Changes In Nursing Field

Nurses are what hold the patient care world together. We are the doctors set of eyes because we spend so much time with our patients. Taking the role as a nurse is a huge responsibility and understanding your job on different levels is very important. People will always need care in their most trying times and nurses and doctors will always be there. Although the disease process will not change, the way we manage them as health professionals does. This is why in the nursing world there is always change.

The change can be from the way we care for our patients to the level of education we receive. Over the decades nursing has changed and evolutionized to meet our patients demands. Nurses are forced to go back to school and obtain higher level educations so they can meet the demands of the ever changing healthcare world. Due to theses changes in work environment and education, nurses are becoming more independent and involved with patient care than ever.

We as nurses work alongside many other interdisciplinary team members to assure our patients receive the best care they need.

Change will always continue to happen in the medical field because there will always be a better way to do something that will benefit our patients. New medications or new processes will always prove to be better than what we did before. People may ask what changes have been made over the past decades. As nurses we have seen so many advancements in our careers it is truly amazing from something as simple as uniforms to the way we chart and what equipment we use.

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According to Jeanine Carr (2015)

The skill set and roles for nurses have expanded and evolved over the last 30 years and will undoubtedly change over the next 30 years. The changing and shifting landscape of healthcare in an inter-professional environment requires that nurses know how to collaborate effectively, resolve conflict with skill, and actively participate in the design of systems that efficiently deliver care. Nurses must be technologically-savvy, grounded in evidence-based practice, knowledgeable about how healthcare is organized and financed, and adaptable to changing roles across the continuum of care. (Carr, 2015)

As nurses instead of being the doctors so called “assistant” we as nurses take a more independent role in patient care. We are now allowed to receive advance practice degrees and specialize in special care units or programs such as care coordinators in the homes or nursing educators. As advance practice nurses such as nurse practitioners we can even do initial assessments and prescribe medications while working under a MD. Due to these advancements nurses are now not limited to just the hospital, they can expand their skills within their communities. Dawn Papandrea (2016) from Nurse.org mentions, “Nurses are needed in medical offices, nursing homes, assisted living facilities, schools, correctional facilities, and to perform home health care services.” (Papandrea, 2016) Working in different settings as nurses allows us to work independently forcing us to broaden our skill set. For example, as a school nurse it is very important to familiarize yourself with the age groups and common illnesses that may occur at those ages and how they might be treated. Working in correctional settings it is very important to understand the different scenarios that can occur as attempts of self harm to chronic disease managements such as diabetes or hypertension. In the correctional setting doctors are not always available right away so it is very important to have strong assessment and critical thinking skills. With all the independence that nurses are seeing there is also another change when working in so many different environments and that is collaboration with different members of the care team.

As a nurse you advocate for your patient, along with independence comes increased communication skills to the interdisciplinary team. When working in the homecare setting if the patient is not improving or has questions about their medications the nurses can collaborate with pharmacists or doctors to better educate the patients about their care. Tricia Hussung (2016) proves that nurses are now moving out of the hospital setting into more community based settings with this statistic, “ In 2010-2011, just over 77 percent of new nurses got their first jobs in hospitals, down from almost 89 percent in 2004-2005.” (Hussung 2016) Another point that plays along with interdisciplinary team communication is decreased hospital stays. Short hospital stays mean that nurses must provide care and education to patients and families efficiently and effectively within a constrained time frame. (Carr, 2015) 

Meaning the sooner the patients leave the hospital the more education is needed for them to maintain care at home, so as a nurse it is very important to collaborate with a social worker who can follow up with the patient at home and accommodate their needs whether it may be the new use of oxygen at home or needing physical therapy. According to US Department of Health and Human Services (2018) A classic study found that nearly 20% of patients experience adverse events within 3 weeks of discharge, nearly three-quarters of which could have been prevented or ameliorated. (US Department of Health and Human Services, 2018) Reflecting upon this statistic it shows how important it is to assess your patient’s readiness to go home. This increases patient safety because the patients are being sent home with the proper tools to decrease their chances of coming back to the hospital and thriving on their own at home.This also allows the nurses to assess situations where going back home may not be the safest for some individuals. 

