Critical Conditions: Preparing the 21st Century Nursing Workforce

The nursing profession stands at a crossroads. Over the past few decades, nurses’ roles have become increasingly complex. As physicians spend less time on the hospital floor, nurses now perform many primary care functions. They treat patients who are more seriously ill yet have shorter hospital stays than patients of years ago, and they use advanced technology in almost every aspect of their jobs, from keeping records to distributing medication to monitoring patients’ conditions. Due to this expansion of the nurse’s role, the Institute of Medicine recommends that 80% of registered nurses hold a bachelor’s degree or higher by 2020. Yet many nurses only hold 2-year degrees: Only 50% of nurses have attained a baccalaureate.

The ongoing nursing shortage compounds the skills gap problem. Many nurses from the Baby Boomer generation are preparing to retire over the next several years, and not enough new nurses stand ready to replace them. The American Health Care Association reports that over 135,000 unfilled RN positions exist in U.S. hospitals and clinics, a vacancy rate of 8.1%. Estimates of the demand for full-time RNs over the next 10 to 15 years range from 260,000 to 1 million. The nursing shortage has serious implications for the quality of healthcare, as overextended nurses are susceptible to burnout and workplace injury, are more likely to make errors, and have less time to spend with each patient.

Experts Consider the Future of Nursing

To provide a forum for experts to discuss these issues and address potential solutions, the University of Phoenix Research Institute will sponsor a panel discussion titled Critical Conditions: Preparing the 21st-Century Nursing Workforce. At this exclusive event, hosted by The Chronicle of Higher Education at the National Press Club in Washington, D.C., on June 21, 2011, healthcare thought leaders from a variety of fields will explore strategies for expanding and educating the nursing workforce. Panelists will address ways that institutions of higher education can close the nursing skills gap, and how policy solutions can help advance a new generation of competent and compassionate nurses.

“The critical state of our nation’s nursing profession is well-documented in current research,” says panel moderator Dr. Tracey Wilen-Daugenti, vice president and managing director of the University of Phoenix Research Institute and a visiting scholar in the Media X program for research on technology and society at Stanford University. “In keeping with the University of Phoenix Research Institute’s scholarly studies, our goal with this event is to analyze a broad spectrum of evidence that will enable us to recommend actions to improve academic outcomes and promote a more prepared workforce.”

Panelists represent a wide range of expertise in nursing education, practice, and policy. They include nurse executives, higher education leaders, and technological innovators:

• Dawn Bazarko, DNP, MPH, RN. Senior Vice President, Center for Nursing Advancement, UnitedHealthGroup
• Carlton G. Brown, Ph.D., RN. President, Oncology Nursing Society
• Kristy Chambers, MSN, RN. Co-Founder and Principal Partner, Medical Simulation Design
• Parvati Dev, Ph.D., FACMI. President, Innovation in Learning, Inc.; Distinguished Visiting Scholar, Media X, Stanford University; Former Director, SUMMIT Lab, Stanford University School of Medicine
• Pamela Fuller, Ed.D., MN, RN. Dean, University of Phoenix College of Nursing; Board, Southwest/Arizona Board of the American Liver Foundation; Member, Arizona State Board of Nursing Education Committee
• Athena Palearas, MS, RN, CNN, LNC. Corporate Vice President of Education, Fresenius Medical Care North America
• Maureen Swick, Ph.D., MSN, RN, NEA-BC. Senior Vice President and Chief Nurse Executive, Inova Health System; Member, American Organization of Nurse Executives
• May Wykle, Ph.D., RN, FAAN, FGSA. Dean and Marvin E. and Ruth Durr Denekas Professor of Nursing, Case Western Reserve University; President, Friends of the National Institute of Nursing Research

The University of Phoenix Research Institute will synthesize the panelists’ contributions into a special report, to be published after the event.

