NURS 3000 – Issues and Trends in Nursing Assignment Papers

NURS 3000 – Issues and Trends in Nursing Assignment Papers

NURS 3000 – Issues and Trends in Nursing Assignment Papers

Improvement of healthcare delivery in the United States relies on many factors, such as effective nurse advocacy through politics, policy, and professional associations. But advocacy depends on the ability to fully understand current issues, systems, policies, and related contexts.NURS 3000 – Issues and Trends in Nursing Essay Paper

In this course, students engage in a systems-level analysis of the implications of healthcare policy on issues of access, equity, affordability, and social justice in healthcare delivery.
Through policy analysis assignments students apply legislative, regulatory, and financial processes relevant to their organization and provision of healthcare services in their community. Students consider the impact of these processes on quality and safety in nursing practice environment and disparities in the healthcare system. Through this course, students gain the knowledge and skills needed to advocate for vulnerable populations and promote positive social change. (Prerequisites: NURS 3000) Note: Students must take this course first in their sequence.NURS 3000 – Issues and Trends in Nursing Essay Paper

♦ Students may take this as a non-degree course, which means they do not have to be enrolled in a program. Contact an Enrollment Advisor [1-866-492-5336 (U.S.);1-443-627-7222 (toll)] for more information.

Improvement of healthcare delivery in the United States relies on many factors, such as effective nurse advocacy through politics, policy, and professional associations. But advocacy depends on the ability to fully understand current issues, systems, policies, and related contexts.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

In this course, students engage in a systems-level analysis of the implications of healthcare policy on issues of access, equity, affordability, and social justice in healthcare delivery.
Through policy analysis assignments students apply legislative, regulatory, and financial processes relevant to their organization and provision of healthcare services in their community. Students consider the impact of these processes on quality and safety in nursing practice environment and disparities in the healthcare system. Through this course, students gain the knowledge and skills needed to advocate for vulnerable populations and promote positive social change. (Prerequisites: NURS 3000) Note: Students must take this course first in their sequence.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Running head: EDUCATING NEW NURSES 1

Educating New Nurses: A Paradox in the Nursing Shortage

Linda Dietz

Walden University

NURS3000, Section 4, Issues and Trends in Nursing

July 10, 2010

ORDER NURS 3000 – Issues and Trends in Nursing Assignment Papers

Running head is written with the exact words

Running head: THEN WRITE THE TITLE IN ALL CAPITAL LETTERS (abbreviated title)

Page numbers are required on each page.

Compare the title of the paper on this page with the title on page 2.

EDUCATING NEW NURSES 2

Educating New Nurses: A Paradox in the Nursing Shortage

The nursing shortage is a national concern. Newspapers or lay publications frequently the public should be within the context of current nursing workforce trends. Therefore, the purpose of this paper is to discuss information from a popular source on the topic of the availability of nursing education as it relates to what is happening in nursing and health care today and in the future.

Summary of an Article

The article chosen for this assignment was published on March 3, 2010, in the Press-

Republican newspaper in Plattsburgh, New York (Bartlett, 2010). The author, Bartlett (2010), addressed the paradox between the restricted number of students accepted into nursing school and the shortage of nurses since 1998. Bartlett reported that there were 960 applicants to the Plattsburgh nursing program and that, because of clinical placements and faculty constraints, the 4-year nursing program allowed only 55 students. The community college was also overwhelmed with applicants; there were 430 applications for 70 available openings (Bartlett, 2010). This could be a national problem; the American Association of Colleges of Nursing (as cited in Bartlett, 2010) reported that, in 2008, 50,000 qualified applicants could not seek admission to schools of nursing because of inadequate numbers of faculty and not enough sites for clinical placement.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Relationship to Nursing Workforce Trends

The public perception of the nursing shortage parallels professional concerns found in the literature. Huston (2010) addressed the same issues regarding the nursing shortage and the paradox of educating future nurses. By 2016, there will be 587,000 new nursing positions available in the United States, “making nursing the nation’s top profession in terms of job

Level one headings bold and centered

Title of the paper centered and not bolded.

Check APA for correct format of in-text citations.

Check APA for correct format to cite secondary source.

Page header is different than title page (all capital letters without the words “Running head”)

Keep in mind using information for a paper from a popular source like a newspaper will be rare.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Pg 4

Most other papers will not have a “summary of an article” section

kouzts
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Completing a “Summary of an Article” is not common to nursing papers or APA papers. (This specific assignment is uncommon)
EDUCATING NEW NURSES 3

growth” (Huston, 2010, p. 72). Job growth demands continue to increase because many

students who have applied to nursing schools do not gain admission, despite the increased

enrollment capacity of 5% to 16.6% each year for the past 10 years (Kuehn, 2007).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Kuehn (2007) attributed this limitation in the enrollment of nursing schools to the lack of faculty. In 2006, to enroll all students applying to the 329 nursing schools Kuehn surveyed, 637 faculty vacancies would have to be filled and 55 additional positions created. Also, because of the anticipated number of nursing faculty planning to retire, the shortage of faculty will only become worse. In a subsequent article, Kuehn (2008) reported that, in 2007, the partnership between the American Association of Retired Persons and the Robert Wood Johnson Foundation created the Center to Champion Nursing in America. The goal of this center was to form multidisciplinary nursing workforce groups from 18 states who will exchange information and create plans to increase nursing school capacity (Kuehn, 2008).

Summary

If current conditions prevail, the nursing shortage in the United States will increase. The problem of educating sufficient numbers of nurses continues because of a lack of faculty and clinical placement sites, as in Bartlett’s (2010) state of New York. Aging nurses ready to retire add to this dilemma. The Center to Champion Nursing in America created multidisciplinary task forces in 18 states to address the problem of limited enrollment. Clearly the fluctuations in nursing shortages cause concern to both the public and nursing leadership (Laureate Education,

Inc., 2009).

Check APA for correct format of quotes and citations.

Avoid using direct quotes.

Notice how this in-text citation is listed in the Reference page.

The author matches the reference page so the reader can clearly locate it.

EDUCATING NEW NURSES 4

References

Bartlett, S. (2010, March 3). Schools helpless against nursing shortage. Press-Republican.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Retrieved from http://pressrepublican.com/0100_news/x1726192928.com

Huston, C. J. (2010). Professional issues in nursing: Challenges and opportunities. Philadelphia,

PA: Wolters Kluwer/Lippincott Williams and Wilkins.

Kuehn, B. M. (2007). No end in sight to nursing shortage: Bottleneck at nursing schools a key

factor. JAMA: The Journal of the American Medical Association, 298, 1623-1625.

doi:10.1001/jama.298.14.1623

Kuehn, B. M. (2008). Groups target nursing school bottleneck to address medical workforce

deficit. JAMA: The Journal of the American Medical Association, 300, 887-888.

doi:10.1001/jama.300.8.887

Laureate Education, Inc. (Producer). (2009). Workforce issues: The crisis in nursing [DVD]. In

Issues and trends in nursing. Baltimore, MD: Author.

TO CHANGE THE HEADER ON THE SECOND PAGE CLICK “Different First Page”

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Reference page starts on a new page. “Reference” is centered, not bold.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Notice how this Reference exactly matches the in-text citation on page 3.

This column addresses the results of the environmental scan, a major input of the Nursing Professional Development (NPD) Practice Model. Environmental scanning is defined as the “process of systematically monitoring an organization’s internal and external environments for the earliest signs of opportunities and threats that may reveal a potential professional practice gap” (Harper & Maloney, 2016, p. 60). Engaging in this process helps the NPD practitioner plan for potential opportunities and changes in NPD practice based on economic, healthcare, political, societal, and technological trends. These trends, outlined in the 2016 Nursing Professional Development: Scope and Standards of Practice, 3rd Edition (Harper & Maloney, 2016) include the workforce, practice environment, organization, technological influences, political influences, and professional development practice changes. The purpose of this column is to inform readers of these trends with potential role implications for the NPD practitioner.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

WORKFORCE
Anticipated workforce issues that may impact NPD practitioners include “multiple generations in the workforce; loss of the expertise with baby boomer retirement; increased diversity in nursing; anticipated growth in the shortage of healthcare professionals; increased demand for transition into practice programs and mandated nurse residencies for licensure; progressive education expectations for nurses; and increasing emphasis on nursing certifications for employment and retention” (Harper & Maloney, 2016, p. 26).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Role implications for the NPD practitioner:

* As a learning facilitator, include nurses from multiple generations in planning and implementing professional development activities.

* As a leader, use your influence and recommend more flexible schedules to retain baby boomer nurses for their expertise and mentoring of less experienced nurses.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

* As a partner for practice transitions, influence decision makers to implement (or continue) a nurse residency program at your organization, then seek accreditation for the program.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

* As a mentor, encourage nurses and set a goal (Why not 100%?) for NPD colleagues in your setting to obtain NPD specialty certification; encourage nurses to pursue a doctoral degree (if applicable, this goes for you too!).

PRACTICE ENVIRONMENT

For the NPD practitioner, 17 practice environment issues have been identified in the new scope and standards. Some of these issues include the following: the promotion of healthy workplace environments, nurses functioning within the full scope of practice (not just advanced practice nurses) including fee for services, a focus on interprofessional teamwork and team competence, a transition from a focus on the clinical setting to the provision of nursing services across the continuum of care, emphasis on the integration of decision support systems and electronic health records, 90% of clinical decisions to be evidence-based by 2020, developments in genetics and genomics, and demonstration of NPD’s impact on patient outcomes (Harper & Maloney, 2016). Two more topics to consider adding to this list are opioid abuse and legalization of cannabis.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Role implications for the NPD practitioner:

* As a leader and a mentor, role model a culture of respect with no tolerance for any type of bullying.

* As a partner for practice transitions collaborate with interprofessional colleagues across care settings to foster smooth transitions across the continuum of care.

* As a champion for scientific inquiry, continually ask “Is this evidence-based?” when dealing with clinical decisions; use scientific, standard metrics to collect and analyze data related to outcomes.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

* As an advocate for NPD specialty, demonstrate and disseminate the influence of NPD to improve outcomes both within your organization and externally.

ORGANIZATION
Specific trends related to the organization for which the NPD practitioner must be alert are “identification of optimal nursing professional development organizational structures (centralized vs. decentralized reporting structure); increased organization complexity due to mergers, acquisitions and expansions; and ongoing challenges in healthcare funding and reimbursement” (Harper & Maloney, 2016, p. 27).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Role implications for the NPD practitioner:

* As a leader, assess NPD services/activities across your individual organization and healthcare system to ensure alignment with organizational priorities.

* As a leader, use your influence and recommend consolidating services where and when appropriate to improve cost and efficiency (e.g., rather than several hospitals offering the same review course at different times and locations, collaborate for one event).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

* As a leader, share evidence with administrators that demonstrates the value and return on investment for the professional development of nurses (Opperman, Liebig, Bowling, Johnson, & Harper, 2016).

TECHNOLOGICAL INFLUENCES
The technological influences identified for NPD practice are “increasing emphasis on privacy of patient data; the use of mobile devices to communicate and retrieve information; the availability of large complex data sets; proliferation of social networking; proliferation of personal electronic devices; increasing use of virtual health programs; transition to connected health; and technology driven care decisions diminishing individual acceptance of accountability” (Harper & Maloney, 2016, p. 27).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Role implications for the NPD practitioner:

* As a leader, identify what data are (and are not) being collected within your NPD practice and setting (microsystem, mesosystem, and macrosystem) as they relate to NPD practice, nursing problems, interventions (education), and outcomes. Then ask, “What is the meaning of these data? How are they being used? Are they being used to improve practice?”

* As a leader, be an active member of the health information technology team and contribute to strategic planning and implementation of data-driven decisions.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

* As a change agent, engage with nurse informaticists to advance nursing-sensitive quality eMeasures, standardized electronic quality indicators that promote consistent measurement (HIMSS, 2015; National Quality Forum, n.d.).

* As an advocate for NPD specialty, implement standardized and accepted terminology and metrics for tracking outcome data.

* As a champion for scientific inquiry, urge colleagues to use research-based, standardized assessment scales and instruments to promote interoperability of data.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

POLITICAL INFLUENCES
Political influences that may impact NPD practice are “increases in number of insured individuals seeking healthcare service; impacts of a global economy; increasing scrutiny of healthcare outcomes and pay for performance/value based payment model; implications of the federal government as primary payor for healthcare; and growing costs of healthcare” (Harper & Maloney, 2016, p. 27).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Role implications for the NPD practitioner:

* As a leader and an advocate for NPD practice, influence decisions of others with the use of credible data.

* As a change agent, access and apply the resources in legislative advocacy toolkits; write letters to those in positions of authority (e.g., congressman) in support of legislative issues that “protect the public” (for the “Web-Based Resource for Public Policy Advocacy” go to http://www.nln.org/docs/default-source/advocacy-public-policy/web-based-resource).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

* As a learning facilitator, register for “E-Mail Alerts” for nursing and public policy issues provided by the American Nurses Association. To register, go to https://www.smartbrief.com/signupSystem/subscribe.action?pageSequence=1&briefNam.

PROFESSIONAL DEVELOPMENT PRACTICE CHANGES
The environmental scan identified 13 professional development practice change issues expected to impact NPD practice. For ease in reading, they are organized here as educational, financial, and other.

Educational changes include increasing interprofessional continuing education; providing just-in-time training and rapid cycle development of education; deemphasizing traditional classroom-based learning; implementing evidence-based teaching and learning strategies; using technology, including simulation, in continuing education and conducting rigorous multisite research related to NPD practice; and promoting accreditation and funding of practice transition programs for newly licensed nurses (Harper & Maloney, 2016). Financial changes include “promoting learning as an investment in human capital and cost avoidance versus an expenditure” and “demonstrating NPD return on investment (ROI)” (Harper & Maloney, 2016, pp. 27-28).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Other changes for NPD practice include “succession planning for future nurse leaders; developing nurses to serve on advisory and governing boards of health-related corporations and non-profit organizations; preparing nurses for the political arena (local, state and federal); and retooling the workforce to enhance nurses’ ability to practice not only in acute care but across the entire continuum of care” (Harper & Maloney, 2016, p. 27).

Role implications for the NPD practitioner:

* As a leader, use your voice and presence to influence health care by joining an advisory or governance board and encourage colleagues to do the same (to get started, register at http://nursesonboardscoalition.org).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

* As a leader, provide evidence for the return on investment of NPD activities (Opperman et al., 2016).

* As a leader and a learning facilitator, increase the number of interprofessional continuing education activities (for Core Competencies for Interprofessional Collaborative Practice, go to http://www.aacn.nche.edu/education-resources/ipecreport.pdf).

* As a leader and a mentor, create and participate in succession planning programs for other NPD practitioners.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

* As a learning facilitator, increase blended learning strategies in virtual and physical spaces; use active and interactive activities, affective computing (e.g., virtual assistant) and robotics, augmented reality (digital information and spaces in real world), and virtual reality; read and apply the simulation information provided in the Journal for Nurses in Professional Development Simulation column.

SUMMARY
This column addressed the current and future issues, innovations, and trends as outlined in the Nursing Professional Development: Scope and Standards of Practice, 3rd Edition (Harper & Maloney, 2016), along with role implications for the NPD practitioner.NURS 3000 – Issues and Trends in Nursing Assignment Papers. Because the NPD practitioner is in a pivotal position to influence these issues and trends, the question is, “What can and will you do to help your organization through these changes?”

Healthcare is a dynamic and changing environment that demands we are well appraised of the issues and trends that influence our beliefs and practice. In this course, you are challenged to advocate for, and defend, a position related to a selected healthcare issue using debate as a learning medium. Debating is a transformative journey that helps you learn more about your own beliefs and principles while teaching you to stand up and be heard. Further, you investigate historical and contemporary healthcare trends and share your learnings with your class colleagues in a conference format.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Multi-media learning resources, online learning activities, and individual and collaborative group assignments are some of the strategies you will use to achieve the course and unit learning outcomes. The nature of the instructional approach is participant-centered, based on Purkey’s invitational educational theory where an educational environment that is respectful, optimistic, and intentional is co-created by students and the instructor (Gregory & Edwards, 2016).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The course is structured so that you become an investigative reporter! Each unit is organized into 3 parts, the “headline,” “uncovering the story” and the “unit in review.” The headline is meant to be a “hook” or advanced organizer that will catch your attention and introduce you to the unit topic. Uncovering the story includes the unit learning outcomes, learning resources and learning activities. The unit in review is a reflection activity that guides you in reviewing key points from the unit and in consolidating take away learnings.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Course Learning Outcomes
By the conclusion of NURS/MHST 609 Trends and Issues you will be able to:

differentiate between trends and issues;
identify and explain logical errors in arguments;
design a reasoned and structured argument and participate in an online debate defending or opposing a current healthcare issue;
demonstrate oral presentation skills and written strategies to justify your opinion on issues;NURS 3000 – Issues and Trends in Nursing Assignment Papers.
appraise and critique the value of arguments proposed to defend or oppose current healthcare issues;
evaluate issues (social, economic, political and educational) that influence healthcare trends;
moderate an online class discussion regarding a selected healthcare trend;
critique and analyze peer reviewed literature related to healthcare trends and issues; and
reflect on personal learning from the course focusing identifying strengths and limitations that have become apparent, and construct a plan for moving forward.NURS 3000 – Issues and Trends in Nursing Assignment Papers.
Learning Resources
There is no print textbook for this course. Instead you are presented with a variety of online, multi-media learning resources including peer reviewed articles from the AU library, e-textbooks, videos, podcasts, TED talks, movies etc. Many of these are open educational resources (OER). The course topic is well suited to utilizing online resources that allow access to emerging research reports and real-time interviews and newscasts that discuss trends as they are developing. You are invited to share learning resources you discover related to course content with others in the class. Locating additional online resources will assist you in achieving the learning outcomes and your own learning goals, as well as help us develop as a learning community.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Course Structure
NURS/MHST 609 Trends and Issues is an asynchronous online course with a specific start and end date extending over 13 weeks. The course “week” runs from a Wednesday to the following Tuesday evening. On the Wednesday, the course instructor will make an online posting that relates to the topic of the week. The purpose of the weekly input by the instructor is to keep everyone focused on the same topic and to stimulate discussion. While there is no predetermined time when you must log on, are asked to log on at least once a week. However, logging on several times a week is desirable so that discussion continues back and forth among participants. Logging on early in the week is most helpful. During the weeks of your debate and your concurrent trends presentation you will need to log on often.

