Strictly Clinical

As a recent nurse graduate practicing at the bedside, I see how interdisciplinary partnerships are crucial in providing competent care in our complex health system. Implementing and investing in the recommendations from the Institute of Medicine (IOM) Future of Nursing Committee will facilitate nursing’s ability to continue meeting the challenges of collaborative healthcare delivery.

As we prepare to transform our complex healthcare system to meet our future needs, highly educated nurses, who are free to practice according to their academic preparation, will be instrumental in the policy development and implementation that aims to close the gaps of our healthcare delivery system. The freedom to practice will enable our profession to step into the increased interdisciplinary opportunities created by healthcare reform and fulfill the goals of the IOM report.

ED practice and education

On a daily basis, my practice is challenged with the complexities of our healthcare system. In emergency department (ED) where I work, we see the daily socio-economic realities of our patient’s lives. We are often everything for certain segments of our population. As with most urban areas, our patients live in primary care “deserts” that are marked by the increasing trend of primary care provider shortages. Our patients often develop diseases that have affected everyone in their family for generations.

In keeping with our hospital nursing philosophy, our ED has developed a nursing practice that identifies existing community agencies that can fill these gaps. We use departmental resources where governmental and community agencies are overextended and/or unable to meet the needs of our patients. Discharge education often involves more than diagnosis review, patient and medication education but, engaging the person to see if the discharge instructions can be followed and if not how can we help the patient meet this goal. The skill set used during this process is based upon a foundation established in my baccalaureate nursing education and strengthened by my current graduate studies. This academic preparation developed my knowledge as a bedside nurse about the some of the preeminent tenets of our profession: inquiry and evidenced-based practice. These core tenets are critical to integrating the bedside nurse as an integral part of the interdisciplinary healthcare team as well as assisting the nurse to assume leadership roles in an interdisciplinary environment.

Evidence-based practice

Interdisciplinary healthcare requires evidence-based practice as its foundation. Although evidence-based practice has revolutionized bedside nursing, we must ensure it is implemented in all facets of nursing practice. According to estimates, 30% to 40% of patients do not receive care consistent with current scientific evidence. In order for these numbers to increase, we must accept a threefold challenge of continuing to ask hard clinical questions, conducting the research to answer these questions, and implementing the discoveries that are made. (Although new discoveries are made every day, the pace in which they are implemented can be sluggish.

The implementation of evidence-based practice has created an unprecedented demand for information related to scientific breakthroughs and better practices as outlined in the nursing literature. The use of technology by the bedside nurse not only helps to deliver these discoveries at a faster pace than in the past, but also ensures the bedside nurses’ practice is current. Another way of keeping the bedside nurses’ practice current is collaborations and partnerships. These entities bridge the separate but intertwined activities in the “clinical supply chain”-research, education, and practice–give hope to the notion that research-borne breakthroughs could reach the bedside more quickly. This will help our nurses become more engaged with the research community and spur scientific inquiry at the bedside to new levels. These engaged nurses, those who integrate the literature’s better practices into their practice, will distinguish themselves and their hospital employers as they deliver superior patient care. Even in this environment of cost cutting and staffing shortages, adherence to tradition cannot become the norm again; instead, we must continue create a culture of inquiry and practice changes based on research and implement new standards that are based on the latest available evidence. This will not only ensure our future, but also help us as we march toward increasing the education levels of the nurses practicing at the bedside.

A call for more education

The IOM’s “The Future of Nursing: Leading Change, Advancing Health” report calls for increasing the percentage of baccalaureate nurses to 80% by 2020. In addition to this report, the possibility of legislating baccalaureate education as entry level for nursing practice is greater now than in the past because of a confluence of several events: the recent nursing shortage and the failure of past approaches to shortages to provide the needed nursing workforce; the changing demographics in the United States with projections of increased demand for health care providers; the enactment of healthcare reform legislation, requiring new approaches to delivery of health care; and nurse leaders and other policy experts calling for changes in nursing education. RN-BSN educational mobility will be imperative for this to happen.
Baccalaureate education that prepare nurses at the bedside are critical because research links BSN-educated RNs with improved patient outcomes, nurse leaders and academicians are retiring in large numbers, and approximately 70% of practicing RNs in the USA are educated at the associate degree or diploma level with only 15% moving on to achieve a degree past the associate level. Also, advocates favoring the baccalaureate degree for entry into nursing practice argue that baccalaureate education develops better skills in leadership and critical thinking, the ability to translate research into nursing practice, and knowledge of population health, important skills not addressed in associate degree program.
There needs to be a seamless transition to the baccalaureate level for those nurses seeking advancement. Measures to foster incentives and inhibit barriers should be implemented at all levels of nursing practice, management, and academia. A viable way to increase the number of BSN graduates is to promote statewide and mandated articulation agreements and create an environment where academic progression is facilitated. Technology will have to embraced and used to its fullest potential in order to facilitate meeting these goals. Hybrid and distance learning will become our new norm as technology creates various ways for our profession to create virtual classrooms that the flexibility to accommodate professional and personal schedules.

The road ahead

Nursing has always answered the call of our nation’s healthcare needs. These current challenges will be met with the unity, determination and creativity that have always been hallmarks of our profession. The future will present exciting opportunities for nurses to expand their practice and assume more leadership roles in an interdisciplinary healthcare team. The integration of technology and the expansion of evidence based practice will provide the bedside nurse with a limitless horizon. The road ahead is bright and exciting. I can’t wait to see where it leads.

Hershaw Davis, Jr., is clinical nurse in the adult emergency department at the Johns Hopkins Hospital, Baltimore, Maryland, and a graduate student at the University of Virginia School of Nursing.

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References

Cohen M, Walker A. Primary care docs in short supply. Baltimore Sun. June 15, 2010.

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Megginson L. RN-BSN education: 21st century barriers and incentives. J Nurs Manag. January 2008; 16:47-55.

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Robert Wood Johnson Foundation Initiative on the Future of Nursing. The Future of Nursing: Leading Change, Advancing Health. Institute of Medicine; October 5, 2010.

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Spencer J. Increasing RN-BSN enrollments: facilitating articulation through curriculum reform. J Contin Educ Nurs. July 2008; 39: 307-313.