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Reforming Care Delivery: How Will It Affect Your Nursing Career?

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By Debra Wood, RN, contributor

Feb. 26, 2010 - While no one knows whether Congress and the president will achieve comprehensive health care reform, nursing experts are convinced that, regardless of what happens in Washington, nurses will find greater career opportunities in the future.

From larger patient populations and greater demand to advances in telemedicine and more community-based, non-hospital careers, a number of factors are converging to change the field of nursing and the jobs that are currently available.

"Regardless of whether health reform passes, demand for nursing will rise in the long-term as the population ages and complexity of care grows with increasing numbers of chronic conditions," said Matthew D. McHugh, Ph.D., JD, MPH, CRNP, RN, assistant professor of nursing at the Center for Health Outcomes & Policy Research at the University of Pennsylvania School of Nursing in Philadelphia.

Linda Tieman, RN, MN, FACHE
Linda Tieman, RN, MN, FACHE, felt there are lots of career opportunities for nurses.

The number of Americans age 65 and older continues to grow, and people who are older need more health care. They tend to have three to five conditions and take five to 10 medications, said Linda Tieman, RN, MN, FACHE, executive director for the Washington Center for Nursing in Tukwila, Wash.

"They need someone to help them understand the conditions and manage those, so absolutely, there will be an increased demand for care from nurses and other people," Tieman said. Health care employment continues to trend upwards, even in the current rough economy, according to the U.S. Bureau of Labor Statistics (BLS). It projects the employment of registered nurses will grow by 22 percent between 2008 and 2018, much faster than the average for all occupations. The BLS's latest report states, "Overall job opportunities are expected to be excellent for registered nurses."

Meg Doherty, MSN, ANP-BC, MBA
Meg Doherty, MSN, ANP-BC, MBA, said health care reform bills can positively impact the numbers of persons entering nursing, while nursing faculties will be challenged to educate all levels of nursing practice.

If reform passes and millions of more Americans are insured, most experts agree it will create an even greater need for registered nurses in their current roles and in new ones, and for advanced practice nurses as primary care providers, due to a physician shortage.

"Health care reform will allow advanced practice nurses to lead multidisciplinary health groups and teams in the community and offers great potential to promote health and wellness for seniors in all settings," said Meg Doherty, MSN, ANP-BC, MBA, executive director of Norwell Visiting Nurse Association and Hospice in Norwell, Mass.

Linda Q. Everett, Ph.D., RN, NEA-BC, FAAN, executive vice president and chief nurse executive at Clarian Health in Indianapolis and a past board member of The Honor Society of Nursing, Sigma Theta Tau International, believes some form of health reform will pass, and when it does people will crowd physicians' offices and hospital emergency departments.

In addition to educating more clinicians, employers will need to work harder to retain the current nurses and novices as they enter the profession.

"Without an increase in the output of nurses to match demand, the nursing workforce will be stretched and the workload will likely increase," McHugh said. "Job satisfaction is a concern and is already low, particularly in acute care settings. Poor work environments and excessive workloads would compound an already concerning problem and contribute to retention and recruitment issues in the settings where nurses are needed most."

Lillee Smith Gélinas, MSN, RN, FAAN, vice president and chief nursing officer for VHA Inc., does not expect hospitals will stretch bedside nurses' responsibilities in ways that would negatively affect job satisfaction, because of the important role nurses play in caring for patients and the progression to a pay-for-performance system.

"VHA's CNOs believe that hospitals will continue to require an adequate number of registered nurses in order to assure that quality care is provided," said Gelinas. "The published evidence on the correlation between quality nursing care and patient outcomes continues to grow. Poor care equals poor outcomes and that equals poor reimbursement."

Rudisill said she believes nursing leadership must listen to staff nurses, and offer them a say in their practice and career opportunities.

"You have to get them engaged in shared decision making, so they feel they are having an impact," Rudisill said. "That's critical to keeping the clinical nurse at the bedside."

Michael Meisel
Michael Meisel said, reform or no reform, there are two overarching factors that are shaping the future of nursing: the aging of the population and the increasing incidence of chronic disease.

Michael Meisel, vice president of product management and marketing, Concerro in San Diego, Calif., which sells self-scheduling software for hospitals, said that a key element in retention efforts will involve helping nurses balance the demands of their professional and personal lives.

Even with changes and improvements to the work environment, the country still may not produce enough nurses. The population is aging, and there are fewer young adults who could possibly provide care.

"We are not going to have enough nurses to perform the roles and responsibilities they do today; there just aren't enough people," Everett said. "A lot of talented people are searching for an answer."

Nursing experts agree that nurse managers, career coaches and educators should also encourage nurses to obtain their degrees, as more opportunities will be available to baccalaureate and master's-prepared nurses. Nursing leadership organizations have already begun working together to look at nurses' roles and the possibility of redefining them.

"We are moving ahead, with or without reform," Rudisill said.

Rudisill and Doherty anticipate more care will move into the community, with nurses in positions to empower patients to take better care of themselves.

BLS projections back that up. Statistics now indicate 60 percent of registered nursing jobs are in hospitals. That likely will change in the future. BLS expects a 48 percent increase in RN employment in physician offices, a 33 percent increase in home health care and a 25 percent increase in nursing care facilities.

Meisel anticipates "Health care organizations will adopt telehealth technology in order to extend the reach of nurses. There will be growing opportunities for nurses in telehealth--starting with remote monitoring and video visits for patients with chronic conditions."

Norwell VNA and Hospice, the Department of Veterans Affairs and other entities have already embraced home telehealth with success. Nurse-run telehealth monitoring creates patient teaching opportunities.

"It allows us to demonstrate what factors influence the patients' chronic conditions," Doherty said. "We are helping patients learn what affects their health and how to manage it better."

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