The course instructor will have expectations for online activities. Dates and days will be assigned and communicated to you by email, or as a posting in the Coffee or News Forum. Each instructor may organize the assignment schedules (dates for your debate and trends presentation) individually. However, there are some specific dates by which certain other course activities need to be achieved by everyone. These dates are specified in the study guide and assessment overview.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Course Overview
The course consists of the following seven units:

Unit 1 Introductions: Course Orientation and Starting the Investigation of Trends and Issues
Unit 2 Foundations of Debating: Structuring an Argument, Logic, and Fallacies
Unit 3 Debate Issues and Preparation for Debates
Unit 4 The Debates
Unit 5 Exploring Healthcare Trends: Past, Present and Future
Unit 6 Trends in Healthcare Online Conference
Unit 7 Review, Reflection and Wrap-up
Assessment Structure, Grading, and Style Requirements
You will have opportunities to complete the following four assignments.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Assignment 1 – DEBATE: Advocate for individuals, families, practices or policies using the principles of structuring an argument and debating. (2 parts)

Assignment 2 – CONCURRENT SESSION PRESENTATION AND MODERATION OF DICUSSION AT A CLASS ONLINE CONFERENCE – TRENDS IN HEALTHCARE: Choose a healthcare trend related to your practice or profession, write a short discussion paper on the trend and moderate discussion of your trend during a concurrent session at a class online conference entitled Trends in Healthcare.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Assignment 3 – REFLECTION PAPER: Write a short reflection paper related to what you learned about yourself during the course and include a plan for utilizing identified strengths and overcoming identified limitations.

Assignment 4 – PARTICIPATION: This includes participation in learning activities throughout the course.

Students must achieve an overall program GPA of 2.7 (B- or 70 percent), to graduate. The minimum passing grade requirement for each course is C- (60 percent).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

All assignment citations are to follow the most current APA (American Psychological Association) style.

Athabasca University reserves the right to amend course outlines occasionally and without notice. Courses offered by other delivery methods may vary from their individualized-study counterparts.

Credits awarded for meeting competencies required to achieve the nursing license through either a diploma program or an associate’s degree program.
Transfer credits from undergraduate courses that they have taken at other universities.
135 of the 180 quarter credits may potentially be transferred into the program (depending upon the qualifications the students bring as they enter).NURS 3000 – Issues and Trends in Nursing Assignment Papers.
Learning Outcomes
Apply leadership and informatics concepts in decision making to promote patient safety and quality care.
Use evidence based on the sciences, humanities, and research to guide nursing practice across the health-illness continuum in a variety of healthcare settings.
Evaluate the implications of policy on issues of access, equity, affordability, and social justice in healthcare delivery including the health of vulnerable populations and healthcare disparities.
Demonstrate effective communication and collaboration skills to improve patient outcomes.
Implement individual and population-focused interventions to promote health and to prevent and manage disease and injuries.
Exhibit accountability for personal and professional behaviors in accordance with standards of moral, ethical, and legal conduct with a commitment to continuous professional development.
Provide patient-centered nursing care based on a comprehensive and focused health assessment across the lifespan using sound clinical judgment as well as developmentally and culturally appropriate approaches.

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Specializations
General
Degree Requirements
180 total credits
General Education (50 cr., at least 10 of which must be completed at Walden and all of which are to be completed prior to BSN core and concentration courses)
First course (1 cr.)
Nursing license transfer of credit (up to 50 cr.)
Upper-level nursing core courses (54 cr.)
NURS 5050, NURS 5051, and NURS 5052 will transfer into the MSN program with a grade of B or higher.
Elective courses (25 cr.)
Curriculum
General Education Courses (50 cr.)
Foundation Course
CMIS 1001 – Introduction to Information Systems♦ Required
Social Science
First Course (1 cr.)
WLDN 1000 – Dynamics of Walden Success: Learning Lab
Nursing License Transfer of Credit (50 cr.)
Upper-Level Nursing Core Courses (54 cr.)
NURS 3000 – Issues and Trends in Nursing♦
NURS 5050 – Policy and Advocacy for Improving Population Health
NURS 3015 – Pathopharmacology♦
NURS 5051 – Transforming Nursing and Healthcare Through Technology
NURS 3020 – Health Assessment♦
NURS 5052 – Essentials of Evidence-Based Practice
NURS 4005 – Topics in Clinical Nursing♦
NURS 4010 – Family, Community, and Population-Based Care
NURS 4015 – Public and Global Health♦
NURS 4020 – Leadership Competencies in Nursing and Healthcare

In Israel, approximately one-third of the country’s nurses work in community settings – primarily as salaried employees in Israel’s four non-profit health plans. Many health system leaders believe that the roles of health plan nurses have changed significantly in recent years due to a mix of universal developments (such as population aging and academization of the profession) and Israel-specific changes (such as the introduction of extensive quality monitoring in primary care).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Objectives
The main objectives of the study were to identify recent changes in the roles of health plan nurses and their current areas of activity. It also explored the experience of front-line nurses with regard to autonomy, work satisfaction, and barriers to further role development.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Methods
The study integrated interviews and surveys of nurses and other professionals conducted across 4 years. Data generated from earlier study components were used to guide questions and focus for later components.

In 2013, in-depth interviews were held with 55 senior nursing and medical professionals supplemented by interviews in mid-2017 with the head nurses in the four health plans. In addition, a national survey was conducted in 2014–5 among a representative sample of 1019 community nurses who work for the health plans and who are engaged in direct patient care. Six hundred ninety-two nurses responded to the survey, yielding a response rate of 69%. The survey sample consisted of an equal number of nurses from each health plan, and the observations were weighted accordingly.

Findings
Senior professionals identified general themes associated with a shift in nursing roles, including a transition from reactive to initiated work, increased specialization, and a shifting of tasks from hospitals to community settings. They identified the current main areas of activity in the health plans as being: routine care, chronic care, health promotion, quality monitoring and improvement, specialized care (such as wound care), and home care.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

In the survey of front-line nurses, 38% of the nurses identified “caring for chronically ill patients” as their main area of activity aside from routine care; 30% did so regarding “health promotion”, and 26% did so regarding “a specific area of specialization” e.g., diabetes, wound care or women’s health). In response to a separate question, 77% reported “great” or “very great” involvement in quality measurement programs.

Four out of five front-line nurses were satisfied with their work to a great or very great extent, and approximately three out of four of them (73%) felt that they had autonomy at work to a great or very great extent. About half of the nurses take into account, to a great or very great extent, the financial concerns of the health plans that employ them.

A large majority of the nurses (85%) indicated that the nature of their work had changed substantially in recent years, with an increase in autonomy noted as one of the key changes. Perceived barriers to further role development include attitudes on the part of some physicians and nurses, an insufficient number of dedicated nursing positions, and insufficiently attractive wage levels.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Conclusions
The findings, gathered over 4 years, indicate alignment between universal and Israel-specific trends in health care and the evolving roles of nurses in Israel’s health plans.

The findings provide support for ongoing efforts in the health plans to give nurses more authority and responsibility in the management of chronically ill patients, a more central role in health promotion efforts, more advanced training – both inter-professional and nurse-specific, and more opportunity to focus on the roles and tasks that require nursing professionals.

Background
The nursing profession is an important component of the provision of community healthcare world-wide. Nearly a third of the nurses in Israel are employed in the community,1 similar to the situation in the United States [2]. In Israel, most community-based nurses work for one of Israel’s four non-profit health plans, which are responsible for the organization and provision of care within the framework of Israel’s National Health Insurance Law [33]. Another major employer is the Ministry of Health (MOH), which employs nurses in its network of preventive mother and child health centers, and in other frameworks.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Traditionally, the main roles of community-based nurses (particularly in urban clinics) were to prepare patients for their meetings with a physician (by taking blood, pulse blood pressure, weight and other measurements) and implementing specific physician directives in the immediate wake of the patients’ encounters with the physicians. However, for over a decade, nursing and other leaders in Israeli health care have been talking about significant changes taking place in the roles of the community nurses. They have been attributing these role changes to a variety of contextual changes, which are described below. Interestingly, some of these contextual changes are happening in health care systems around the world, while others are Israel-specific. Some relate to changes in the population, other to changes in the health care system and still others to changes in the nursing profession itself.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Changes in the population
With the aging of the population, there is a growing recognition among health care leaders of the need to better address chronic health problems [19, 22]. There is a considerable body of research demonstrating the substantial contribution that nurses can and do make to the management of chronic illness ([4, 5] CAN, 2013; Trehearne, Fishman and Lin, 2014). They improve quality and access to care [30] and play a central role in the provision of other types of health services that are particularly important to an aging population, such as home care and home hospitalizations.

Changes in the health system
The increased attention being given by Israeli health plans to chronic care stems not only from population aging. Another motivator has been Israel’s National Quality Monitoring Program that has galvanized the plans to seek ways to improve the quality of care, particularly in the areas of chronic care and screening and prevention. Nurses are playing a central role in the health plans’ efforts to improve those measures [34].NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Community nursing can play a major role in effecting life-style changes in chronically ill patients, in guiding direct caregivers in elder and childcare and in long-term care, and in identifying and preventing abuse [1, 9, 18, 20]. Moreover, various technological advances are making it increasingly feasible to manage the care of chronic patients and integrate the care across several geographic locations [3] and a range of different types of providers [7]; nurses play a central role in such integration efforts [8]. Interestingly, in some ways this a return to Israel’s 1980s “teamwork” model in which nurses played a significant role in chronic care.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Israeli health plans are also gradually recognizing the need to do more in the area of health promotion [14], well beyond those elements of health promotion related to the quality indicators. The growing health plan involvement in health promotion seems to stem from a mix of a mission-driven commitment to wellness, an interest in reducing health expenditures, and marketing considerations. Health promotion is clearly an area in which nurses are well situated to play important roles [13, 21]. Health promotion practices of nurses include disease prevention and health education; however, they seek to work in more collaborative way with other professionals [16].NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The 2012 decision by the Israeli government to transfer the responsibility for mental health services from the government to the health plans has catalyzed health plan managers to also consider how various staffing models could help them address mental health needs in an efficient and effective manner ([32]: Nirel et al., 2007). In many countries, nurses play a major role in the provision of community-based mental health services ([11]; Heslop, Wynaden, Tohotoa and Heslop, 2016),), including identifying depression and other mental health problems and monitoring medication adherence/compliance. Note that the 2012 decision called for a 3-year transition period to prepare for a transfer of responsibility in mid-2015.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

It is also important to note that physician salaries in Israel have increased significantly in recent years [33, 36]. There is a certain amount of overlap between the set of tasks that community-based physicians typically carry out, and the set of tasks that nurses are authorized to perform ([15]; Laurant, 2007). Accordingly, an increase in physician wages could encourage the health plans to shift certain responsibilities from physicians to nurses, and this in turn could contribute to both an increase in the number of nurses the plans employ and the scope of the nurses’ responsibilities.

Changes in the nursing profession
Important changes are also taking place within the nursing profession itself. In particular, for several decades, the profession has been moving toward greater academization and advanced specialty training [15]. In recent years, various changes in primary legislation and Ministry of Health directives have broadened the scope of nursing practice, with increased authority in such areas as changing medication regimens, and palliative care.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

At the same time, there are several barriers to change in the role of nurses in community settings in Israel. These include traditional perceptions of the role of nursing as “handmaiden to medicine” (and hence limited in autonomy), and opposition on the part of the Israel Medical Association to some of the changes being advocated by the nursing profession.

Interestingly, the major nursing shortage facing Israel [31, 23, 24] and countries around the world, could function either as a barrier to change (with the argument that basic functions be given top priority) or as a catalyst for change (due to the widespread belief that new and autonomous roles for nurses will attract more applicants to the profession). It will be important to see how these conflicting forces are playing out in Israel.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

In several countries, major studies have been carried out to explore how such factors as the increasing importance of chronic, mental and preventive care are changing the roles of nurses in community settings [10, 17, 35]. Meanwhile, unique features of the Israeli health system, such as the pervasiveness of managed care plans, could result in a uniquely Israeli dynamic. However, until recently, no such studies had been carried out in Israel.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Study goals
The study had two main goals:
♦ To document the main changes in the roles of health plan nurses in Israel in recent years

♦ To document the main areas of health plan nursing work today and the extent of their occupation in these areas.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

In addition, the study was designed to:

♦ Examine the extent of autonomy felt by nurses in their work

♦ Examine the extent of satisfaction felt by nurses with various aspects of their work

♦ Examine how nurses perceive their contribution to the quality measurement program and how the program affects them

♦ Identify the barriers to the continued development of the role of community nurses.

Apart from these issues, the study was designed to examine the varying perceptions of nurses based on the following variables: age, country of birth, level of education, professional status, and position of management or otherwise. Further, it compared the situation in Israel with that in the US and England regarding both how roles of community nurses have changed in recent years and the current nature of their roles.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The study focuses on nurses employed by Israel’s four non-profit health plans. Background information on the status of nurses in each of the four plans can be found in Appendix A.

Methods
This paper is based on a broad study conducted in 2014 [28].

The study had two main components:
In-depth interviews with approximately 50 leading professionals in the field of nursing and related fields.

A survey of more than 1000 community nurses who engage in direct patient care

The two main components are complementary; the leading professionals are uniquely situated to identify the role changes that have taken place over time and to provide a broader system perspective, while the front-line nurses are uniquely situated to provide detail and quantification regarding the current nature and content of the work.NURS 3000 – Issues and Trends in Nursing Assignment Papers. Moreover, the in-depth, open-ended interviews with the leaders contributed to the development of the largely closed-ended questionnaire for the front-line nurses, (as did informal discussions with a number of front-line nurses). For example, the in-depth interviews generated a list of current areas of activity and then the survey was used to quantify the centrality of each area of activity and then explore it in greater detail.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

These two main components are described further below; the study team also explored how the Israeli situation compares with the situations in the US and the UK, as described in Appendix B.

A. Methods – The In-Depth Interviews of Leading Professionals

Fifty-five semi-structured, in-depth interviews were held with leading figures from the field of nursing and related fields. Interviewees were suggested by the members of the members of the Community Nursing Study Group (which included head nurses from the health plans and MOH nursing leaders). NURS 3000 – Issues and Trends in Nursing Assignment Papers. The interviewees included past and present heads of nursing at the MOH, the health plans, and the hospitals; leading academics in the field; managers at various levels of the health system (physicians, nurses and other personnel), the Israel Medical Association, the National Association of Nurses in Israel, hospitals, and various professional societies. The interviewees included both nurse managers and managers from other professions. The mix of interviewees made it possible to obtain a variety of perspectives on the processes affecting the nursing profession.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The interviews were conducted between January and August 2013. A semi-structured interview guide was used including questions on: the main current areas of activity of health plan nurses, how their work has changed in recent years, the challenges they face at work, their view of the future of the profession and of the barriers to changes to the profession.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The in-depth interviews were analyzed by first extracting the main themes and then exploring how these themes were addressed in the various interviews. Each interview was summarized in writing. An initial content analysis was carried out shortly after the interview, and significant issues were identified. In cases where a gap was discovered or a question arose, we returned to the interviewees and asked for clarifications.

In the analysis of the interviews, we compiled a detailed list of all the roles performed by the nurses and categorized them according to relevant groups. We made comparisons among health plans, different levels of management and regions. We focused on topics that were mentioned by many interviewees, but we also addressed noted significant issues raised by one or two interviewees. In addition, we analyzed reports and documents submitted to us by the interviewees.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

In mid-2017, supplementary interviews were held with the head nurses in the four plans, focusing on changes in the most recent years, against the background of the findings from the survey.

B. Methods – The Survey of Front-Line Health Plan Nurses
The study population consisted of all health-plan nurses in the four health plans spending most of their time in non-management work, regardless of whether their positions were full- or part-time. Registered nurses, Licensed practical nurses, and RNs with advanced certification were included. Nurses whose main occupation was managerial were not included in the survey to ensure that the focus was on nurses involved primarily in direct patient care. According to the data of the health plans, in 2014 this amounted to more than 4600 nurses.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Sample
Despite the differences in size between the four health plans in the number of employees and persons insured, approximately 250 nurses were sampled at random from each health plan to permit a reliable analysis for each plan.2

Data collection and distribution of the questionnaire
The research questionnaires were computerized and emailed to all the nurses using the addresses supplied by the health plans. The survey was conducted between August 2014 and February 2015. The appeal to the nurses invited them to respond by email through the link provided or by telephone.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

In each health plan, 250 nurses were sampled randomly. This random sampling is relied upon to provide a representative mix of full v. part time, etc. within each health plan.3 At the data analysis stage, the observations were weighted to reflect inter-plan differences in sampling probability and response rate. Thus, the weighted sample can reasonably be expected to reflect the composition of the population of community nurses in Israel with at least some direct care responsibility – both in terms of health plan mix, managerial position mix, full-part time mix, etc.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The sample numbered 1019 nurses. Of these, 6.6% chose not to cooperate and 1.4% did not meet sampling criteria. In total, 692 or 69% of the nurses responded to the questionnaire.4 The response rate varied among the health plans, ranging from 56% to 82%. Four hundred forty-eight interviews were conducted by email; 175 – by telephone; and 69 were completed manually and posted by regular mail.

Research tool
The survey was composed of 70 questions, of which 15 were open-ended.

The topics covered included the following: the main areas of the nurses’ work; their main activities within those areas; perceptions of autonomy; perceptions of the quality measurement program; job satisfaction; perceptions of the professional future of health plan nurses; and background characteristics.5 A pre-test was conducted among 12 community nurses and the questionnaire was refined accordingly.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The categories for the question about usual work activities were derived from the leadership interviews.

The research questionnaires were computerized and emailed to all the nurses using the addresses supplied by the health plans. The survey was conducted between August 2014 and February 2015. The appeal to the nurses invited them to respond by email through the link provided or by telephone or regular mail. 65% of the responses were by e-mail, 25% by phone and 10% by regular mail. Comparison of key response variables (e.g. satisfaction, extent of role change, etc.) found very similar patterns of response across data collection modalities.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The questionnaire made it clear to the respondents that their responses would remain anonymous and the st.

udy team abided by that commitment, sharing with the health plans only aggregate results.