In some cases elderly patients that live on their own who can no longer care for themselves if discharged home can be unsafe for them so as nurse it is very important to reach out to social services to set up proper and safe placement for the patient. Another example can be if the patient just had knee or hip surgery and needs accommodations wheelchair or crutches at home that is very important to communicate with the care team so they can get the proper equipment needed at home.The advancements for nurses continue to increase and this career will only head towards more growth into the community which was once a limited career has now flourished into a independent role.

With all the change in health care nurses are provided with more opportunities than ever. The two main education pathways a individual can take to become an nurse is the associate’s degree approach or the bachelors. Initially, the only difference seems to be the cost and time it takes to complete these two degrees but the difference is far more complex than just price and length. As a bachelors prepared nurse according to By the College for the People (2017)

The main focus of BSN programs is for the learner to broaden their scope of practice and have the opportunity for enhanced professional development. As a BSN nurse, you will have a better understanding of the cultural, economic, and social issues that affect patients and influence health care delivery systems. (By the College for the People,2017)

As noted above the BSN provides the nurses a more in depth understanding of a holistic approach not just medically but also environmentally. As a BSN nurse we not only focus on the clinical aspect such as how to complete a procedure needed or administering medications but we also look at patient care outside of the hospital when the patient is sent home and what we can do to keep this patient safe in their home environment by collaborating with the proper team members such as physical therapy, occupational therapy, speech therapy, etc. As BSN prepared nurses we can take on more independent setting such as school nursing or care coordination within the hospital. As a BSN prepared nurse you can become a clinical leader and be exposed to how certain rules and regulations affect patient care and then relay that to your team members. BSN prepared nurses are trained more in nursing theory and nursing informatics which allows them to critically think beyond the clinical presentation of the patient. For example, the nursing theory consists of the Nursing Metaparadigm which provides the framework for understanding the four basic components of interest to the nursing profession – person, environment, health, and nursing practice. (Nursing Pyramid Theories, n.d.) Expanding our knowledge to this extent allows us to continually and progress with change in patient care because we look at research and how it affects our patients.

So to set the ADN and BSN scope of practice apart it is important to assess how in patient care they differ. Educational Levels of Hospital Nurses and Surgical Patient Mortality (2011) shows statistics as follows: if the proportion of BSN nurses in all hospitals was 60% rather than 20%, 3.6 fewer deaths per 1000 patients (21.1–17.5) and 14.2 fewer deaths per 1000 patients with complications (failure to rescue) would be expected. (NCBI, 2011) To explain this statistic in depth it shows that BSN trained nurses are using clinical judgment from research they have been exposed to, to catch problems in patients before they worsen or possibly develop. BSN nurses spend time evaluating different patient outcomes and setting based on evidence based practice and research. For example, ICU patients on ventilators need to have many preventive measure taken place in order to ensure safety for them. As a BSN prepared nurse who realize prevention is key and you assess situation before they even take place. In ICU patients the ventilators are life saving tools but the consequences of being in bed and immobile can be harmful to the patient. According to American Nurse today (2011)

The ventilator bundle recognized by IHI and the Joint Commission consists of a group of evidence-based practices that, when implemented together, dramatically reduce VAP incidence in mechanically ventilated patients. The bundle includes these interventions:

• head-of-bed elevation above 30 degrees
• peptic-ulcer disease (stress ulcer) prophylaxis
• deep-vein thrombosis prophylaxis
• appropriate sedation use (“sedation vacation”).

These interventions prevent further harm for the patient so as a BSN prepared nurse you understand why are you giving the IM heparin shots, or why the patient needs to have proper mouth care and head elevation. Prevention and research analysis as a BSN nurse is very essential for safer patient outcomes.

Being a registered nurse is a great responsibility and although it always has been, in today’s day and age as nurses are required to work independently and different situation and outcomes it is very important to know what preventative measures to take for patient safety. With so many changes nurses are being required to go back to school and educate themselves in more intense research settings so the care we provide for our patients is not only safe but cost effective. As a BSN nurse it is important to educate yourself on change and then mold your care based on standards and research presented. That is why most hospitals are requiring now for nurses to go back and obtain their BSN degrees.