"When we are busy and stressed by the environment the surrounds us, it is a personal challenge to be "caring" - the very essence of what nursing is all about..."
Karen L. Miller, RN, PhD, FAAN is Dean and Professor at the University of Kansas School of Nursing in Kansas City, Kansas.

Changing Face of Nursing

Demanding job description always been part of work

Many nurses have been personally affected by recent changes in the environment of health care. In a few short years, we have moved from a nursing shortage to a surplus of hospital nurses. We seem to have fewer and fewer resources to care for patients and families with increasing severity of need.

Biotechnology is expanding so rapidly that we have experienced dramatic changes in clinical treatments and the disappearance of whole groups of in-patients to a variety of ambulatory services. We are a part of a national health care system believed by the public to be inefficient, overly expensive and unavailable to many Americans.

When any environment changes so rapidly, it is difficult to feel secure in our work. It is difficult to feel confident that our knowledge base will be sufficient to meet the demands for new and better approaches to patient care. When we are busy and stressed by the environment that surrounds us, it is a personal challenge to be "caring" - the very essence of what nursing is all about and what our patients and families need the most.

Assess your own caring for yourself and your profession.

Despite the difficulties inherent in the rapid race of change, we must work together. As I see it, there are five imperatives for nursing's future:

Nurses must be a strong voice in national and state health legislation. Nurses have long supported efforts to create a health care system that delivers affordable, quality care services to all people in need.
While future health legislation is expected to be complex, no matter what specific initiatives are enacted, nurses can help support a restructured system that enhances consumer access to cost-effective primary health care in community-based settings.
Nurses must be accountable for clinical outcomes along with physicians and other care givers. Throughout clinical research and program evaluation, we can show evidence of nursing's contribution to the health and well-being of our patients. Through planning and careful monitoring, we can make improvements in the quality of nursing services we provide.
Nurses must be able to identify the most cost-effective ways to deliver care. In doing so, we can help shape a system that benefits public health and maximizes our health care dollars.
Nurses must design new systems for care delivery that ensure access for all to quality, cost-effective health care services.
The care continuum is changing. Nurses see changes in the needs of patients and families that suggest the need for redesign of our care modalities. Patient-centered care places patients' needs before care giver convenience.
Alternative care settings, new technologies, creative models of care delivery and collaborative work teams that can demonstrate their effectiveness are the hallmarks of successful transition to the future.
Nursing education must be designed to meet the changing needs. Traditional teaching methods will need to be replaced with non-traditional clinical practice sites and interactive information exchange and learning technologies. Increasing numbers of advanced practice nurses will need graduate education. Support for APN roles in a variety of primary care, case management and mental health services in a continuum of care giver services. Nurses must be leaders in collaborative efforts with physicians and others in creating systems to meet the needs for universal access to health care for a diverse, multi-cultural population.
Practicing nurses must recognize their influence on students and faculty and their obligation to help share nursing education. We must encourage the efforts of new graduates to practice nursing differently and to develop different care systems.
Nurses must participate in world health initiatives.
Nurses can support world-wide efforts to improve the health of publics in need. We can learn for the experiences of other nurses and health care systems. Many of us are directly involved with health caring activities in foreign countries. All of us can applaud these efforts, opening our hearts to minds to new ideas generated by diversity among nurses.
We must ensure our place in the continuum of health care services by taking actions to address these imperatives for the future of nursing. We have very little time to mourn the loss of the health care system of the past. Nurses must take action now to seize the opportunities of our future.

Used with permission of the Kansas City Nursing News for the 1996 Guide to Nursing in Kansas City, p.8.