A key distinction in the survey was between routine work and “professional work”. Routine work was defined in the questionnaire as “work that is carried out routinely in the nurses’ room, e.g., blood tests, ECG, blood pressure, vaccinations, inhalations, etc.” Professional work was defined as “work in a specific professional field, such as treatment of complex wounds, stomas, follow-up in diabetes clinic, heart failure, giving instructions for genetic survey testing, geriatrics, women’s health, mental health, day hospital, minor surgical procedures, etc.”.6

Data analysis
The data were weighted to reflect differences among health plans in the sampling proportions and the response rate. After the weighting, the data presented unbiased national estimates of the parameters examined. The analysis focused on the findings for the full sample. Comparisons were also carried among population sub-groups defined in terms of age, educational level, and other background variables.7

The data were analyzed using SPSS version 21, and its complex samples utility. The open questions were analyzed using Naralyzer, a program that makes it possible to consider the entire set of responses to any given question. The responses were coded by category and a codebook was built for the questionnaire, after which the respondents’ responses were transferred to SPSS.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Results
A. Findings from the in-depth interviews of senior professionals
Senior professionals identified 4 key trends influencing the evolution of the work and functions of community and health plan nurses [26, 27]:
1.
A transition from reactive to initiated work

2.
Increased specialization of nurses in various areas of care, including diabetes and wound care

3.
The integration of nursing work into various circles of care-giving and support (for example, with the patient as an individual, the patient within the family, and the patient within the group of patients suffering from the same condition).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

4.
A transfer of activities from the hospital to the community.

The general picture arising from the interviews is that the work of community nurses has broadened in recent years, and this trend is expected to continue.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The interviews identified the following as the main areas of current work of health plan nurses8:
♦ Routine work (as defined above)

♦ Care of chronic patients

♦ Health promotion (health education, encouraging screening tests etc.)

♦ Quality measurement and improvement (involvement in quality measurement programs in both her routine work and special projects).

♦ Home visits (Nurses perform most home visits, including assessments of pain and activities of daily living, functioning, care-giver teaching and support, treating wounds, changing catheters, and drawing samples for laboratory tests.)

♦ Specialized care in various areas including diabetes, stoma, treating wounds, and geriatrics

♦ Participation in unique health-plan initiatives such as “conversation maps for diabetes” and a “personal physician”.

The in-depth interviews also surfaced similarities and differences among the health plans; these are depicted in Appendix C.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Interviews in mid-2017 of the health plans’ nursing directors highlighted the following recent developments:
With the support of top management, technical tasks are increasingly being delegated by nurses to support staff

Nurses are increasingly being appointed to general management positions such as regional directors and program directors

Inter-professional education, involving training of the full primary care team, is on the rise

Nurses are increasingly being given patient management roles in chronic care

and lead roles in health promotion and hospital-community transitions

B. Findings from the Survey of Front-line Nurses
Overview
The main findings emerging from the survey are that the nurses feel that their role has broadened, that they enjoy substantial autonomy and, in general, they are satisfied with their work. They believe that the profession will continue to develop in the future, but at the same time, they point to significant problems and barriers.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Personal and professional characteristics
As indicated in Table 1, 93% of health plan nurses responding to the survey were women, 84% are Jewish, and 59% were born in Israel. Approximately 2/3 of respondents had academic degrees (47% bachelors and 17% masters), 90% were registered nurses (of whom almost half have taken advanced courses), almost half have been working as nurses for over 25 years (albeit not just in community settings), and about a third have supervisory or managerial roles.
Table 1
Distribution of respondents by key personal and professional characteristics (percents)

Personal characteristics

Professional characteristics

Age

Educational level

Up to 40

25%

Diploma (i..e. no degree)

36%

From 41 to 55

40%

Bachelors’ degree

47%

Over 55

35%

Masters’ or PhD degree

17%

Sex

Professional status

Female

93%

Licensed practical nurse

11%

Male

7%

Registered nurse

50%

RN with advanced course

39%

Population group

Jewish

84%

Managerial responsibility

Non-Jewish

16%

With managerial role

38%

Without managerial role

62%

Country of birth

Israel

59%

Nursing experience (years)

Outside of Israel

41%

0–14

29%

15–24

26%

25+

45%

The study team compared the characteristics of the respondents and the study population for Israel’s two largest health plan, which account for more than half of the nurse population (similar data were unavailable from the other two plans).NURS 3000 – Issues and Trends in Nursing Assignment Papers. In one of the large plans, the characteristics were found to be very similar with regard to sex and education level, but with the sample having a slightly higher proportion of nurses who had done Diploma courses (54% v. 43%). In the other large plan, the population and sample were very similar with regard to sex, the proportion of the nurses who had done Diploma courses was slightly lower in the sample (33% v. 40%), and the sample also had a lower percentage of LPNs (8% v. 18%). (Note that the impact of these small differences on the overall study findings is apparently quite limited, as the study found few substantial differences in key study variables among these sub-groups – see Tables 5, 6 and 7 below).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Main areas of activity
A majority of front line staff (71%) continue to engage in routine activities (as defined in this study) to a great or very great extent. In addition, approximately one quarter to a third of the respondents indicated that their major area of care, besides routine work, was chronic illness care (38%), health promotion (30%), specialized care (26%) and home care (6%).

Caring for chronically ill patients
Those nurses who indicated that caring for the chronically ill was their main area of non-routine activity were presented with a list of relevant activities and asked to indicate in which of them they are involved to a great or very great extent. As indicated in Table 2, when it comes to chronic care, there is extensive involvement in several proactive and professionally demanding activities, such as management of the care process (80%) and interactions with specific patients (79%). About half also indicated great and very great involvement in the development of policy and general approaches to care regarding chronic patients. This process was also accompanied by the development of digital information systems and services.NURS 3000 – Issues and Trends in Nursing Assignment Papers.
Table 2
Percent of nurses who indicated that they were involved to a great or very great extent in various aspects of caring for the chronically ill

Management of the care process

80%

Pro-active interactions with specific patients

79%

Monitoring continuity of care for specific patients

79%

Development of policy and general approaches to care regarding chronic patients

48%

Outreach to the target population

52%

Development of proactive action plan for patients with chronic diseases

77%

Monitoring the implementation of proactive action plans

68%

(From among those nurses who indicated that caring for the chronically ill was their main area of non-routine activity)

The same group of nurses was also presented with a list of tasks associated with caring for individuals with chronic illness (Table 3) and asked whether the tasks constituted a significant part of their work. The vast majority affirmed that this was the case regarding healthy lifestyle counseling (91%) and deciding which patients to invite to visit (75%). In contrast, only 4% indicated that changing doses in prescriptions was a significant part of their work.NURS 3000 – Issues and Trends in Nursing Assignment Papers.
Table 3
Percent of nurses who indicated that various tasks were a significant part of their work

Healthy lifestyle counseling

91%

Functional and health status assessments

90%

Monitoring specific patients

86%

Deciding which patients to invite to visit

75%

Deciding, on the basis of protocols, computer alerts, and patient assessments whether/when particular patients should be immunized

63%

Changing doses in prescriptions

4%

(From among those nurses who indicated that caring for the chronically ill was their main area of non-routine activity)

Health promotion
Those nurses who indicated that health promotion was their main area of non-routine activity were similarly asked about the extent of their involvement in a list of relevant activities. As indicated in Table 4, there is extensive involvement in the identification of target populations for interventions (86%) and counseling about nutrition (79%), smoking (65%) and physical activity (73%). The nurses were much more likely to be involved in health promotion events within the clinic (38%) than in those outside the clinic (14%). When asked about the extent to which they engage in outreach (in general), 78% indicated that they do so to a great or very great extent.NURS 3000 – Issues and Trends in Nursing Assignment Papers.
Table 4
Percent of nurses who indicated that they were engaged in various activities related to health promotion, to a great or very great extent

Identification of target populations for interventions

86%

Workshops and counseling sessions in the area of health promotion

38%

Health promotion activities that take place outside the clinic

14%

Health promotion activities that take place in the clinic

44%

Counseling about nutrition

79%

Counseling about smoking

65%

Counseling about physical activity

73%

(From among those nurses who indicated that health promotion was their main area of non-routine activity)

Change in the way of working
Eighty-five percent of the nurses felt that concerning their main area of activity, in the past 5 years there have been significant changes in the way that they work. Among other things, the changes cited included: more planned work than in the past, focused activity on specific areas (such as the those noted above), and expansion of medical knowledge. Furthermore, 61% of the nurses noted that the working environment in this period had changed to a great or very great extent, and another 26% indicated that it had changed to a moderate extent.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Social and economic considerations
Almost all of the nurses (90%) take into account the family and economic situation of the patient to a great or very great extent while only 2% of them take it into account to a small or very small extent or not at all. Moreover, almost half (47%) of the nurses take into account financial considerations of the health plan to a great or very great extent while 18% of them take it into account to a small, very small extent or not at all. (The remainder takes these factors into account to a moderate extent.)

The quality measurement program
Approximately three-quarters of the nurses (77%) reported involvement to a great or very great extent in quality measurement programs; only 10% felt that they were not involved or were involved to a very small extent. Similarly, 75% of the nurses felt that the program had impacted their work to a great or very great extent, and 73% of them felt that their workload had increased to a great or very great extent as a result of the program.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Sense of autonomy
Approximately three-quarters of the nurses (73%) felt that they had autonomy at work to a great or very great extent. Similarly, 75% of the nurses felt that their professional autonomy had broadened in the preceding 5 years in contrast to 9% who reported a sense of curtailed autonomy in this period, and 16% who noted that they had felt no change. 70% indicated that, to a great or very great extent, they had the authority needed to do their jobs.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Work satisfaction
Four out of every five nurses (80%) were satisfied to a great or very great extent with their work overall, and only 3% felt little or very little satisfaction; the rest were moderately satisfied. In keeping with these feelings, 80% said that they would recommend to others to enter the profession.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

As indicated in Chart 1, the aspects of work with which the most nurses were satisfied to a great or very great extent were: the impact of their work with patients (84%), the extent of responsibility given to them (81%), and their co-workers (82%). The aspects of work with which the lowest proportion of nurses were satisfied were: the salary (39%), physical conditions (14%, and appreciation of their work by their superiors (17% dissatisfied).

Barriers to the development of the nursing profession
Asked about barriers to the development of the profession, the front-line nurses who participated in the survey and the managerial nurses who participated in the in-depth interviews cited similar barriers. These included:
♦ Physicians’ perceptions. Some nurses believe that physicians fear the profession’s development, being interested in keeping the nurses in the position of following physicians’ directives.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

♦ Nurses. Some nurses believe that they and/or some of their colleagues slow down the profession’s development, having no interest in broadening their authority for fear of a greater workload.

♦ Lack of resources and positions. Many nurses regard the lack of resources as a barrier to the profession’s development: the large workforce shortage, and the fact that there are no established positions

♦ Compensation. Subsequent to the relative wage dissatisfaction, some nurses regard low levels of compensation as a barrier to the profession’s development. Low compensation attracts fewer young people to the profession and increases the workload.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Note that the barriers identified in the survey were largely similar to those that came up in the in-depth interviews.

Differences among nurses related to background characteristics
The nurses’ perceptions were examined according to the following variables: age, country of birth, level of education, professional status and managerial position. As a rule, very few large or statistically significant differences were found among the groups (See Tables 5, 6 and 7).NURS 3000 – Issues and Trends in Nursing Assignment Papers. However, we did find that the more educated the nurses were, the more likely they were to take into account financial considerations of the health plan and the more satisfied they were than less-educated nurses. We also found that the higher the level of their professional training, the more they tended to take into consideration the family and economic situation of a patient. In addition, nurses with a higher level of professional training felt were more likely to indicate that the quality monitoring led to an increase in competition among the front-line clinicians, managerial pressure and overload.NURS 3000 – Issues and Trends in Nursing Assignment Papers.
Table 5
Authority and autonomy by sub-group

Autonomy to a great or very great extent (in %)

Sufficient authority to carry out job (in %)

Total

78

70

Age

Under 40

70

60

41–55

80

72

Over 55

83

76

Education level

No degree

84

84

BA

75

75

MA+

75

75

Professional status

LPN

66

67

RN

78

72

Beyond

80

68

Managerial responsibility

With managerial role

85

78

Without managerial role

74

65

Table 6
Perceptions of significant change and level of satisfaction, by subgroup

Significant change in past five years (in %)

Satisfied to a great or very great extent (in %)

Total

52

78

Age

Under 40

47

79

41–55

56

77

Over 55

52

80

Education level

No degree

53

78

BA

54

80

MA+

43

79

Professional status

LPN

61

71

RN

51

81

Beyond

49

77

Managerial responsibility

With managerial role

62

81

Without managerial role

45

78

Table 7
Social and economic care considerations by subgroup

Significant weight given to family and economic circumstances

Significant weight given to health plan financial considerations

Total

90%

47%

Age

Under 40

84%

38%

41–55

95%

55%

Over 55

84%

46%

Education level

No degree

95%

44%

BA

86%

46%

MA+

88%

55%

Professional status

LPN

81%

51%

RN

91%

46%

Beyond

89%

48%

Managerial responsibility

With managerial role

89%

38%

Without managerial role

88%

55%

NURS 3000 – Issues and Trends in Nursing Assignment Papers

Discussion and conclusions

This study provides the first empirically based description of the role of health plan nurses in Israel. Interviews with national leaders in nursing and medicine conducted in 2013 foreshadowed changes described by front-line nurses in interviews 2 years later. Leaders identified emergent trends in chronic illness and specialized care in the health plans as well a shift from reactive to nurse-initiated work. Findings from the 2014–5 survey of front-line nurses showed these trends were indeed occurring. Follow-up interviews with nurse plan leaders in 2017 provided key updates and were consistent with the earlier findings. All study components indicated that major changes have occurred in Israel in the role and functions of health plan nurses and their involvement in patient care.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The changes found included a transition from reactive to initiated work and increased specialization. Moreover, aside from routine care, the study has documented the central place of chronic care; health promotion and specialized care in the work of health plan nurses. Activities related to the quality monitoring and improvement are another significant component of the work of Israel’s health plan nurses. The findings provide support for ongoing efforts in the health plans to give nurses more authority and responsibility in the management of chronically ill patients, a more central role in health promotion efforts, more advanced training – both inter-professional and nurse-specific, and more opportunity to focus on the roles and tasks that require nursing professionals.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

One of the study’s key findings is that about half of the nurses take into account, to a great or very great extent, the financial concerns of the health plans that employ them. This may be due, in part, to the growing roles of nurses in care coordination and management. This sensitivity to cost considerations, combined with the nurses’ broad professional expertise and patient-centric perspective, make nurses an extremely valuable resource for the plans, and positions them for greater responsibility and authority.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

We examined whether there were differences between the nurses who are managers and the other nurses with regard to the extent to which they take into account various considerations. The two groups were equally likely to take into account the patients’ economic circumstances (approximately 90% do so to a great or very great extent). Surprisingly, however, the nurse-managers were less likely than the others to report that take into account the economic interests of their health plans (22% vs. 36%). The reasons for this difference might be a good subject of a future study.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Another key finding is that a significant proportion of the nurses (38%) indicated that care of the chronically ill patient is their main area of activity beyond routine care. With the population continuing to age, work in this area is likely to expand. It will be important to develop patient-centered projections of the amount and nature of the work that will be needed to care effectively for the chronically ill, and then think strategically about how health plan leaders, and physicians, nurses, and other professionals on the front-line can best work together to address this important challenge. This will clearly have important implications for the number of professionals required and continuing education, and this could be an important area for inter-professional continuing education. Serious consideration should be given to continuing the trend of giving nurses a greater role in care coordination and management of the chronically ill.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Health promotion is the main area of non-routine activity for another large group (30%) of health plan nurses. In the future, it will be important to explore in greater detail in which health promotion challenges they are most involved, the nature of their involvement in those challenges, and the degree of their success in those areas. This could have important implications for ensuring that nurses have the opportunity to engage in relevant continuing education opportunities regarding health promotion strategies, concepts and techniques. The major role that nurses are playing in patient-level health promotion should also be give greater recognition.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The study also confirms the extensive involvement of nurses in quality monitoring and improvement efforts, hence another area where inter-professional education should be given greater emphasis. A related finding is that almost all the nurses are quite attuned to the family and economic situation of the patient. This attention to context can be vitally important in efforts to improve a health plan’s quality performance, particularly with regard to those dimensions of quality, which require patient compliance and/or behavioral change. They will be even more important in the future if/when quality measures are developed that assess quality in such areas as depression care and community-based long-term care.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

As indicated earlier, this study found that nurses perceive quality monitoring and improvement to be an important part of their work, but that this comes with various costs – more managerial pressure, more competition and a higher workload. A previous study by Nissanholtz et al. adds valuable context to these findings. In a national representative survey of health plan primary care physicians, most respondents (74%) agreed that nurses contribute to practice quality and share responsibility for improving quality measures.NURS 3000 – Issues and Trends in Nursing Assignment Papers. Physicians who felt that quality monitoring improved the quality of care and those who supported the program were more likely to consider that nurses shared responsibility for the quality of care [26, 27]. That study also found that, like nurses, the physicians also experienced the quality monitoring to increase managerial pressure, but to a lesser extent than did the nurses (58% v. 84%). Similarly, it found that physicians also felt that the quality monitoring increased competition, but to a lesser extent than did the nurses (47% v. 81%). The two professions were more similar in the extent to which they felt that the monitoring increased the workload (64% and 72%) [25].NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The findings also indicated that a very high proportion of the health plan nurses are very satisfied with their work overall (80%). However, the study also highlighted pervasive concerns with the shortage of nursing positions, wage levels and the attitudes of some physicians and nurses that constrains the professional development of health plan nurses. Expanding nurses’ role is one of the factors that improve satisfaction of nurses [12]. Dealing with these problems would clearly contribute to the satisfaction and commitment of those already working as health plan nurses. It may also help attract additional young people to the profession.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

A related finding is that the vast majority of the health plan nurses are significantly involved in both routine work (in which they function largely as supports for primary care physicians) and more specialized work (in which they typically have more independent roles). In theory, a mix of this sort could be either a source of frustration (related to time constraints and/or the complexity of role identity) or a source of satisfaction (related to task diversity). Unfortunately, we do not have information on how this mix of roles is affecting nurse satisfaction. What we do know is that the vast majority of health plan nurses are satisfied with their work and that, at present, for most of them work entails a mix of routine tasks and specialized work.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

In general, there is a good fit between the study’s findings about the evolving content of the work of health plan nurses and the contextual changes highlighted at the beginning of this article. One important exception is that, despite the ongoing reform of Israel’s mental health care system, the nurses did not indicate that mental health care is an important component of their workload. This may be because the in-depth interviews were carried out in 2013 and the survey of front-line nurses took place in 2014; while these were subsequent to the 2012 government decision to transfer responsibility for mental health care to the health plans, the transfer itself did not go into effect until 2015. Interestingly, in 2017 presentations to the Mental Health Reform Administration, the health plans spoke about significant strides in involving nurses in mental health care and in the future it will be important to study systematically the extent and nature of this evolution.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The changes in the roles of community nurses has apparently been a gradual evolution spread over many years. Interestingly, the main changes emphasized by nursing leaders in the 2013 in-depth interviews were largely similar to those emphasized in the 2017 follow-up interviews. At the same time, several new points were made in the 2017 interviews, suggesting that this evolution continues; these include the appointment of several nurses to regional director positions, greater expose of the nurses to patient clinical data, and more inter—professional educational.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Overall, the data presented in this study can contribute to Israeli efforts in the following areas:
♦ Recruiting more people to the nursing profession, especially to community nursing. The data can enable recruiters to provide a clearer picture of the current content of the work (including its diversity), how that content is changing in exciting directions, and how satisfied community nurses are with their work.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

♦ Intra-organizational thinking within the health plans and other relevant organizations Key topics including the place of nursing resources in the budgeting of community-based services, the provision of appropriate levels of compensation, the definition of nursing tasks, the division of labor between the various staff members and mechanisms for increased cooperation.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

♦ Sharing information with the public on the changed role of health plan nurses. This could contribute significantly to the empowerment of both nurses and their patients and to cooperation between these two groups.

