN) have periodically analyzed APN (nurse practitioner and clinical nurse specialist) development around the world. The primary objective of this study was to describe the global status of APN practice regarding scope of practice, education, regulation, and practice climate. An additional objective was to look for gaps in these same areas of role development in order to recommend future initiatives.
An online survey was developed by the research team, and included questions on APN practice roles, education, regulation/credentialing, and practice climate. The study was launched in August 2018 at the 10
Annual ICN NP/APNN Conference in Rotterdam, Netherlands. Links to the survey were provided there and via multiple platforms over the next year.
Survey results from 325 respondents, representing 26 countries, were analyzed through descriptive techniques. Although progress was reported, particularly in education, results indicated the APN profession around the world continues to struggle over titling, title protection, regulation development, credentialing, and barriers to practice.
APNs have the potential to help the world reach the Sustainable Development Goal of universal health coverage. Several recommendations are provided to help ensure APNs achieve these goals.
Journal Article
Assessing Progress on the Institute of Medicine Report The Future of Nursing
Nurses make up the largest segment of the health care profession, with 3 million registered nurses in the United States. Nurses work in a wide variety of settings, including hospitals, public health centers, schools, and homes, and provide a continuum of services, including direct patient care, health promotion, patient education, and coordination of care. They serve in leadership roles, are researchers, and work to improve health care policy. As the health care system undergoes transformation due in part to the Affordable Care Act (ACA), the nursing profession is making a wide-reaching impact by providing and affecting quality, patient-centered, accessible, and affordable care.
In 2010, the Institute of Medicine (IOM) released the report The Future of Nursing: Leading Change, Advancing Health , which made a series of recommendations pertaining to roles for nurses in the new health care landscape. This current report assesses progress made by the Robert Wood Johnson Foundation/AARP Future of Nursing: Campaign for Action and others in implementing the recommendations from the 2010 report and identifies areas that should be emphasized over the next 5 years to make further progress toward these goals.
eBook
IMPLEMENTATION OF A UNIT-BASED NURSE WELL-BEING \SUNSHINE\ COMMITTEE TO IMPROVE NURSE RECOGNITION & RETENTION
Significance & Background: In Spring 2023, the 2023 Jefferson Employee Survey revealed concerning results for our unit-specific nursing scores, with only 61% for \"recognition\" and 50% for \"intent to stay,\" both falling below healthcare benchmarks and hospital averages. Recognizing the critical importance of nurse retention and motivation, we sought to address these issues by implementing a designated nurse well-being committee. Purpose: Our goal was to foster a culture of recognition, enhance team bonding, and improve overall job enjoyment. Interventions: In April 2023, we established the \"Sunshine Committee,\" which focused on initiatives to promote recognition and teamwork. Key strategies included frequent staffrecognition celebrations for both professional milestones- such as graduating with advanced degrees or passing certification exams-and personal achievements, like significant birthdays or family milestones. We also created bulletin boards to highlight nurses' fun facts and accomplishments, allowing patients to connect with our team. Additionally, we organized team-bonding events, such as holiday giftexchanges and community fundraising activities, while ensuring that new nurses received a warm welcome to the unit. Results: After 16 months of implementing these interventions, we conducted a follow-up survey in August 2024. The results were encouraging: the recognition score improved significantly to 83%, reflecting a 22% increase from 2023, while the intent to stay score rose to 61%, marking an 11% improvement. These findings suggest that our initiatives positively impacted nurses' feelings of recognition and their intent to remain in the unit. Discussion: In conclusion, the Sunshine Committee's efforts have yielded measurable improvements in key indicators of nurse satisfaction. Moving forward, we aim to maintain this momentum by continuing to solicit dynamic feedback from our colleagues. This ongoing input will help us refine our initiatives and identify new strategies that can further enhance the work environment, ensuring that our nursing stafffeels valued and supported
Journal Article
Importing care, faithful service : Filipino and Indian American nurses at a veteran's hospital
\"Every year thousands of foreign-born Filipino and Indian nurses immigrate to the United States. Despite being well trained and desperately needed, they enter the country at a time, not unlike the past, when the American social and political climate is once again increasingly unwelcoming to them as immigrants. Drawing on rich ethnographic and survey data, collected over a four-year period, this study explores the role Catholicism plays in shaping the professional and community lives of foreign-born Filipino and Indian American nurses in the face of these challenges, while working at a Veterans hospital. Their stories provide unique insights into the often-unseen roles race, religion and gender play in the daily lives of new immigrants employed in American healthcare. In many ways, these nurses find themselves foreign in more ways than just their nativity. Seeing nursing as a religious calling, they care for their patients, both at the hospital and in the wider community, with a sense of divine purpose but must also confront the cultural tensions and disconnects between how they were raised and trained in another country and the legal separation of church and state. How they cope with and engage these tensions and disconnects plays an important role in not only shaping how they see themselves as Catholic nurses but their place in the new American story\"-- Provided by publisher.
BOOK
TAXANE TITRATION: TAILORED FOR BETTER OUTCOMES
Significance & Background: The Dana Farber Cancer Institute (DFCI), Boston, MA, conducted a project to evaluate the benefits of taxane titration to reduce hypersensitivity reactions (HSRs). They concluded that the patient group with titrated taxanes had significantly less taxane related HSRs than the non-titrated patient group. Outpatient Infusion Quality Team (OIQT) decided to implement our own quality project and attempt to replicate their project outcomes. Taxanes are at greatest risk of causing HSRs during the first and second lifetime exposures. HSRs need immediate care and can interfere with the continuation of preferred treatment. Currently, our infusion nurses use different approaches of slow titration to prevent HSR. In preparation for this project, a literature review was conducted and identified no published standardized recommendations for taxane titrations to prevent HSRs. DFCI came to the same conclusion and stated they used a desensitization protocol developed by their allergy team. We trialed the DFCI protocol to standardize our administration guidelines for all taxanes given in infusion. Purpose: The goal was to determine if a standardized gradual infusion rate titration would decrease the incidence and severity of immediate HRSs during the first two exposures to taxanes. Interventions: Education was created by the OIQT and presented to the infusion nurses at a staff meeting. The charge nurses and preceptors served as resources for any questions encountered throughout implementation. Any HSRs to taxanes were documented in the medical record and occurrence report (OR) system so the OIQT could track outcome data. Results: A key objective addressed by the DFCI project was to \"prime\" the administration tubing with medication, so the titration volume was drug, not saline. It was hypothesized that desensitization would be more reliable if the taxane was delivered from the initiation of the infusion via slow titration. We contacted the IV tubing manufacturer to verify recommended prime volumes. A three-month baseline review of ORs revealed four documented HSRs with the first and/or second taxane cycles. The OIQT chose to match the same timeframe for the quality project. Outcome data identified zero HSRs to taxanes when using the standardized titration method. Discussion: The project demonstrated similar outcomes to our peers, utilizing a standardized titration protocol results in a decrease in HSRs during first and second exposures to taxanes.
Journal Article