On the Agenda: The Nursing Shortage, Technology, and Higher Education

Much of the discussion at this event will center around the complex and hotly-debated issue of the nursing shortage. Nursing experts differ in their assessment of the extent, duration, and seriousness of the shortage. Panelist Dawn Bazarko, senior vice president for the Center for Nursing Advancement at UnitedHealth Group, describes the nursing shortage as a “paradox,” observing that new nurses are having difficulty finding jobs in some locations, while in other regions, many positions remain unfilled. “It’s challenging to gain support to rigorously address the shortage when many graduates can’t find employment,” she notes. Pamela Fuller, dean of the College of Nursing at University of Phoenix, suggests that forecasters consider the broader picture. “The nursing population is aging,” she says. “To deal appropriately with the shortage, we need to look not only at what is happening today, but anticipate what will happen in the future.” The panel will also discuss strategies for coping with the shortage. Some educators believe part of the answer is recruiting more men and minorities into the profession, as well as getting young people interested in nursing. To do so, nursing schools at universities such as Case Western are undertaking initiatives such as community outreach programs in which nursing students work with underserved schoolchildren and teenagers.

Panelists will also consider the proper role of technology in healthcare. Technologies such as smart IV pumps, which use software to calculate dosages of medication, can reduce the chance of medical errors, while innovations like high-fidelity manikins and virtual clinics make nursing education more immersive. One of the most important benefits that technology can provide for nursing students, says Parvati Dev, president of Innovation in Learning, Inc., is a “library of virtual experiences that it would take years for them to acquire in real life.” Maureen Swick, senior vice president and chief nurse executive at Inova Health System, notes that new nursing graduates find such experiences invaluable. “In our hi-fi scenarios, which use manikins to simulate medical conditions, new nurses realize within the first minute that they’re completely responsible for a patient,” she says. “That experience gives them confidence when they treat real patients in the hospital.”

However, technology has its drawbacks. Many nurses are reluctant to learn new technologies, partly because technology training adds another task to their already-full workdays. Technologies that aren’t integrated well into nurses’ workflow—or into educational programs—can be a hindrance rather than a tool. “Sometimes, institutions buy expensive equipment without ensuring that it meets their needs or that it works in tandem with their existing technologies,” says Kristy Chambers, co-founder and principal partner of Medical Simulation Design. “Many hospitals have multiple computer systems that do not work together,” Swick adds. “Nurses create workarounds to deal with this situation, which wastes their time and energy.”

Another major issue panelists will discuss is the future of nursing education. They will share best practices for workforce development, including partnerships between educational institutions and healthcare organizations. Many professionals at UnitedHealth, for instance, serve as adjunct faculty and consult on curriculum for higher education institutions. “Academia needs to partner with organizations employing nurses to ensure that students are learning the skills employers need today,” Bazarko says. Fuller stresses the importance of making education accessible to working nurses. “Many nurses have heavy family and work obligations, and need education that fits their full schedules,” she says. “Educators need to provide them with flexible options for taking classes, whether on-campus or online.”

Panelists will also explore the crucial factor of caring. “Nobody touches lives like nurses do,” says Athena Palearas, corporate vice president of education at Fresenius Medical Care North America, who has studied the relationship between empathy and nursing success. “Their displays of caring have an important impact on patient outcomes.”

Working Together to Solve the Problems of Tomorrow

The problems in the nursing profession are complex, and stakeholders from the educational, healthcare, business, technology, and policy fields will need to work together to solve them. This panel represents a step toward collaborative solutions, says Wilen-Daugenti. “The event takes a multidisciplinary approach towards shedding light on the healthcare and workforce development issues of tomorrow,” she observes. “It’s an exciting opportunity for thought leaders from different industries to share their ideas about the challenges the nursing profession must undertake.”

References

Committee on Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine. (2010, October 5). The future of nursing: Leading change, advancing health. Available from http://www.nap.edu/catalog/12956.html

Ibid.

American Association of Colleges of Nursing. (September 2009). Nursing shortage fact sheet. Retrieved November 11, 2009 from http://www.aacn.nche.edu/Media/FactSheets/NursingShortage.htm.

Ibid.

Keenan, P. (2003, January). The nursing workforce shortage: Causes, consequences, proposed solutions. Issue brief prepared for the Commonwealth Fund/John. F. Kennedy School of Government Bipartisan Congressional Health Policy Conference. January 16-18, 2003. Retrieved from http://www.commonwealthfund.org/usr_doc/Keenan_nursing.pdf