Limitations
The main study limitation is that the interviews were carried out at only one point in time. Thus, the findings about changes in the nurses’ roles are based, in part, on the nurses’ ability to recall the substance of their roles several years prior to the interviews and their assessments of how those roles had changed. This limited the extent to which the changes in the roles could be detailed and quantified.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Another limitation is that no formal assessment was made of the reliability and validity of the questionnaire used in the survey of front-line nurses. However, it was carefully derived from the in-depth interviews of the 55 nursing and other leaders and also reviewed for face validity.

Finally, as indicated in the methods section, there may be small-moderate under-representation of some sub-groups of nurses. However, the impact of these on the overall study findings is apparently quite limited, as the study found few substantial differences in key study variables among these sub-groups.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Directions for further research
While the current study focused on Israel, it highlights developments, trends and issues, which may be relevant to other countries as well. For example, in the U.S. a 2017 report by the Macy Foundation called for using RNs as significant contributors to health promotion efforts in primary care settings [6]. That report identified a number of goals, including: giving more emphasis to primary care in nursing schools, developing primary care specializations, and encouraging teamwork.9

The study team plans to be in touch with researchers in other countries to identify similar studies, compare findings, and reflect together on similarities and differences. One of the issues of particular interest is whether the predominance of health plans in Israel has resulted in a unique mix of roles for its community nurses and whether Israel might be a harbinger for other countries in the process of adopting more organized systems of community care.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Directions for further research within Israel include:
An exploration of how the nature of the interactions between health plan nurses and physicians are changing and how both professional groups feel about it

Qualitative research to further understand how front-line nurses experience the mix of traditional/routine and newer/proactive roles

More detailed analysis of the survey data regarding such topics as nurse involvement in the quality monitoring program, change barriers and facilitators, similarities and differences across age groups, etc.

An analysis of how nurses answer the challenge of caring for the mentally ill and persons with mental health problems

The evaluation of new nursing roles as nurse practitioners and nurse consultants and their impact upon patients’ and families’ quality of care and quality of life

An analysis of the current roles of the nurses in preventive mother and child health centers, and how these have changed over time

An exploration of of Israeli models of physician-nurse teamwork, which were recently praised by the OECD [29], and are continuing

Footnotes
1
This figure of one-third is based on data from the Central Bureau of Statistics Labor Force Surveys for the years 2012–2014. It is up from one-quarter a decade earlier.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

2
The data appearing in this report do not distinguish between the health plans. However, each health plan has received, for internal use, a series of tables comparing the findings concerning it and the others.

3
Inadvertently, in one of the health plans, nurses with less than 5years of experience were largely excluded in the sampling process. However, sensitivity analysis indicates that this had only a very limited impact on the study findings. This is because there were only small differences in key study variables between nurses with less than 5 years of experience and the nurses with five or more years of experience. In addition, the nurse with less than 5 years of experience constitute a relative small part of the study population (between 18% and 25% in the three plans for which we have data).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

4
The non-response was due to an inability to contact 17% of the sample, 7% who refused to cooperate, 6% who initially indicated that they would respond but did not follow through, and 1% who were found to be irrelevant to the study.

5
The background variables included age, gender, ethnic background (Jewish, Arab, Druze, etc.), country of birth, level of education, professional status, management role, and years in the profession. They were included because they were felt to be potentially related to key study variables such as work satisfaction and perceived professional autonomy.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

6
Education, giving guidance to patients, and referrals were not defined as routine work, nor as professional work. Evidently, they should be included in the professional work of nurses and not as routine work, but we cannot say with certainty that all the nurses understood that the educational part, as noted, belongs to professional work.

7
The analyses presented in this article do not distinguish among health plans, as the health plans’ agreement to participate in the study was conditioned on a commitment from the study team not to publish plan-specific findings. Each health plan has been presented with the findings for the results for their own nurses, compared with the national results.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

8
These areas are consistent with the major changes in the health care system. For example, the fact that people live longer, but with more chronic diseases, requires increased attention to chronic patients, both to prevent deterioration of health status through the promotion of health and to respond to patients who are disabled. The fact that nurses learn more and have more extensive knowledge and capabilities than in the past affects the subject of “specialization” in various subjects and the nurses’ desire to develop in the field closest to their hearts and improve their abilities in this field

9
This approach is a natural continuation of the IOM report on the future of caregiving (IOM 2011). The IOM report noted that the nursing profession’s focus on patient management and coordination, patient education and public health intervention, is a good fit for a world in which health promotion and care management are increasingly being emphasized.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

10
See the appendix for a brief note on the historical development of nursing in Clalit clinics.

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Notes
A comment to this article is available online at https://doi.org/10.1186/s13584-018-0257-5.

Declarations
Acknowledgements
The authors thank Steve Schoenbaum and Gerri Lamb for the comments on an earlier draft of this manuscript. The Community Nursing Study Group consists of Liat Arad, Shlomit Bloomenthal, Dorit Goldman, Yafa Haron, Miriam Hirschfeld, Calanit Kaye, Galit Kauffman, Idit Kogan, Rachel Nissanholtz-Ganot, Bruce Rosen, Bruria Sherman, Hedva Stoyer, Yulia Nigel, and Dorit Weiss.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Funding
The study was funded in part by a grant from the Israel National Institute for Health Policy and Health Services Research 62–2010-R.

Availability of data and materials
The principal investigators are open to suggestions for joint analyses and collaborations based on the data collected as part of this study.

Authors’ contributions
RN and BR jointly developed the study design and carried out the study, with substantial input from MH. RN took the lead in preparing the project report on which this article is based and BR took the lead in turning the project report into a journal manuscript. The members of the Community Nursing Study Group provided valuable input into the study design, the research instruments and the data analysis. All authors read and approved the final manuscript.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Ethics approval and consent to participate
An exemption from a full review was granted by Human Subjects Committee of the Clalit health plan. Authorization number: 0032–14-COM. The voluntary nature of the study was emphasized to all the nurses in the sample and only those who wished to participate did so.

Consent for publication
All the authors have agreed to publication.

Competing interests
RN, BR and MH declare that they have no competing interests. Several of the members of the Community Nursing Study Group have senior management roles in the health plans and the Ministry of Health.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open Access
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Appendix A: The status of nurses in Israeli health plans
Israel has four health plans (Clalit, Maccabi, Meuhedet and Leumit), and they have several important features in common. They are all non-profits and all were established at least 80 years ago. They all are nation-wide in scope and all have more than half a million members. They also have sophisticated IT systems, with all primary care clinicians working with electronic health records.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

At the same time, there are several important differences among the plans. These include their size; the age, income and geographic mix of their members; and the extent to which their physicians are plan employees v. independent contractors. There are also important differences with regard to plan history, culture and operating style. Most significantly, for the purposes of this study, there are difference with regard to the extent, and manner, in which the plans work with nurses in community settings.

Clalit, with 4.4 million members, employs approximately 3000 nurses in community settings; most of them work on a full-time basis. The dominant model of primary care in Clalit is a community clinic with an interdisciplinary staff that has overall responsibility for the health and health care of the members registered in that clinic.10 The physicians and nurses jointly manage the care of each patient, including both responsive and proactive care, with a clear division of responsibility between the two professions. They also take a population approach and seek ways to improve the care of groups of patients (defined in such terms as age, illness and ethnicity).

Maccabi, with 2.1 million members, employs approximately 1100 nurses; this is up from 650 four years ago. Almost all of Maccabi’s nurses are RNs and two-thirds hold academic degrees. Most of them work either in municipal/district branches or in the clinics of independent physicians registered in the personal physician program (PPP); others work in such settings as specialty clinics or national nurse-led call centers that operate 24/7. In the PPP they function primarily as case managers for chronic illnesses and preventive/outreach services. In the branches, their jobs entail both proactive and reactive work. In recent years, the nurses have been able to delegate many of the more technical and routine tasks to nurse assistants or other support staff.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Meuhedet, with 1.2 million members, employs 880 nurses; many of them work on a part-time basis. The number of nurses in the plan has doubled over the last 5–6 years. Almost all the nurses work in Meuhedet’s municipal/district branches, each of which has a large number of specialist physicians and nurses. This has facilitated a rapid movement toward greater specialization of the nurses, particularly in those clinical areas where nurses have substantial authority and independence. These include diabetes, stoma, genetic counseling, and most recently palliative care. In each of these areas, the nurses play a central role in integrating the work of different types of professionals (physicians, dieticians, pharmacists, etc.) and in managing the care of the patient. The need for integration has been a major driver toward greater specialization.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Leumit, with 0.8 million members, has almost 500 nurses, with about 60% of them working full-time. Approximately 90% of them are RNs. The number of nurses working in the plan has been stable in recent years. The nurses work predominantly in the clinics that are operated by the health plan and secondarily in home care units, rather than in IP offices. Their work has expanded from the more technical tasks to include a large component of chronic care management and patient education. Recently, a new nursing management level – the district head nurse – was created, with a focus on implementing and inculcating various guidelines related to nurses’ newer responsibilities.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Nurses also play a central role in health plan call centers, in which have they have a great deal of autonomy to make decisions which often have significant clinical and economic implications.

Appendix B: An initial examination of community nursing roles in the US and England, in comparison with Israel
Methods
Ten telephone conversations were held with key figures in the US and England and the relevant professional literature was reviewed. This was followed by a comparison with the situation in Israel as it emerged from the in-depth interviews.

Findings
Changes over time. The role of community nurses has expanded in recent years. However, it is difficult to estimate the pace of change or point to countries with more rapid change. This topic would seem to deserve a separate study.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Different types of nurses. One prominent difference between Israel and the other countries examined is that the latter have a category of Nurse Practitioners – NPs. In the US and England, nurses in this category enjoy broader authority. Though not many nurses in England are defined as NPs, their numbers are steadily growing. In the US, there are more than 222,000. In Israel, the Ministry of Health has begun to recognize nurse practitioners only in recent years and this, too, only in select areas (such as palliative care, geriatrics and diabetes care). Thus, the situation in Israel is very far from that in the US and England.

Managing the care of chronic patients. The main difference between Israel and the other countries in managing the care of chronic patients concerns the nurses’ scope of authority. In Israel, the authorization of nurses to prescribe medication is very limited and hardly implemented and they do not make referrals. In the US and England, there are differences based on a nurse’s status and training. Some nurse work only according to a physician’s directives while others work more independently, make referrals and prescribe medications.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Home visits. In Israel, as well as in the other countries, home visits for bedridden patients are performed mainly by nurses. However, in the US and England, the nurses working in homecare do it exclusively. In Israel, on the other hand, most of the nurses work in homecare in addition to their work at the clinic.

Measuring quality. Both of the countries examined have quality monitoring programs. However, whereas in Israel the program has for many years encompassed the entire community and virtually all nurses are involved in or affected – in the US, until recently, it applies only to organizations of managed care (about a third of the population). Recently, the federal government has instituted a program of quality reporting on care for the elderly; it is related to payment that has led to reporting from almost all primary care practices. Still, while nurses are involved in quality measurement programs in both Israel and the US, the extent of their involvement apparently differs. Moreover, in England and the US there are financial incentives for participating in these programs whereas in Israel there are none.

Authority to prescribe medication. In both of the countries examined, nurses have partial authority to prescribe medication and the differences between the countries are reflected in the substance of their authority. Another difference relates to the extent that this authority is actually practiced. In these countries, nurses defined as NPs are authorized to prescribe medication. In Israel, virtually no nurses prescribe medication without a physician’s authorization.

Caution should be exercised in interpreting these differences between countries and their causes. Factors such as the structure of the system, cultural differences, and the milieu of the health system should be taken into account.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Appendix C: Similarities and differences among the health plans that emerged from the in-depth interviews
The similarities related to the following aspects: a shortage of nurses, overall and for all districts except for the north; considerable advances in the technologies used by nurses; more studies and training than in the past; creativity.

Alongside the great similarity found between the nurses’ jobs in all the health plans, there were also several differences, including:
The implementation of the provision for special authorization: Although the Ministry of Health widened the authority of community nurses, not all the health plans have implemented the provisions.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Integration of nurses into the measurement program. There are differences in the extent of involvement and responsibility of community nurses in the measurement program, directed by the Ministry of Health and examining the quality of prevention, diagnosis, and treatment provided by the health plans. (The program is implemented by the Israel National Institute for Health Policy Research and contains indicators for the following areas: immunization, early detection of breast and colon cancer, treatment of diabetes, asthma and heart problems.) In three of the four health plans, nurses are responsible for some of the indicators and manage them on the local, district and national levels. In the fourth, they deal with the technical aspects of measurement, such as administering vaccines or inviting patients to come in for a mammography or other tests.

Integrating nurses into various levels of health-plan management. In three health plans, nurses serve in senior positions of general management (i.e., beyond nursing): they are integrated into the management of health-plan branches and districts, and of the health plan as a whole. In one health plan, they manage only the nursing sector and are not part of the general management of the health plan.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Developing and focusing on areas of specialization. Each health plan invests in different areas of specialization. Differences in specialization also exist among the districts of a single health plan.

Perceptions of barriers to the development of the profession
Despite the great potential for professional development of community nursing, the interviewees identified barriers such as: a lack of established positions; physicians’ perceptions of the profession and their fear of encroachment by nurses into their areas of responsibility; some nurses themselves do not wish to broaden their roles or are afraid of carrying responsibility even when they do receive it; nursing schools focus more on hospital-related studies, dealing less with the community and its diverse work possibilities.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

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I loved getting a new view on breastfeeding. As a medical doctor, unfortunately the teaching about breastfeeding is very sparse and students are not taught to teach breastfeeding to patients. This often leads to a vicious cycle of the doctor prescribing antibiotics for mastitis without taking care of the underlying issue. I feel having completed this course will hopefully give me a niche market of clients that want the medical view as well as the breastfeeding counselling.NURS 3000 – Issues and Trends in Nursing Assignment Papers. I am so happy I have broadened my horizon with this course and deepended my knowledge about breastfeeding in general. During training I have already managed to make a difference to some women and their babies and it was very rewarding. It feels very good to have an impact on the start a mother and baby get to their breastfeeding experience, since the first few weeks are most crucial. This training will give my career the turn I was hoping for and let me work closely with mothers and babies.NURS 3000 – Issues and Trends in Nursing Assignment Papers.
Sharon, London, UK (Doctor)

I enjoyed how much it pushed me. Learning about breastfeeding is absolutely amazing. I’m not sure I will ever be satiated with what I currently know, but always be seeking to gain more insight. The case studies really pushed me, from having a book knowledge, to applying it to real life situations. They were hard, but so helpful in understanding how to dialogue with women in various breastfeeding situations.NURS 3000 – Issues and Trends in Nursing Assignment Papers.
Amy, Singapore

Throughout my training, I have learned how to listen better, be more compassionate, and follow a mom’s cues in supporting her and how she wants to feed her baby. As important as the informational part of this course is, the communications portion has been VITAL. That goes for all of my courses! But especially in breastfeeding, as it can be such a sensitive area, I learned that my approach really sets the tone in how a mom feels about breastfeeding. And how she feels about it truly is a determining factor in whether or not she decides to continue on or seek alternative feeding methods.NURS 3000 – Issues and Trends in Nursing Assignment Papers.
Emilie, Kansas, USA
Questions About Breastfeeding Counselor Training
Is this course accredited or recognized?
Yes!! Childbirth International Training is accredited with distinction as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. We are the only doula training organization to have been accredited with distinction by the ANCC. Your final certificate will show the continuing education hours and can be used for any organization that recognizes ANCC continuing nurse education hours. Read more about our accreditation.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Do you have discounts or scholarships available??
We do not offer scholarships at this point in time. We do, however, have a number of discounts. Existing students and graduates receive a 15% discount on all subsequent courses that they purchase. If you purchase more than one course together, a discount of 15-25% is available. We offer group discounts for friends or work colleagues who register for the same course together. Our Green option allows you to reduce the cost of training by working online. In addition, we have payment plans available to enable you to pay for your course over five months.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Do I have to have breastfed to be a Breastfeeding Counselor?
Not at all! Your training will provide you with the knowledge you need to support breastfeeding parents. We have students who have never given birth, or who chose not, or were unable to, breastfeed.

