Chapter 16: Nursing’s
Future Challenges
Bonnie M. Wivell, MS, RN, CNS
Overview
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U.S. is the wealthiest of the industrialized
nations and still falls short of the goal of
having a healthy nation in spite of spending
nearly $2 trillion annually on health care
45 million Americans have no health
insurance
Infant death rates remain high – nearly 5
per 1000 babies
Fitness levels declining as obesity is
increasing
U.S. spends more of its GDP (16% in 2004)
on health than any nation in the world
Societal Challenges
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Demographics: study of vital statistics
and social trends
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Birthrates
Morbidity rates (illness)
Mortality rates (deaths)
Marriages
Ages of various populations
Migration patterns
Futurists: people who try to project
what will occur, draw conclusions about
what these trends mean for the future
Societal Challenges Cont’d
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Aging Population:
• By 2020, 21.8 million will be 75 + years old
• “Baby boomers” knowledgeable, expect more
and tolerate less
• Centenarians: represent one of the fastest
growing groups in the U.S.
• 1 of 2 people over 90 will develop Alzheimer’s
• Euthanasia/assisted suicide; Netherlands and
Belgium legalized it
• End of life care/palliative care
Societal Challenges Cont’d
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Poverty
• Working poor basic needs not met; has
grown since reform of 1996
• Medically indigent don’t qualify for Medicaid
but cannot pay for health care
• Disenfranchised have no power in political
system & limited access to health care,
• Government with limited resources must
look at more strategies for health care for
these vulnerable populations
Societal Challenges Cont’d
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Cultural diversity: people from different racial,
ethnic, religious, social, & geographic
backgrounds
• Homogeneous: similar cultural beliefs and
practices
• Heterogeneous: cultural mix
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Nurses need to take cultural beliefs, values and
practices into consideration when planning and
implementing nursing care
Urbanization: move from rural areas to cities
• Decaying inner cities with large populations of
poor people create major social problems
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Homelessness, drugs, gangs, single-parent
households, mental illness, violence, and crime
More Societal Challenges
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Environment: gradual deterioration of the
world’s air, water, and plant and animal life
Acute and chronic respiratory diseases,
debilitating allergic reactions and cancers are
increasing
Epidemiologists study origin/spread of disease
and believe that environmental decline
increases incidence of certain diseases
Emerging MDRS of organisms will challenge
health care resources
Disasters: an event or situation that is of
greater magnitude than an emergency
disaster; can be natural of man-made
• Core preparedness competencies
• Practice 2 times/year
More Societal Challenges Cont’d.
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Bioterrorism: refers to use of biological or
chemical agent as a weapon
• Keep up with emerging information to be
prepared
• See CDC’s bioterrorism website
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Unhealthy life styles: obesity, tobacco use,
lack of exercise, eating disorders, stress,
HIV/AIDs and drug use
Cost Containment: must do more with less
Regulation of Health Care: costs rise with
aging, increased use of advanced practice
nurses for primary health care
Challenges in Nursing Practice
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Differentiated Practice Levels: ADN/BSN, MS +
• Should have different, well-defined roles
• Possibly different levels of licensure
• Only health care profession for which entry into
practice is less than a baccalaureate degree
• Credential for entry into a profession and
educational standards are rising in all fields but
nursing
• This has hampered nursing’s quest for
professionalism
• Differentiated practice can only be realized if we
give up the notion that “a nurse is a nurse is a
nurse”
Challenges in Nursing Practice
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Cost Containment: managed care,
capitation
• Nurses will need resource management skills
• Business expertise will be needed as much as
clinical experience
• UAP utilization and delegation
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Autonomy & Accountability
• Shared governance: participation by nurses on
strong policymaking hospital committees;
mandated by JACHO
• Practice in community settings; autonomy and
accountability will become increasingly
important
• Life long learning a requirement
Technology & Nursing Informatics
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Nursing informatics: the organization and use
of nursing data continue to change
Telecommunication (telemedicine) will improve
access to medical services for rural and elderly
Genetic engineering & genomic revolution
• Makes it potentially possible to treat & prevent
genetically transmitted and predisposed diseases
• Designer medicines are drugs tailor made to treat
patients based on their individual genetic makeup
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Complementary & alternative therapies more
utilized as persons take responsibility for their
own health
Internet can provide reliable medical & health
information
Challenges Continued
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Practice in Community Settings: Nurse
managed clinics serve inner city/rural areas;
school nurses needed in large numbers as well
as hospice nurses and those specializing in
gerontology and chronic illnesses
Cultural Competence: patient/families & health
care providers cultural sensitivity due to
change in the nation’s demographics
Maintaining Health Work Environment: needle
sticks, latex allergy, shift work, risk of violence
in workplace, bloodborne diseases, back
injuries
Challenges in Nursing Education
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Outcome-based Education: student
competency and evidence-based education
required to maintain accreditation
Diversity: students reflect US demographics;
culturally competent education; distance
learning increases access
• Education about chronic diseases, gerontology,
hospice
• Foreign language requirement for BSN
• Culturally competent care as an outcome
criterion for graduates
Challenges in Nursing
Education Continued
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Technology & Nursing Informatics’
Impact
• Computer competence
• Internet utilization
• Faculty required to actively practice
to keep up with changes
• Lifelong learning a requirement
• NCLEX changes
• New grad internships
Challenges Continued
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Collaboration: Nurses with more education
equal footing with physicians & others,
interdisciplinary
Reforms in Health Care & Higher Education:
• Graduate education producing practitioners to meet
consumer demands
• Curricula standardized & streamlined to reduce cost
and confusion and improve student mobility
• Nurses will need to be well versed in the costs,
budgeting and finance of health care
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Faculty Shortage/Student Shortage: current
faculty retire, few younger nurses into
education as salaries lag; students turned
away as no one to teach them; fewer students
means fewer nurses; medical schools respond
by producing hospitalists (care for patients
only while hospitalized)
Challenges to Entire Nursing
Profession
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As the largest health care profession in the US,
nursing should have a powerful voice and presence
at every table where substantive health care issues
are discussed.
Use of Collective Power to resolve issues, but only
10% of all nurses belong to their professional
association
Nursing Agenda for Future:
• 2001 Nursing Profession Summit (ANA grant)
• Steering committee formed and established the
document entitled Nursing’s Agenda for the Future
• How nursing should look and where it should be by
the year 2010; you help decide; involve nurses in
charting own future
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Nurses can accomplish more working together
FOCUS, UNITE, ACT!
“Be the change you wish to see in the world”