After I have finished the course, can I become an IBCLC?
You can use CBI’s Breastfeeding Counselor course for the 90 hours of lactation specific education required for IBCLC certification – many of our students have done just that! You will still need to meet the other requirements as stipulated by the IBLCE. You can read more about IBCLC requirements on the IBLCE website.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Will I be able to find a job working in a hospital or clinic?
That will depend on the requirements that the hospital or clinic determine. Many of our graduates have gone on to work in healthcare settings. Sometimes an organization will require the IBCLC designation, while others will be looking for an individual who has completed a set amount of lactation specific education.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

How much can I earn as a Breastfeeding Counselor?
That will depend on how you decide to establish your business and the clients that you work with. Generally, a Breastfeeding Counselor charges by the hour and may charge anything from $25-$100 per hour. Sometimes they might offer packages of a fixed number of visits.

Can I provide documentation of clients I supported before I started the course?
The client support that you provide (30 hours in total) must have taken place after you started your training with CBI. You can use hours on telephone and email support (up to four hours), as well as facilitating breastfeeding support groups or running childbirth classes (up to six hours).

Do I have to recertify or pay membership fees?
We don’t require you to pay membership and recertification fees in order to stay certified. We provide training – and we’re really good at it! Similar to a university program, you deserve to have your hard work acknowledged for life! We’re not going to charge you every three years to prove that you still have the knowledge and skills that you built. We also will not charge you to continue to belong to CBI – your membership is lifelong.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

If you need to show recertification in order to belong to a local organization you can do so – you just submit the required documents for proof, we will review them and reissue your certification – showing it is a recertification. And we’ll do this for a minimum fee that just covers our costs.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Improvement of healthcare delivery in the United States relies on many factors, such as effective nurse advocacy through politics, policy, and professional associations. But advocacy depends on the ability to fully understand current issues, systems, policies, and related contexts.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

ORDER A PLAGIARISM-FREE PAPER HERE

In this course, students engage in a systems-level analysis of the implications of healthcare policy on issues of access, equity, affordability, and social justice in healthcare delivery.
Through policy analysis assignments students apply legislative, regulatory, and financial processes relevant to their organization and provision of healthcare services in their community. Students consider the impact of these processes on quality and safety in nursing practice environment and disparities in the healthcare system. Through this course, students gain the knowledge and skills needed to advocate for vulnerable populations and promote positive social change. (Prerequisites: NURS 3000) Note: Students must take this course first in their sequence.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Running head: EDUCATING NEW NURSES 1

Educating New Nurses: A Paradox in the Nursing Shortage

Linda Dietz

Walden University

NURS3000, Section 4, Issues and Trends in Nursing

July 10, 2010

Running head is written with the exact words

Running head: THEN WRITE THE TITLE IN ALL CAPITAL LETTERS (abbreviated title)

Page numbers are required on each page.

Compare the title of the paper on this page with the title on page 2.

EDUCATING NEW NURSES 2

Educating New Nurses: A Paradox in the Nursing Shortage

The nursing shortage is a national concern. Newspapers or lay publications frequently

the public should be within the context of current nursing workforce trends. Therefore, the

purpose of this paper is to discuss information from a popular source on the topic of the

availability of nursing education as it relates to what is happening in nursing and health care

today and in the future.

Summary of an Article

The article chosen for this assignment was published on March 3, 2010, in the Press-

Republican newspaper in Plattsburgh, New York (Bartlett, 2010). The author, Bartlett (2010),

addressed the paradox between the restricted number of students accepted into nursing school

and the shortage of nurses since 1998. Bartlett reported that there were 960 applicants to the

Plattsburgh nursing program and that, because of clinical placements and faculty constraints, the

4-year nursing program allowed only 55 students. The community college was also

overwhelmed with applicants; there were 430 applications for 70 available openings (Bartlett,

2010). This could be a national problem; the American Association of Colleges of Nursing (as

cited in Bartlett, 2010) reported that, in 2008, 50,000 qualified applicants could not seek

admission to schools of nursing because of inadequate numbers of faculty and not enough sites

for clinical placement.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Relationship to Nursing Workforce Trends

The public perception of the nursing shortage parallels professional concerns found in the

literature. Huston (2010) addressed the same issues regarding the nursing shortage and the

paradox of educating future nurses. By 2016, there will be 587,000 new nursing positions

available in the United States, “making nursing the nation’s top profession in terms of job

Level one headings bold and centered

Title of the paper centered and not bolded.

Check APA for correct format of in-text citations.

Check APA for correct format to cite secondary source.

Page header is different than title page (all capital letters without the words “Running head”)

Keep in mind using information for a paper from a popular source like a newspaper will be rare.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Pg 4

Most other papers will not have a “summary of an article” section

kouzts
Highlight
Completing a “Summary of an Article” is not common to nursing papers or APA papers. (This specific assignment is uncommon)
EDUCATING NEW NURSES 3

growth” (Huston, 2010, p. 72). Job growth demands continue to increase because many

students who have applied to nursing schools do not gain admission, despite the increased

enrollment capacity of 5% to 16.6% each year for the past 10 years (Kuehn, 2007).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Kuehn (2007) attributed this limitation in the enrollment of nursing schools to the lack of

faculty. In 2006, to enroll all students applying to the 329 nursing schools Kuehn surveyed, 637

faculty vacancies would have to be filled and 55 additional positions created. Also, because of

the anticipated number of nursing faculty planning to retire, the shortage of faculty will only

become worse. In a subsequent article, Kuehn (2008) reported that, in 2007, the partnership

between the American Association of Retired Persons and the Robert Wood Johnson Foundation

created the Center to Champion Nursing in America. The goal of this center was to form

multidisciplinary nursing workforce groups from 18 states who will exchange information and

create plans to increase nursing school capacity (Kuehn, 2008).

Summary

If current conditions prevail, the nursing shortage in the United States will increase. The

problem of educating sufficient numbers of nurses continues because of a lack of faculty and

clinical placement sites, as in Bartlett’s (2010) state of New York. Aging nurses ready to retire

add to this dilemma. The Center to Champion Nursing in America created multidisciplinary task

forces in 18 states to address the problem of limited enrollment. Clearly the fluctuations in

nursing shortages cause concern to both the public and nursing leadership (Laureate Education,

Inc., 2009).

Check APA for correct format of quotes and citations.

Avoid using direct quotes.

Notice how this in-text citation is listed in the Reference page.

The author matches the reference page so the reader can clearly locate it.

EDUCATING NEW NURSES 4

References

Bartlett, S. (2010, March 3). Schools helpless against nursing shortage. Press-Republican.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Retrieved from http://pressrepublican.com/0100_news/x1726192928.com

Huston, C. J. (2010). Professional issues in nursing: Challenges and opportunities. Philadelphia,

PA: Wolters Kluwer/Lippincott Williams and Wilkins.

Kuehn, B. M. (2007). No end in sight to nursing shortage: Bottleneck at nursing schools a key

factor. JAMA: The Journal of the American Medical Association, 298, 1623-1625.

doi:10.1001/jama.298.14.1623

Kuehn, B. M. (2008). Groups target nursing school bottleneck to address medical workforce

deficit. JAMA: The Journal of the American Medical Association, 300, 887-888.

doi:10.1001/jama.300.8.887

Laureate Education, Inc. (Producer). (2009). Workforce issues: The crisis in nursing [DVD]. In

Issues and trends in nursing. Baltimore, MD: Author.

TO CHANGE THE HEADER ON THE SECOND PAGE CLICK “Different First Page”

AFTER YOU CLICK INSIDE THE HEADER.

Check APA for correct format of all references. ♦♦♦♦♦♦♦

Notice the hanging indent for each reference. ♦♦♦♦♦♦♦

Pay close attention to electronic and DVD references. ♦♦♦♦♦♦♦

Check DocSharing and the Walden Writing Center.

Reference page starts on a new page. “Reference” is centered, not bold.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Notice how this Reference exactly matches the in-text citation on page 3.

This column addresses the results of the environmental scan, a major input of the Nursing Professional Development (NPD) Practice Model. Environmental scanning is defined as the “process of systematically monitoring an organization’s internal and external environments for the earliest signs of opportunities and threats that may reveal a potential professional practice gap” (Harper & Maloney, 2016, p. 60). Engaging in this process helps the NPD practitioner plan for potential opportunities and changes in NPD practice based on economic, healthcare, political, societal, and technological trends. These trends, outlined in the 2016 Nursing Professional Development: Scope and Standards of Practice, 3rd Edition (Harper & Maloney, 2016) include the workforce, practice environment, organization, technological influences, political influences, and professional development practice changes. The purpose of this column is to inform readers of these trends with potential role implications for the NPD practitioner.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

WORKFORCE
Anticipated workforce issues that may impact NPD practitioners include “multiple generations in the workforce; loss of the expertise with baby boomer retirement; increased diversity in nursing; anticipated growth in the shortage of healthcare professionals; increased demand for transition into practice programs and mandated nurse residencies for licensure; progressive education expectations for nurses; and increasing emphasis on nursing certifications for employment and retention” (Harper & Maloney, 2016, p. 26).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Role implications for the NPD practitioner:

* As a learning facilitator, include nurses from multiple generations in planning and implementing professional development activities.

* As a leader, use your influence and recommend more flexible schedules to retain baby boomer nurses for their expertise and mentoring of less experienced nurses.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

* As a partner for practice transitions, influence decision makers to implement (or continue) a nurse residency program at your organization, then seek accreditation for the program.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

* As a mentor, encourage nurses and set a goal (Why not 100%?) for NPD colleagues in your setting to obtain NPD specialty certification; encourage nurses to pursue a doctoral degree (if applicable, this goes for you too!).

PRACTICE ENVIRONMENT
For the NPD practitioner, 17 practice environment issues have been identified in the new scope and standards. Some of these issues include the following: the promotion of healthy workplace environments, nurses functioning within the full scope of practice (not just advanced practice nurses) including fee for services, a focus on interprofessional teamwork and team competence, a transition from a focus on the clinical setting to the provision of nursing services across the continuum of care, emphasis on the integration of decision support systems and electronic health records, 90% of clinical decisions to be evidence-based by 2020, developments in genetics and genomics, and demonstration of NPD’s impact on patient outcomes (Harper & Maloney, 2016). Two more topics to consider adding to this list are opioid abuse and legalization of cannabis.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Role implications for the NPD practitioner:

* As a leader and a mentor, role model a culture of respect with no tolerance for any type of bullying.

* As a partner for practice transitions collaborate with interprofessional colleagues across care settings to foster smooth transitions across the continuum of care.

* As a champion for scientific inquiry, continually ask “Is this evidence-based?” when dealing with clinical decisions; use scientific, standard metrics to collect and analyze data related to outcomes.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

* As an advocate for NPD specialty, demonstrate and disseminate the influence of NPD to improve outcomes both within your organization and externally.

ORGANIZATION
Specific trends related to the organization for which the NPD practitioner must be alert are “identification of optimal nursing professional development organizational structures (centralized vs. decentralized reporting structure); increased organization complexity due to mergers, acquisitions and expansions; and ongoing challenges in healthcare funding and reimbursement” (Harper & Maloney, 2016, p. 27).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Role implications for the NPD practitioner:

* As a leader, assess NPD services/activities across your individual organization and healthcare system to ensure alignment with organizational priorities.

* As a leader, use your influence and recommend consolidating services where and when appropriate to improve cost and efficiency (e.g., rather than several hospitals offering the same review course at different times and locations, collaborate for one event).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

* As a leader, share evidence with administrators that demonstrates the value and return on investment for the professional development of nurses (Opperman, Liebig, Bowling, Johnson, & Harper, 2016).

TECHNOLOGICAL INFLUENCES

The technological influences identified for NPD practice are “increasing emphasis on privacy of patient data; the use of mobile devices to communicate and retrieve information; the availability of large complex data sets; proliferation of social networking; proliferation of personal electronic devices; increasing use of virtual health programs; transition to connected health; and technology driven care decisions diminishing individual acceptance of accountability” (Harper & Maloney, 2016, p. 27).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Role implications for the NPD practitioner:

* As a leader, identify what data are (and are not) being collected within your NPD practice and setting (microsystem, mesosystem, and macrosystem) as they relate to NPD practice, nursing problems, interventions (education), and outcomes. Then ask, “What is the meaning of these data? How are they being used? Are they being used to improve practice?”

* As a leader, be an active member of the health information technology team and contribute to strategic planning and implementation of data-driven decisions.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

* As a change agent, engage with nurse informaticists to advance nursing-sensitive quality eMeasures, standardized electronic quality indicators that promote consistent measurement (HIMSS, 2015; National Quality Forum, n.d.).

* As an advocate for NPD specialty, implement standardized and accepted terminology and metrics for tracking outcome data.

* As a champion for scientific inquiry, urge colleagues to use research-based, standardized assessment scales and instruments to promote interoperability of data.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

POLITICAL INFLUENCES
Political influences that may impact NPD practice are “increases in number of insured individuals seeking healthcare service; impacts of a global economy; increasing scrutiny of healthcare outcomes and pay for performance/value based payment model; implications of the federal government as primary payor for healthcare; and growing costs of healthcare” (Harper & Maloney, 2016, p. 27).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Role implications for the NPD practitioner:

* As a leader and an advocate for NPD practice, influence decisions of others with the use of credible data.

* As a change agent, access and apply the resources in legislative advocacy toolkits; write letters to those in positions of authority (e.g., congressman) in support of legislative issues that “protect the public” (for the “Web-Based Resource for Public Policy Advocacy” go to http://www.nln.org/docs/default-source/advocacy-public-policy/web-based-resource).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

* As a learning facilitator, register for “E-Mail Alerts” for nursing and public policy issues provided by the American Nurses Association. To register, go to https://www.smartbrief.com/signupSystem/subscribe.action?pageSequence=1&briefNam.

PROFESSIONAL DEVELOPMENT PRACTICE CHANGES
The environmental scan identified 13 professional development practice change issues expected to impact NPD practice. For ease in reading, they are organized here as educational, financial, and other.

Educational changes include increasing interprofessional continuing education; providing just-in-time training and rapid cycle development of education; deemphasizing traditional classroom-based learning; implementing evidence-based teaching and learning strategies; using technology, including simulation, in continuing education and conducting rigorous multisite research related to NPD practice; and promoting accreditation and funding of practice transition programs for newly licensed nurses (Harper & Maloney, 2016). Financial changes include “promoting learning as an investment in human capital and cost avoidance versus an expenditure” and “demonstrating NPD return on investment (ROI)” (Harper & Maloney, 2016, pp. 27-28).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Other changes for NPD practice include “succession planning for future nurse leaders; developing nurses to serve on advisory and governing boards of health-related corporations and non-profit organizations; preparing nurses for the political arena (local, state and federal); and retooling the workforce to enhance nurses’ ability to practice not only in acute care but across the entire continuum of care” (Harper & Maloney, 2016, p. 27).

Role implications for the NPD practitioner:

* As a leader, use your voice and presence to influence health care by joining an advisory or governance board and encourage colleagues to do the same (to get started, register at http://nursesonboardscoalition.org).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

* As a leader, provide evidence for the return on investment of NPD activities (Opperman et al., 2016).

* As a leader and a learning facilitator, increase the number of interprofessional continuing education activities (for Core Competencies for Interprofessional Collaborative Practice, go to http://www.aacn.nche.edu/education-resources/ipecreport.pdf).

* As a leader and a mentor, create and participate in succession planning programs for other NPD practitioners.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

* As a learning facilitator, increase blended learning strategies in virtual and physical spaces; use active and interactive activities, affective computing (e.g., virtual assistant) and robotics, augmented reality (digital information and spaces in real world), and virtual reality; read and apply the simulation information provided in the Journal for Nurses in Professional Development Simulation column.

SUMMARY
This column addressed the current and future issues, innovations, and trends as outlined in the Nursing Professional Development: Scope and Standards of Practice, 3rd Edition (Harper & Maloney, 2016), along with role implications for the NPD practitioner.NURS 3000 – Issues and Trends in Nursing Assignment Papers. Because the NPD practitioner is in a pivotal position to influence these issues and trends, the question is, “What can and will you do to help your organization through these changes?”

Healthcare is a dynamic and changing environment that demands we are well appraised of the issues and trends that influence our beliefs and practice. In this course, you are challenged to advocate for, and defend, a position related to a selected healthcare issue using debate as a learning medium. Debating is a transformative journey that helps you learn more about your own beliefs and principles while teaching you to stand up and be heard. Further, you investigate historical and contemporary healthcare trends and share your learnings with your class colleagues in a conference format.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Multi-media learning resources, online learning activities, and individual and collaborative group assignments are some of the strategies you will use to achieve the course and unit learning outcomes. The nature of the instructional approach is participant-centered, based on Purkey’s invitational educational theory where an educational environment that is respectful, optimistic, and intentional is co-created by students and the instructor (Gregory & Edwards, 2016).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The course is structured so that you become an investigative reporter! Each unit is organized into 3 parts, the “headline,” “uncovering the story” and the “unit in review.” The headline is meant to be a “hook” or advanced organizer that will catch your attention and introduce you to the unit topic. Uncovering the story includes the unit learning outcomes, learning resources and learning activities. The unit in review is a reflection activity that guides you in reviewing key points from the unit and in consolidating take away learnings.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Course Learning Outcomes
By the conclusion of NURS/MHST 609 Trends and Issues you will be able to:

differentiate between trends and issues;
identify and explain logical errors in arguments;
design a reasoned and structured argument and participate in an online debate defending or opposing a current healthcare issue;
demonstrate oral presentation skills and written strategies to justify your opinion on issues;NURS 3000 – Issues and Trends in Nursing Assignment Papers.
appraise and critique the value of arguments proposed to defend or oppose current healthcare issues;
evaluate issues (social, economic, political and educational) that influence healthcare trends;
moderate an online class discussion regarding a selected healthcare trend;
critique and analyze peer reviewed literature related to healthcare trends and issues; and
reflect on personal learning from the course focusing identifying strengths and limitations that have become apparent, and construct a plan for moving forward.NURS 3000 – Issues and Trends in Nursing Assignment Papers.
Learning Resources
There is no print textbook for this course. Instead you are presented with a variety of online, multi-media learning resources including peer reviewed articles from the AU library, e-textbooks, videos, podcasts, TED talks, movies etc. Many of these are open educational resources (OER). The course topic is well suited to utilizing online resources that allow access to emerging research reports and real-time interviews and newscasts that discuss trends as they are developing. You are invited to share learning resources you discover related to course content with others in the class. Locating additional online resources will assist you in achieving the learning outcomes and your own learning goals, as well as help us develop as a learning community.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Course Structure
NURS/MHST 609 Trends and Issues is an asynchronous online course with a specific start and end date extending over 13 weeks. The course “week” runs from a Wednesday to the following Tuesday evening. On the Wednesday, the course instructor will make an online posting that relates to the topic of the week. The purpose of the weekly input by the instructor is to keep everyone focused on the same topic and to stimulate discussion. While there is no predetermined time when you must log on, are asked to log on at least once a week. However, logging on several times a week is desirable so that discussion continues back and forth among participants. Logging on early in the week is most helpful. During the weeks of your debate and your concurrent trends presentation you will need to log on often.

The course instructor will have expectations for online activities. Dates and days will be assigned and communicated to you by email, or as a posting in the Coffee or News Forum. Each instructor may organize the assignment schedules (dates for your debate and trends presentation) individually. However, there are some specific dates by which certain other course activities need to be achieved by everyone. These dates are specified in the study guide and assessment overview.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Course Overview
The course consists of the following seven units:

Unit 1 Introductions: Course Orientation and Starting the Investigation of Trends and Issues
Unit 2 Foundations of Debating: Structuring an Argument, Logic, and Fallacies
Unit 3 Debate Issues and Preparation for Debates
Unit 4 The Debates
Unit 5 Exploring Healthcare Trends: Past, Present and Future
Unit 6 Trends in Healthcare Online Conference
Unit 7 Review, Reflection and Wrap-up
Assessment Structure, Grading, and Style Requirements
You will have opportunities to complete the following four assignments.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Assignment 1 – DEBATE: Advocate for individuals, families, practices or policies using the principles of structuring an argument and debating. (2 parts)

Assignment 2 – CONCURRENT SESSION PRESENTATION AND MODERATION OF DICUSSION AT A CLASS ONLINE CONFERENCE – TRENDS IN HEALTHCARE: Choose a healthcare trend related to your practice or profession, write a short discussion paper on the trend and moderate discussion of your trend during a concurrent session at a class online conference entitled Trends in Healthcare.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Assignment 3 – REFLECTION PAPER: Write a short reflection paper related to what you learned about yourself during the course and include a plan for utilizing identified strengths and overcoming identified limitations.

Assignment 4 – PARTICIPATION: This includes participation in learning activities throughout the course.

Students must achieve an overall program GPA of 2.7 (B- or 70 percent), to graduate. The minimum passing grade requirement for each course is C- (60 percent).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

All assignment citations are to follow the most current APA (American Psychological Association) style.

Athabasca University reserves the right to amend course outlines occasionally and without notice. Courses offered by other delivery methods may vary from their individualized-study counterparts.

Credits awarded for meeting competencies required to achieve the nursing license through either a diploma program or an associate’s degree program.
Transfer credits from undergraduate courses that they have taken at other universities.
135 of the 180 quarter credits may potentially be transferred into the program (depending upon the qualifications the students bring as they enter).NURS 3000 – Issues and Trends in Nursing Assignment Papers.
Learning Outcomes
Apply leadership and informatics concepts in decision making to promote patient safety and quality care.
Use evidence based on the sciences, humanities, and research to guide nursing practice across the health-illness continuum in a variety of healthcare settings.
Evaluate the implications of policy on issues of access, equity, affordability, and social justice in healthcare delivery including the health of vulnerable populations and healthcare disparities.
Demonstrate effective communication and collaboration skills to improve patient outcomes.
Implement individual and population-focused interventions to promote health and to prevent and manage disease and injuries.
Exhibit accountability for personal and professional behaviors in accordance with standards of moral, ethical, and legal conduct with a commitment to continuous professional development.
Provide patient-centered nursing care based on a comprehensive and focused health assessment across the lifespan using sound clinical judgment as well as developmentally and culturally appropriate approaches.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Specializations
General
Degree Requirements
180 total credits
General Education (50 cr., at least 10 of which must be completed at Walden and all of which are to be completed prior to BSN core and concentration courses)
First course (1 cr.)
Nursing license transfer of credit (up to 50 cr.)
Upper-level nursing core courses (54 cr.)
NURS 5050, NURS 5051, and NURS 5052 will transfer into the MSN program with a grade of B or higher.
Elective courses (25 cr.)
Curriculum
General Education Courses (50 cr.)
Foundation Course
CMIS 1001 – Introduction to Information Systems♦ Required
Social Science
First Course (1 cr.)
WLDN 1000 – Dynamics of Walden Success: Learning Lab
Nursing License Transfer of Credit (50 cr.)
Upper-Level Nursing Core Courses (54 cr.)

NURS 3000 – Issues and Trends in Nursing♦
NURS 5050 – Policy and Advocacy for Improving Population Health
NURS 3015 – Pathopharmacology♦
NURS 5051 – Transforming Nursing and Healthcare Through Technology
NURS 3020 – Health Assessment♦
NURS 5052 – Essentials of Evidence-Based Practice
NURS 4005 – Topics in Clinical Nursing♦
NURS 4010 – Family, Community, and Population-Based Care
NURS 4015 – Public and Global Health♦
NURS 4020 – Leadership Competencies in Nursing and Healthcare

In Israel, approximately one-third of the country’s nurses work in community settings – primarily as salaried employees in Israel’s four non-profit health plans. Many health system leaders believe that the roles of health plan nurses have changed significantly in recent years due to a mix of universal developments (such as population aging and academization of the profession) and Israel-specific changes (such as the introduction of extensive quality monitoring in primary care).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Objectives
The main objectives of the study were to identify recent changes in the roles of health plan nurses and their current areas of activity. It also explored the experience of front-line nurses with regard to autonomy, work satisfaction, and barriers to further role development.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Methods
The study integrated interviews and surveys of nurses and other professionals conducted across 4 years. Data generated from earlier study components were used to guide questions and focus for later components.

In 2013, in-depth interviews were held with 55 senior nursing and medical professionals supplemented by interviews in mid-2017 with the head nurses in the four health plans. In addition, a national survey was conducted in 2014–5 among a representative sample of 1019 community nurses who work for the health plans and who are engaged in direct patient care. Six hundred ninety-two nurses responded to the survey, yielding a response rate of 69%. The survey sample consisted of an equal number of nurses from each health plan, and the observations were weighted accordingly.

Findings
Senior professionals identified general themes associated with a shift in nursing roles, including a transition from reactive to initiated work, increased specialization, and a shifting of tasks from hospitals to community settings. They identified the current main areas of activity in the health plans as being: routine care, chronic care, health promotion, quality monitoring and improvement, specialized care (such as wound care), and home care.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

In the survey of front-line nurses, 38% of the nurses identified “caring for chronically ill patients” as their main area of activity aside from routine care; 30% did so regarding “health promotion”, and 26% did so regarding “a specific area of specialization” e.g., diabetes, wound care or women’s health). In response to a separate question, 77% reported “great” or “very great” involvement in quality measurement programs.

Four out of five front-line nurses were satisfied with their work to a great or very great extent, and approximately three out of four of them (73%) felt that they had autonomy at work to a great or very great extent. About half of the nurses take into account, to a great or very great extent, the financial concerns of the health plans that employ them.

A large majority of the nurses (85%) indicated that the nature of their work had changed substantially in recent years, with an increase in autonomy noted as one of the key changes. Perceived barriers to further role development include attitudes on the part of some physicians and nurses, an insufficient number of dedicated nursing positions, and insufficiently attractive wage levels.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Conclusions
The findings, gathered over 4 years, indicate alignment between universal and Israel-specific trends in health care and the evolving roles of nurses in Israel’s health plans.

The findings provide support for ongoing efforts in the health plans to give nurses more authority and responsibility in the management of chronically ill patients, a more central role in health promotion efforts, more advanced training – both inter-professional and nurse-specific, and more opportunity to focus on the roles and tasks that require nursing professionals.

Background
The nursing profession is an important component of the provision of community healthcare world-wide. Nearly a third of the nurses in Israel are employed in the community,1 similar to the situation in the United States [2]. In Israel, most community-based nurses work for one of Israel’s four non-profit health plans, which are responsible for the organization and provision of care within the framework of Israel’s National Health Insurance Law [33]. Another major employer is the Ministry of Health (MOH), which employs nurses in its network of preventive mother and child health centers, and in other frameworks.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Traditionally, the main roles of community-based nurses (particularly in urban clinics) were to prepare patients for their meetings with a physician (by taking blood, pulse blood pressure, weight and other measurements) and implementing specific physician directives in the immediate wake of the patients’ encounters with the physicians. However, for over a decade, nursing and other leaders in Israeli health care have been talking about significant changes taking place in the roles of the community nurses. They have been attributing these role changes to a variety of contextual changes, which are described below. Interestingly, some of these contextual changes are happening in health care systems around the world, while others are Israel-specific. Some relate to changes in the population, other to changes in the health care system and still others to changes in the nursing profession itself.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Changes in the population
With the aging of the population, there is a growing recognition among health care leaders of the need to better address chronic health problems [19, 22]. There is a considerable body of research demonstrating the substantial contribution that nurses can and do make to the management of chronic illness ([4, 5] CAN, 2013; Trehearne, Fishman and Lin, 2014). They improve quality and access to care [30] and play a central role in the provision of other types of health services that are particularly important to an aging population, such as home care and home hospitalizations.

Changes in the health system
The increased attention being given by Israeli health plans to chronic care stems not only from population aging. Another motivator has been Israel’s National Quality Monitoring Program that has galvanized the plans to seek ways to improve the quality of care, particularly in the areas of chronic care and screening and prevention. Nurses are playing a central role in the health plans’ efforts to improve those measures [34].NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Community nursing can play a major role in effecting life-style changes in chronically ill patients, in guiding direct caregivers in elder and childcare and in long-term care, and in identifying and preventing abuse [1, 9, 18, 20]. Moreover, various technological advances are making it increasingly feasible to manage the care of chronic patients and integrate the care across several geographic locations [3] and a range of different types of providers [7]; nurses play a central role in such integration efforts [8]. Interestingly, in some ways this a return to Israel’s 1980s “teamwork” model in which nurses played a significant role in chronic care.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Israeli health plans are also gradually recognizing the need to do more in the area of health promotion [14], well beyond those elements of health promotion related to the quality indicators. The growing health plan involvement in health promotion seems to stem from a mix of a mission-driven commitment to wellness, an interest in reducing health expenditures, and marketing considerations. Health promotion is clearly an area in which nurses are well situated to play important roles [13, 21]. Health promotion practices of nurses include disease prevention and health education; however, they seek to work in more collaborative way with other professionals [16].NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The 2012 decision by the Israeli government to transfer the responsibility for mental health services from the government to the health plans has catalyzed health plan managers to also consider how various staffing models could help them address mental health needs in an efficient and effective manner ([32]: Nirel et al., 2007). In many countries, nurses play a major role in the provision of community-based mental health services ([11]; Heslop, Wynaden, Tohotoa and Heslop, 2016),), including identifying depression and other mental health problems and monitoring medication adherence/compliance. Note that the 2012 decision called for a 3-year transition period to prepare for a transfer of responsibility in mid-2015.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

It is also important to note that physician salaries in Israel have increased significantly in recent years [33, 36]. There is a certain amount of overlap between the set of tasks that community-based physicians typically carry out, and the set of tasks that nurses are authorized to perform ([15]; Laurant, 2007). Accordingly, an increase in physician wages could encourage the health plans to shift certain responsibilities from physicians to nurses, and this in turn could contribute to both an increase in the number of nurses the plans employ and the scope of the nurses’ responsibilities.

Changes in the nursing profession
Important changes are also taking place within the nursing profession itself. In particular, for several decades, the profession has been moving toward greater academization and advanced specialty training [15]. In recent years, various changes in primary legislation and Ministry of Health directives have broadened the scope of nursing practice, with increased authority in such areas as changing medication regimens, and palliative care.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

At the same time, there are several barriers to change in the role of nurses in community settings in Israel. These include traditional perceptions of the role of nursing as “handmaiden to medicine” (and hence limited in autonomy), and opposition on the part of the Israel Medical Association to some of the changes being advocated by the nursing profession.

Interestingly, the major nursing shortage facing Israel [31, 23, 24] and countries around the world, could function either as a barrier to change (with the argument that basic functions be given top priority) or as a catalyst for change (due to the widespread belief that new and autonomous roles for nurses will attract more applicants to the profession). It will be important to see how these conflicting forces are playing out in Israel.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

In several countries, major studies have been carried out to explore how such factors as the increasing importance of chronic, mental and preventive care are changing the roles of nurses in community settings [10, 17, 35]. Meanwhile, unique features of the Israeli health system, such as the pervasiveness of managed care plans, could result in a uniquely Israeli dynamic. However, until recently, no such studies had been carried out in Israel.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Study goals
The study had two main goals:
♦ To document the main changes in the roles of health plan nurses in Israel in recent years

♦ To document the main areas of health plan nursing work today and the extent of their occupation in these areas.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

In addition, the study was designed to:

♦ Examine the extent of autonomy felt by nurses in their work

♦ Examine the extent of satisfaction felt by nurses with various aspects of their work

♦ Examine how nurses perceive their contribution to the quality measurement program and how the program affects them

♦ Identify the barriers to the continued development of the role of community nurses.

Apart from these issues, the study was designed to examine the varying perceptions of nurses based on the following variables: age, country of birth, level of education, professional status, and position of management or otherwise. Further, it compared the situation in Israel with that in the US and England regarding both how roles of community nurses have changed in recent years and the current nature of their roles.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The study focuses on nurses employed by Israel’s four non-profit health plans. Background information on the status of nurses in each of the four plans can be found in Appendix A.

Methods
This paper is based on a broad study conducted in 2014 [28].

The study had two main components:
In-depth interviews with approximately 50 leading professionals in the field of nursing and related fields.

A survey of more than 1000 community nurses who engage in direct patient care

The two main components are complementary; the leading professionals are uniquely situated to identify the role changes that have taken place over time and to provide a broader system perspective, while the front-line nurses are uniquely situated to provide detail and quantification regarding the current nature and content of the work.NURS 3000 – Issues and Trends in Nursing Assignment Papers. Moreover, the in-depth, open-ended interviews with the leaders contributed to the development of the largely closed-ended questionnaire for the front-line nurses, (as did informal discussions with a number of front-line nurses). For example, the in-depth interviews generated a list of current areas of activity and then the survey was used to quantify the centrality of each area of activity and then explore it in greater detail.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

These two main components are described further below; the study team also explored how the Israeli situation compares with the situations in the US and the UK, as described in Appendix B.

A. Methods – The In-Depth Interviews of Leading Professionals
Fifty-five semi-structured, in-depth interviews were held with leading figures from the field of nursing and related fields. Interviewees were suggested by the members of the members of the Community Nursing Study Group (which included head nurses from the health plans and MOH nursing leaders). NURS 3000 – Issues and Trends in Nursing Assignment Papers. The interviewees included past and present heads of nursing at the MOH, the health plans, and the hospitals; leading academics in the field; managers at various levels of the health system (physicians, nurses and other personnel), the Israel Medical Association, the National Association of Nurses in Israel, hospitals, and various professional societies. The interviewees included both nurse managers and managers from other professions. The mix of interviewees made it possible to obtain a variety of perspectives on the processes affecting the nursing profession.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The interviews were conducted between January and August 2013. A semi-structured interview guide was used including questions on: the main current areas of activity of health plan nurses, how their work has changed in recent years, the challenges they face at work, their view of the future of the profession and of the barriers to changes to the profession.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The in-depth interviews were analyzed by first extracting the main themes and then exploring how these themes were addressed in the various interviews. Each interview was summarized in writing. An initial content analysis was carried out shortly after the interview, and significant issues were identified. In cases where a gap was discovered or a question arose, we returned to the interviewees and asked for clarifications.

In the analysis of the interviews, we compiled a detailed list of all the roles performed by the nurses and categorized them according to relevant groups. We made comparisons among health plans, different levels of management and regions. We focused on topics that were mentioned by many interviewees, but we also addressed noted significant issues raised by one or two interviewees. In addition, we analyzed reports and documents submitted to us by the interviewees.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

In mid-2017, supplementary interviews were held with the head nurses in the four plans, focusing on changes in the most recent years, against the background of the findings from the survey.

B. Methods – The Survey of Front-Line Health Plan Nurses
The study population consisted of all health-plan nurses in the four health plans spending most of their time in non-management work, regardless of whether their positions were full- or part-time. Registered nurses, Licensed practical nurses, and RNs with advanced certification were included. Nurses whose main occupation was managerial were not included in the survey to ensure that the focus was on nurses involved primarily in direct patient care. According to the data of the health plans, in 2014 this amounted to more than 4600 nurses.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Sample
Despite the differences in size between the four health plans in the number of employees and persons insured, approximately 250 nurses were sampled at random from each health plan to permit a reliable analysis for each plan.2

Data collection and distribution of the questionnaire
The research questionnaires were computerized and emailed to all the nurses using the addresses supplied by the health plans. The survey was conducted between August 2014 and February 2015. The appeal to the nurses invited them to respond by email through the link provided or by telephone.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

In each health plan, 250 nurses were sampled randomly. This random sampling is relied upon to provide a representative mix of full v. part time, etc. within each health plan.3 At the data analysis stage, the observations were weighted to reflect inter-plan differences in sampling probability and response rate. Thus, the weighted sample can reasonably be expected to reflect the composition of the population of community nurses in Israel with at least some direct care responsibility – both in terms of health plan mix, managerial position mix, full-part time mix, etc.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The sample numbered 1019 nurses. Of these, 6.6% chose not to cooperate and 1.4% did not meet sampling criteria. In total, 692 or 69% of the nurses responded to the questionnaire.4 The response rate varied among the health plans, ranging from 56% to 82%. Four hundred forty-eight interviews were conducted by email; 175 – by telephone; and 69 were completed manually and posted by regular mail.

Research tool
The survey was composed of 70 questions, of which 15 were open-ended.

The topics covered included the following: the main areas of the nurses’ work; their main activities within those areas; perceptions of autonomy; perceptions of the quality measurement program; job satisfaction; perceptions of the professional future of health plan nurses; and background characteristics.5 A pre-test was conducted among 12 community nurses and the questionnaire was refined accordingly.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The categories for the question about usual work activities were derived from the leadership interviews.

The research questionnaires were computerized and emailed to all the nurses using the addresses supplied by the health plans. The survey was conducted between August 2014 and February 2015. The appeal to the nurses invited them to respond by email through the link provided or by telephone or regular mail. 65% of the responses were by e-mail, 25% by phone and 10% by regular mail. Comparison of key response variables (e.g. satisfaction, extent of role change, etc.) found very similar patterns of response across data collection modalities.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The questionnaire made it clear to the respondents that their responses would remain anonymous and the st.

udy team abided by that commitment, sharing with the health plans only aggregate results.

A key distinction in the survey was between routine work and “professional work”. Routine work was defined in the questionnaire as “work that is carried out routinely in the nurses’ room, e.g., blood tests, ECG, blood pressure, vaccinations, inhalations, etc.” Professional work was defined as “work in a specific professional field, such as treatment of complex wounds, stomas, follow-up in diabetes clinic, heart failure, giving instructions for genetic survey testing, geriatrics, women’s health, mental health, day hospital, minor surgical procedures, etc.”.6

Data analysis
The data were weighted to reflect differences among health plans in the sampling proportions and the response rate. After the weighting, the data presented unbiased national estimates of the parameters examined. The analysis focused on the findings for the full sample. Comparisons were also carried among population sub-groups defined in terms of age, educational level, and other background variables.7

The data were analyzed using SPSS version 21, and its complex samples utility. The open questions were analyzed using Naralyzer, a program that makes it possible to consider the entire set of responses to any given question. The responses were coded by category and a codebook was built for the questionnaire, after which the respondents’ responses were transferred to SPSS.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Results
A. Findings from the in-depth interviews of senior professionals
Senior professionals identified 4 key trends influencing the evolution of the work and functions of community and health plan nurses [26, 27]:
1.
A transition from reactive to initiated work

2.
Increased specialization of nurses in various areas of care, including diabetes and wound care

3.
The integration of nursing work into various circles of care-giving and support (for example, with the patient as an individual, the patient within the family, and the patient within the group of patients suffering from the same condition).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

4.
A transfer of activities from the hospital to the community.

The general picture arising from the interviews is that the work of community nurses has broadened in recent years, and this trend is expected to continue.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The interviews identified the following as the main areas of current work of health plan nurses8:
♦ Routine work (as defined above)

♦ Care of chronic patients

♦ Health promotion (health education, encouraging screening tests etc.)

♦ Quality measurement and improvement (involvement in quality measurement programs in both her routine work and special projects).

♦ Home visits (Nurses perform most home visits, including assessments of pain and activities of daily living, functioning, care-giver teaching and support, treating wounds, changing catheters, and drawing samples for laboratory tests.)

♦ Specialized care in various areas including diabetes, stoma, treating wounds, and geriatrics

♦ Participation in unique health-plan initiatives such as “conversation maps for diabetes” and a “personal physician”.

The in-depth interviews also surfaced similarities and differences among the health plans; these are depicted in Appendix C.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Interviews in mid-2017 of the health plans’ nursing directors highlighted the following recent developments:
With the support of top management, technical tasks are increasingly being delegated by nurses to support staff

Nurses are increasingly being appointed to general management positions such as regional directors and program directors

Inter-professional education, involving training of the full primary care team, is on the rise

Nurses are increasingly being given patient management roles in chronic care

and lead roles in health promotion and hospital-community transitions

B. Findings from the Survey of Front-line Nurses
Overview
The main findings emerging from the survey are that the nurses feel that their role has broadened, that they enjoy substantial autonomy and, in general, they are satisfied with their work. They believe that the profession will continue to develop in the future, but at the same time, they point to significant problems and barriers.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Personal and professional characteristics
As indicated in Table 1, 93% of health plan nurses responding to the survey were women, 84% are Jewish, and 59% were born in Israel. Approximately 2/3 of respondents had academic degrees (47% bachelors and 17% masters), 90% were registered nurses (of whom almost half have taken advanced courses), almost half have been working as nurses for over 25 years (albeit not just in community settings), and about a third have supervisory or managerial roles.
Table 1
Distribution of respondents by key personal and professional characteristics (percents)

Personal characteristics

Professional characteristics

Age

Educational level

Up to 40

25%

Diploma (i..e. no degree)

36%

From 41 to 55

40%

Bachelors’ degree

47%

Over 55

35%

Masters’ or PhD degree

17%

Sex

Professional status

Female

93%

Licensed practical nurse

11%

Male

7%

Registered nurse

50%

RN with advanced course

39%

Population group

Jewish

84%

Managerial responsibility

Non-Jewish

16%

With managerial role

38%

Without managerial role

62%

Country of birth

Israel

59%

Nursing experience (years)

Outside of Israel

41%

0–14

29%

15–24

26%

25+

45%

The study team compared the characteristics of the respondents and the study population for Israel’s two largest health plan, which account for more than half of the nurse population (similar data were unavailable from the other two plans).NURS 3000 – Issues and Trends in Nursing Assignment Papers. In one of the large plans, the characteristics were found to be very similar with regard to sex and education level, but with the sample having a slightly higher proportion of nurses who had done Diploma courses (54% v. 43%). In the other large plan, the population and sample were very similar with regard to sex, the proportion of the nurses who had done Diploma courses was slightly lower in the sample (33% v. 40%), and the sample also had a lower percentage of LPNs (8% v. 18%). (Note that the impact of these small differences on the overall study findings is apparently quite limited, as the study found few substantial differences in key study variables among these sub-groups – see Tables 5, 6 and 7 below).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Main areas of activity
A majority of front line staff (71%) continue to engage in routine activities (as defined in this study) to a great or very great extent. In addition, approximately one quarter to a third of the respondents indicated that their major area of care, besides routine work, was chronic illness care (38%), health promotion (30%), specialized care (26%) and home care (6%).

Caring for chronically ill patients

Those nurses who indicated that caring for the chronically ill was their main area of non-routine activity were presented with a list of relevant activities and asked to indicate in which of them they are involved to a great or very great extent. As indicated in Table 2, when it comes to chronic care, there is extensive involvement in several proactive and professionally demanding activities, such as management of the care process (80%) and interactions with specific patients (79%). About half also indicated great and very great involvement in the development of policy and general approaches to care regarding chronic patients. This process was also accompanied by the development of digital information systems and services.NURS 3000 – Issues and Trends in Nursing Assignment Papers.
Table 2
Percent of nurses who indicated that they were involved to a great or very great extent in various aspects of caring for the chronically ill

Management of the care process

80%

Pro-active interactions with specific patients

79%

Monitoring continuity of care for specific patients

79%

Development of policy and general approaches to care regarding chronic patients

48%

Outreach to the target population

52%

Development of proactive action plan for patients with chronic diseases

77%

Monitoring the implementation of proactive action plans

68%

(From among those nurses who indicated that caring for the chronically ill was their main area of non-routine activity)

The same group of nurses was also presented with a list of tasks associated with caring for individuals with chronic illness (Table 3) and asked whether the tasks constituted a significant part of their work. The vast majority affirmed that this was the case regarding healthy lifestyle counseling (91%) and deciding which patients to invite to visit (75%). In contrast, only 4% indicated that changing doses in prescriptions was a significant part of their work.NURS 3000 – Issues and Trends in Nursing Assignment Papers.
Table 3
Percent of nurses who indicated that various tasks were a significant part of their work

Healthy lifestyle counseling

91%

Functional and health status assessments

90%

Monitoring specific patients

86%

Deciding which patients to invite to visit

75%

Deciding, on the basis of protocols, computer alerts, and patient assessments whether/when particular patients should be immunized

63%

Changing doses in prescriptions

4%

(From among those nurses who indicated that caring for the chronically ill was their main area of non-routine activity)

Health promotion
Those nurses who indicated that health promotion was their main area of non-routine activity were similarly asked about the extent of their involvement in a list of relevant activities. As indicated in Table 4, there is extensive involvement in the identification of target populations for interventions (86%) and counseling about nutrition (79%), smoking (65%) and physical activity (73%). The nurses were much more likely to be involved in health promotion events within the clinic (38%) than in those outside the clinic (14%). When asked about the extent to which they engage in outreach (in general), 78% indicated that they do so to a great or very great extent.NURS 3000 – Issues and Trends in Nursing Assignment Papers.
Table 4
Percent of nurses who indicated that they were engaged in various activities related to health promotion, to a great or very great extent

Identification of target populations for interventions

86%

Workshops and counseling sessions in the area of health promotion

38%

Health promotion activities that take place outside the clinic

14%

Health promotion activities that take place in the clinic

44%

Counseling about nutrition

79%

Counseling about smoking

65%

Counseling about physical activity

73%

(From among those nurses who indicated that health promotion was their main area of non-routine activity)

Change in the way of working
Eighty-five percent of the nurses felt that concerning their main area of activity, in the past 5 years there have been significant changes in the way that they work. Among other things, the changes cited included: more planned work than in the past, focused activity on specific areas (such as the those noted above), and expansion of medical knowledge. Furthermore, 61% of the nurses noted that the working environment in this period had changed to a great or very great extent, and another 26% indicated that it had changed to a moderate extent.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Social and economic considerations
Almost all of the nurses (90%) take into account the family and economic situation of the patient to a great or very great extent while only 2% of them take it into account to a small or very small extent or not at all. Moreover, almost half (47%) of the nurses take into account financial considerations of the health plan to a great or very great extent while 18% of them take it into account to a small, very small extent or not at all. (The remainder takes these factors into account to a moderate extent.)

The quality measurement program
Approximately three-quarters of the nurses (77%) reported involvement to a great or very great extent in quality measurement programs; only 10% felt that they were not involved or were involved to a very small extent. Similarly, 75% of the nurses felt that the program had impacted their work to a great or very great extent, and 73% of them felt that their workload had increased to a great or very great extent as a result of the program.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Sense of autonomy
Approximately three-quarters of the nurses (73%) felt that they had autonomy at work to a great or very great extent. Similarly, 75% of the nurses felt that their professional autonomy had broadened in the preceding 5 years in contrast to 9% who reported a sense of curtailed autonomy in this period, and 16% who noted that they had felt no change. 70% indicated that, to a great or very great extent, they had the authority needed to do their jobs.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Work satisfaction
Four out of every five nurses (80%) were satisfied to a great or very great extent with their work overall, and only 3% felt little or very little satisfaction; the rest were moderately satisfied. In keeping with these feelings, 80% said that they would recommend to others to enter the profession.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

As indicated in Chart 1, the aspects of work with which the most nurses were satisfied to a great or very great extent were: the impact of their work with patients (84%), the extent of responsibility given to them (81%), and their co-workers (82%). The aspects of work with which the lowest proportion of nurses were satisfied were: the salary (39%), physical conditions (14%, and appreciation of their work by their superiors (17% dissatisfied).

Barriers to the development of the nursing profession
Asked about barriers to the development of the profession, the front-line nurses who participated in the survey and the managerial nurses who participated in the in-depth interviews cited similar barriers. These included:
♦ Physicians’ perceptions. Some nurses believe that physicians fear the profession’s development, being interested in keeping the nurses in the position of following physicians’ directives.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

♦ Nurses. Some nurses believe that they and/or some of their colleagues slow down the profession’s development, having no interest in broadening their authority for fear of a greater workload.

♦ Lack of resources and positions. Many nurses regard the lack of resources as a barrier to the profession’s development: the large workforce shortage, and the fact that there are no established positions

♦ Compensation. Subsequent to the relative wage dissatisfaction, some nurses regard low levels of compensation as a barrier to the profession’s development. Low compensation attracts fewer young people to the profession and increases the workload.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Note that the barriers identified in the survey were largely similar to those that came up in the in-depth interviews.

Differences among nurses related to background characteristics
The nurses’ perceptions were examined according to the following variables: age, country of birth, level of education, professional status and managerial position. As a rule, very few large or statistically significant differences were found among the groups (See Tables 5, 6 and 7).NURS 3000 – Issues and Trends in Nursing Assignment Papers. However, we did find that the more educated the nurses were, the more likely they were to take into account financial considerations of the health plan and the more satisfied they were than less-educated nurses. We also found that the higher the level of their professional training, the more they tended to take into consideration the family and economic situation of a patient. In addition, nurses with a higher level of professional training felt were more likely to indicate that the quality monitoring led to an increase in competition among the front-line clinicians, managerial pressure and overload.NURS 3000 – Issues and Trends in Nursing Assignment Papers.
Table 5
Authority and autonomy by sub-group

Autonomy to a great or very great extent (in %)

Sufficient authority to carry out job (in %)

Total

78

70

Age

Under 40

70

60

41–55

80

72

Over 55

83

76

Education level

No degree

84

84

BA

75

75

MA+

75

75

Professional status

LPN

66

67

RN

78

72

Beyond

80

68

Managerial responsibility

With managerial role

85

78

Without managerial role

74

65

Table 6
Perceptions of significant change and level of satisfaction, by subgroup

Significant change in past five years (in %)

Satisfied to a great or very great extent (in %)

Total

52

78

Age

Under 40

47

79

41–55

56

77

Over 55

52

80

Education level

No degree

53

78

BA

54

80

MA+

43

79

Professional status

LPN

61

71

RN

51

81

Beyond

49

77

Managerial responsibility

With managerial role

62

81

Without managerial role

45

78

Table 7
Social and economic care considerations by subgroup

Significant weight given to family and economic circumstances

Significant weight given to health plan financial considerations

Total

90%

47%

Age

Under 40

84%

38%

41–55

95%

55%

Over 55

84%

46%

Education level

No degree

95%

44%

BA

86%

46%

MA+

88%

55%

Professional status

LPN

81%

51%

RN

91%

46%

Beyond

89%

48%

Managerial responsibility

With managerial role

89%

38%

Without managerial role

88%

55%

Discussion and conclusions
This study provides the first empirically based description of the role of health plan nurses in Israel. Interviews with national leaders in nursing and medicine conducted in 2013 foreshadowed changes described by front-line nurses in interviews 2 years later. Leaders identified emergent trends in chronic illness and specialized care in the health plans as well a shift from reactive to nurse-initiated work. Findings from the 2014–5 survey of front-line nurses showed these trends were indeed occurring. Follow-up interviews with nurse plan leaders in 2017 provided key updates and were consistent with the earlier findings. All study components indicated that major changes have occurred in Israel in the role and functions of health plan nurses and their involvement in patient care.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The changes found included a transition from reactive to initiated work and increased specialization. Moreover, aside from routine care, the study has documented the central place of chronic care; health promotion and specialized care in the work of health plan nurses. Activities related to the quality monitoring and improvement are another significant component of the work of Israel’s health plan nurses. The findings provide support for ongoing efforts in the health plans to give nurses more authority and responsibility in the management of chronically ill patients, a more central role in health promotion efforts, more advanced training – both inter-professional and nurse-specific, and more opportunity to focus on the roles and tasks that require nursing professionals.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

One of the study’s key findings is that about half of the nurses take into account, to a great or very great extent, the financial concerns of the health plans that employ them. This may be due, in part, to the growing roles of nurses in care coordination and management. This sensitivity to cost considerations, combined with the nurses’ broad professional expertise and patient-centric perspective, make nurses an extremely valuable resource for the plans, and positions them for greater responsibility and authority.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

We examined whether there were differences between the nurses who are managers and the other nurses with regard to the extent to which they take into account various considerations. The two groups were equally likely to take into account the patients’ economic circumstances (approximately 90% do so to a great or very great extent). Surprisingly, however, the nurse-managers were less likely than the others to report that take into account the economic interests of their health plans (22% vs. 36%). The reasons for this difference might be a good subject of a future study.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Another key finding is that a significant proportion of the nurses (38%) indicated that care of the chronically ill patient is their main area of activity beyond routine care. With the population continuing to age, work in this area is likely to expand. It will be important to develop patient-centered projections of the amount and nature of the work that will be needed to care effectively for the chronically ill, and then think strategically about how health plan leaders, and physicians, nurses, and other professionals on the front-line can best work together to address this important challenge. This will clearly have important implications for the number of professionals required and continuing education, and this could be an important area for inter-professional continuing education. Serious consideration should be given to continuing the trend of giving nurses a greater role in care coordination and management of the chronically ill.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Health promotion is the main area of non-routine activity for another large group (30%) of health plan nurses. In the future, it will be important to explore in greater detail in which health promotion challenges they are most involved, the nature of their involvement in those challenges, and the degree of their success in those areas. This could have important implications for ensuring that nurses have the opportunity to engage in relevant continuing education opportunities regarding health promotion strategies, concepts and techniques. The major role that nurses are playing in patient-level health promotion should also be give greater recognition.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The study also confirms the extensive involvement of nurses in quality monitoring and improvement efforts, hence another area where inter-professional education should be given greater emphasis. A related finding is that almost all the nurses are quite attuned to the family and economic situation of the patient. This attention to context can be vitally important in efforts to improve a health plan’s quality performance, particularly with regard to those dimensions of quality, which require patient compliance and/or behavioral change. They will be even more important in the future if/when quality measures are developed that assess quality in such areas as depression care and community-based long-term care.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

As indicated earlier, this study found that nurses perceive quality monitoring and improvement to be an important part of their work, but that this comes with various costs – more managerial pressure, more competition and a higher workload. A previous study by Nissanholtz et al. adds valuable context to these findings. In a national representative survey of health plan primary care physicians, most respondents (74%) agreed that nurses contribute to practice quality and share responsibility for improving quality measures.NURS 3000 – Issues and Trends in Nursing Assignment Papers. Physicians who felt that quality monitoring improved the quality of care and those who supported the program were more likely to consider that nurses shared responsibility for the quality of care [26, 27]. That study also found that, like nurses, the physicians also experienced the quality monitoring to increase managerial pressure, but to a lesser extent than did the nurses (58% v. 84%). Similarly, it found that physicians also felt that the quality monitoring increased competition, but to a lesser extent than did the nurses (47% v. 81%). The two professions were more similar in the extent to which they felt that the monitoring increased the workload (64% and 72%) [25].NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The findings also indicated that a very high proportion of the health plan nurses are very satisfied with their work overall (80%). However, the study also highlighted pervasive concerns with the shortage of nursing positions, wage levels and the attitudes of some physicians and nurses that constrains the professional development of health plan nurses. Expanding nurses’ role is one of the factors that improve satisfaction of nurses [12]. Dealing with these problems would clearly contribute to the satisfaction and commitment of those already working as health plan nurses. It may also help attract additional young people to the profession.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

A related finding is that the vast majority of the health plan nurses are significantly involved in both routine work (in which they function largely as supports for primary care physicians) and more specialized work (in which they typically have more independent roles). In theory, a mix of this sort could be either a source of frustration (related to time constraints and/or the complexity of role identity) or a source of satisfaction (related to task diversity). Unfortunately, we do not have information on how this mix of roles is affecting nurse satisfaction. What we do know is that the vast majority of health plan nurses are satisfied with their work and that, at present, for most of them work entails a mix of routine tasks and specialized work.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

In general, there is a good fit between the study’s findings about the evolving content of the work of health plan nurses and the contextual changes highlighted at the beginning of this article. One important exception is that, despite the ongoing reform of Israel’s mental health care system, the nurses did not indicate that mental health care is an important component of their workload. This may be because the in-depth interviews were carried out in 2013 and the survey of front-line nurses took place in 2014; while these were subsequent to the 2012 government decision to transfer responsibility for mental health care to the health plans, the transfer itself did not go into effect until 2015. Interestingly, in 2017 presentations to the Mental Health Reform Administration, the health plans spoke about significant strides in involving nurses in mental health care and in the future it will be important to study systematically the extent and nature of this evolution.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The changes in the roles of community nurses has apparently been a gradual evolution spread over many years. Interestingly, the main changes emphasized by nursing leaders in the 2013 in-depth interviews were largely similar to those emphasized in the 2017 follow-up interviews. At the same time, several new points were made in the 2017 interviews, suggesting that this evolution continues; these include the appointment of several nurses to regional director positions, greater expose of the nurses to patient clinical data, and more inter—professional educational.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Overall, the data presented in this study can contribute to Israeli efforts in the following areas:
♦ Recruiting more people to the nursing profession, especially to community nursing. The data can enable recruiters to provide a clearer picture of the current content of the work (including its diversity), how that content is changing in exciting directions, and how satisfied community nurses are with their work.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

♦ Intra-organizational thinking within the health plans and other relevant organizations Key topics including the place of nursing resources in the budgeting of community-based services, the provision of appropriate levels of compensation, the definition of nursing tasks, the division of labor between the various staff members and mechanisms for increased cooperation.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

♦ Sharing information with the public on the changed role of health plan nurses. This could contribute significantly to the empowerment of both nurses and their patients and to cooperation between these two groups.

Limitations
The main study limitation is that the interviews were carried out at only one point in time. Thus, the findings about changes in the nurses’ roles are based, in part, on the nurses’ ability to recall the substance of their roles several years prior to the interviews and their assessments of how those roles had changed. This limited the extent to which the changes in the roles could be detailed and quantified.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Another limitation is that no formal assessment was made of the reliability and validity of the questionnaire used in the survey of front-line nurses. However, it was carefully derived from the in-depth interviews of the 55 nursing and other leaders and also reviewed for face validity.

Finally, as indicated in the methods section, there may be small-moderate under-representation of some sub-groups of nurses. However, the impact of these on the overall study findings is apparently quite limited, as the study found few substantial differences in key study variables among these sub-groups.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Directions for further research
While the current study focused on Israel, it highlights developments, trends and issues, which may be relevant to other countries as well. For example, in the U.S. a 2017 report by the Macy Foundation called for using RNs as significant contributors to health promotion efforts in primary care settings [6]. That report identified a number of goals, including: giving more emphasis to primary care in nursing schools, developing primary care specializations, and encouraging teamwork.9

The study team plans to be in touch with researchers in other countries to identify similar studies, compare findings, and reflect together on similarities and differences. One of the issues of particular interest is whether the predominance of health plans in Israel has resulted in a unique mix of roles for its community nurses and whether Israel might be a harbinger for other countries in the process of adopting more organized systems of community care.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Directions for further research within Israel include:
An exploration of how the nature of the interactions between health plan nurses and physicians are changing and how both professional groups feel about it

Qualitative research to further understand how front-line nurses experience the mix of traditional/routine and newer/proactive roles

More detailed analysis of the survey data regarding such topics as nurse involvement in the quality monitoring program, change barriers and facilitators, similarities and differences across age groups, etc.

An analysis of how nurses answer the challenge of caring for the mentally ill and persons with mental health problems

The evaluation of new nursing roles as nurse practitioners and nurse consultants and their impact upon patients’ and families’ quality of care and quality of life

An analysis of the current roles of the nurses in preventive mother and child health centers, and how these have changed over time

An exploration of of Israeli models of physician-nurse teamwork, which were recently praised by the OECD [29], and are continuing

Footnotes
1
This figure of one-third is based on data from the Central Bureau of Statistics Labor Force Surveys for the years 2012–2014. It is up from one-quarter a decade earlier.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

2
The data appearing in this report do not distinguish between the health plans. However, each health plan has received, for internal use, a series of tables comparing the findings concerning it and the others.

3
Inadvertently, in one of the health plans, nurses with less than 5years of experience were largely excluded in the sampling process. However, sensitivity analysis indicates that this had only a very limited impact on the study findings. This is because there were only small differences in key study variables between nurses with less than 5 years of experience and the nurses with five or more years of experience. In addition, the nurse with less than 5 years of experience constitute a relative small part of the study population (between 18% and 25% in the three plans for which we have data).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

4
The non-response was due to an inability to contact 17% of the sample, 7% who refused to cooperate, 6% who initially indicated that they would respond but did not follow through, and 1% who were found to be irrelevant to the study.

5
The background variables included age, gender, ethnic background (Jewish, Arab, Druze, etc.), country of birth, level of education, professional status, management role, and years in the profession. They were included because they were felt to be potentially related to key study variables such as work satisfaction and perceived professional autonomy.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

6
Education, giving guidance to patients, and referrals were not defined as routine work, nor as professional work. Evidently, they should be included in the professional work of nurses and not as routine work, but we cannot say with certainty that all the nurses understood that the educational part, as noted, belongs to professional work.

7
The analyses presented in this article do not distinguish among health plans, as the health plans’ agreement to participate in the study was conditioned on a commitment from the study team not to publish plan-specific findings. Each health plan has been presented with the findings for the results for their own nurses, compared with the national results.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

8
These areas are consistent with the major changes in the health care system. For example, the fact that people live longer, but with more chronic diseases, requires increased attention to chronic patients, both to prevent deterioration of health status through the promotion of health and to respond to patients who are disabled. The fact that nurses learn more and have more extensive knowledge and capabilities than in the past affects the subject of “specialization” in various subjects and the nurses’ desire to develop in the field closest to their hearts and improve their abilities in this field

9
This approach is a natural continuation of the IOM report on the future of caregiving (IOM 2011). The IOM report noted that the nursing profession’s focus on patient management and coordination, patient education and public health intervention, is a good fit for a world in which health promotion and care management are increasingly being emphasized.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

10
See the appendix for a brief note on the historical development of nursing in Clalit clinics.

Notes
A comment to this article is available online at https://doi.org/10.1186/s13584-018-0257-5.

Declarations
Acknowledgements
The authors thank Steve Schoenbaum and Gerri Lamb for the comments on an earlier draft of this manuscript. The Community Nursing Study Group consists of Liat Arad, Shlomit Bloomenthal, Dorit Goldman, Yafa Haron, Miriam Hirschfeld, Calanit Kaye, Galit Kauffman, Idit Kogan, Rachel Nissanholtz-Ganot, Bruce Rosen, Bruria Sherman, Hedva Stoyer, Yulia Nigel, and Dorit Weiss.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Funding
The study was funded in part by a grant from the Israel National Institute for Health Policy and Health Services Research 62–2010-R.

Availability of data and materials
The principal investigators are open to suggestions for joint analyses and collaborations based on the data collected as part of this study.

Authors’ contributions
RN and BR jointly developed the study design and carried out the study, with substantial input from MH. RN took the lead in preparing the project report on which this article is based and BR took the lead in turning the project report into a journal manuscript. The members of the Community Nursing Study Group provided valuable input into the study design, the research instruments and the data analysis. All authors read and approved the final manuscript.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Ethics approval and consent to participate
An exemption from a full review was granted by Human Subjects Committee of the Clalit health plan. Authorization number: 0032–14-COM. The voluntary nature of the study was emphasized to all the nurses in the sample and only those who wished to participate did so.

Consent for publication
All the authors have agreed to publication.

Competing interests
RN, BR and MH declare that they have no competing interests. Several of the members of the Community Nursing Study Group have senior management roles in the health plans and the Ministry of Health.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open Access
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Appendix A: The status of nurses in Israeli health plans

Israel has four health plans (Clalit, Maccabi, Meuhedet and Leumit), and they have several important features in common. They are all non-profits and all were established at least 80 years ago. They all are nation-wide in scope and all have more than half a million members. They also have sophisticated IT systems, with all primary care clinicians working with electronic health records.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

At the same time, there are several important differences among the plans. These include their size; the age, income and geographic mix of their members; and the extent to which their physicians are plan employees v. independent contractors. There are also important differences with regard to plan history, culture and operating style. Most significantly, for the purposes of this study, there are difference with regard to the extent, and manner, in which the plans work with nurses in community settings.

Clalit, with 4.4 million members, employs approximately 3000 nurses in community settings; most of them work on a full-time basis. The dominant model of primary care in Clalit is a community clinic with an interdisciplinary staff that has overall responsibility for the health and health care of the members registered in that clinic.10 The physicians and nurses jointly manage the care of each patient, including both responsive and proactive care, with a clear division of responsibility between the two professions. They also take a population approach and seek ways to improve the care of groups of patients (defined in such terms as age, illness and ethnicity).

Maccabi, with 2.1 million members, employs approximately 1100 nurses; this is up from 650 four years ago. Almost all of Maccabi’s nurses are RNs and two-thirds hold academic degrees. Most of them work either in municipal/district branches or in the clinics of independent physicians registered in the personal physician program (PPP); others work in such settings as specialty clinics or national nurse-led call centers that operate 24/7. In the PPP they function primarily as case managers for chronic illnesses and preventive/outreach services. In the branches, their jobs entail both proactive and reactive work. In recent years, the nurses have been able to delegate many of the more technical and routine tasks to nurse assistants or other support staff.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Meuhedet, with 1.2 million members, employs 880 nurses; many of them work on a part-time basis. The number of nurses in the plan has doubled over the last 5–6 years. Almost all the nurses work in Meuhedet’s municipal/district branches, each of which has a large number of specialist physicians and nurses. This has facilitated a rapid movement toward greater specialization of the nurses, particularly in those clinical areas where nurses have substantial authority and independence. These include diabetes, stoma, genetic counseling, and most recently palliative care. In each of these areas, the nurses play a central role in integrating the work of different types of professionals (physicians, dieticians, pharmacists, etc.) and in managing the care of the patient. The need for integration has been a major driver toward greater specialization.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Leumit, with 0.8 million members, has almost 500 nurses, with about 60% of them working full-time. Approximately 90% of them are RNs. The number of nurses working in the plan has been stable in recent years. The nurses work predominantly in the clinics that are operated by the health plan and secondarily in home care units, rather than in IP offices. Their work has expanded from the more technical tasks to include a large component of chronic care management and patient education. Recently, a new nursing management level – the district head nurse – was created, with a focus on implementing and inculcating various guidelines related to nurses’ newer responsibilities.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Nurses also play a central role in health plan call centers, in which have they have a great deal of autonomy to make decisions which often have significant clinical and economic implications.

Appendix B: An initial examination of community nursing roles in the US and England, in comparison with Israel
Methods
Ten telephone conversations were held with key figures in the US and England and the relevant professional literature was reviewed. This was followed by a comparison with the situation in Israel as it emerged from the in-depth interviews.

Findings
Changes over time. The role of community nurses has expanded in recent years. However, it is difficult to estimate the pace of change or point to countries with more rapid change. This topic would seem to deserve a separate study.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Different types of nurses. One prominent difference between Israel and the other countries examined is that the latter have a category of Nurse Practitioners – NPs. In the US and England, nurses in this category enjoy broader authority. Though not many nurses in England are defined as NPs, their numbers are steadily growing. In the US, there are more than 222,000. In Israel, the Ministry of Health has begun to recognize nurse practitioners only in recent years and this, too, only in select areas (such as palliative care, geriatrics and diabetes care). Thus, the situation in Israel is very far from that in the US and England.

Managing the care of chronic patients. The main difference between Israel and the other countries in managing the care of chronic patients concerns the nurses’ scope of authority. In Israel, the authorization of nurses to prescribe medication is very limited and hardly implemented and they do not make referrals. In the US and England, there are differences based on a nurse’s status and training. Some nurse work only according to a physician’s directives while others work more independently, make referrals and prescribe medications.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Home visits. In Israel, as well as in the other countries, home visits for bedridden patients are performed mainly by nurses. However, in the US and England, the nurses working in homecare do it exclusively. In Israel, on the other hand, most of the nurses work in homecare in addition to their work at the clinic.

Measuring quality. Both of the countries examined have quality monitoring programs. However, whereas in Israel the program has for many years encompassed the entire community and virtually all nurses are involved in or affected – in the US, until recently, it applies only to organizations of managed care (about a third of the population). Recently, the federal government has instituted a program of quality reporting on care for the elderly; it is related to payment that has led to reporting from almost all primary care practices. Still, while nurses are involved in quality measurement programs in both Israel and the US, the extent of their involvement apparently differs. Moreover, in England and the US there are financial incentives for participating in these programs whereas in Israel there are none.

Authority to prescribe medication. In both of the countries examined, nurses have partial authority to prescribe medication and the differences between the countries are reflected in the substance of their authority. Another difference relates to the extent that this authority is actually practiced. In these countries, nurses defined as NPs are authorized to prescribe medication. In Israel, virtually no nurses prescribe medication without a physician’s authorization.

Caution should be exercised in interpreting these differences between countries and their causes. Factors such as the structure of the system, cultural differences, and the milieu of the health system should be taken into account.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Appendix C: Similarities and differences among the health plans that emerged from the in-depth interviews
The similarities related to the following aspects: a shortage of nurses, overall and for all districts except for the north; considerable advances in the technologies used by nurses; more studies and training than in the past; creativity.

Alongside the great similarity found between the nurses’ jobs in all the health plans, there were also several differences, including:
The implementation of the provision for special authorization: Although the Ministry of Health widened the authority of community nurses, not all the health plans have implemented the provisions.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Integration of nurses into the measurement program. There are differences in the extent of involvement and responsibility of community nurses in the measurement program, directed by the Ministry of Health and examining the quality of prevention, diagnosis, and treatment provided by the health plans. (The program is implemented by the Israel National Institute for Health Policy Research and contains indicators for the following areas: immunization, early detection of breast and colon cancer, treatment of diabetes, asthma and heart problems.) In three of the four health plans, nurses are responsible for some of the indicators and manage them on the local, district and national levels. In the fourth, they deal with the technical aspects of measurement, such as administering vaccines or inviting patients to come in for a mammography or other tests.

Integrating nurses into various levels of health-plan management. In three health plans, nurses serve in senior positions of general management (i.e., beyond nursing): they are integrated into the management of health-plan branches and districts, and of the health plan as a whole. In one health plan, they manage only the nursing sector and are not part of the general management of the health plan.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Developing and focusing on areas of specialization. Each health plan invests in different areas of specialization. Differences in specialization also exist among the districts of a single health plan.

Perceptions of barriers to the development of the profession
Despite the great potential for professional development of community nursing, the interviewees identified barriers such as: a lack of established positions; physicians’ perceptions of the profession and their fear of encroachment by nurses into their areas of responsibility; some nurses themselves do not wish to broaden their roles or are afraid of carrying responsibility even when they do receive it; nursing schools focus more on hospital-related studies, dealing less with the community and its diverse work possibilities.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

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equipment and supplies
Building Your Business
The Building Your Business module provides you with everything you need to know about starting up, or growing, your business. We take away the daunting aspects of running a business and help you to find strategies to get started. With this in mind, our easy step-by-step process will soon have you on track with a business plan (that you understand!) and all the documentation you need for success.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

This is an optional module and does not include any assignments. However, some students prefer to have more guidance. For this reason, we offer three different mentorship options that you can choose from.

Topics in this module
becoming a birth and parenting professional
determine your personal and business goals
learn marketing strategies such as segmentation, targeting, and positioning
develop a customer profile
analyze your competitors
determine your unique selling point
identify ways to broaden your products and services
develop your brand
learn the basics of website design
develop a social media strategy
determine your advertising approach
learn how to carry out financial analysis and avoid debt
understand the different options for a legal business structure
time management and ways to deal with work stresses

I enjoyed that I could work at my own pace and go back to recover information as needed. I enjoyed the challenge of this course. There is so much to know about breastfeeding and I really appreciate that the manual covered so much information.NURS 3000 – Issues and Trends in Nursing Assignment Papers.
I really enjoyed the hands on of helping other women learn and also enjoyed learning from them. The thanks from a mother who has finally gotten her baby to latch on and nurse is incredibly gratifying.
I feel like at the end of this course, particularly after working on the case studies, I understand so much more that the word ‘counselor’ in the title of breastfeeding counselor is incredibly important. We are not there only to educate mothers about the technical elements of breastfeeding (although that is part of what we do). We are there also to listen and help mothers to find their own breastfeeding path. This is so much more than a physical act; breastfeeding is emotional, and it’s important to support and validate those emotions.NURS 3000 – Issues and Trends in Nursing Assignment Papers.
Stefanie, WA, USA

All the trainers I had contact with, and especially my own trainer, spoke with such kindness and genuine caring towards the progress and growth of my course. I’ve studied at my own pace in the past with different colleges, but with Childbirth International trainers never did I once feel unsupported or ignored.
Carla, WA, Australia

I loved getting a new view on breastfeeding. As a medical doctor, unfortunately the teaching about breastfeeding is very sparse and students are not taught to teach breastfeeding to patients. This often leads to a vicious cycle of the doctor prescribing antibiotics for mastitis without taking care of the underlying issue. I feel having completed this course will hopefully give me a niche market of clients that want the medical view as well as the breastfeeding counselling.NURS 3000 – Issues and Trends in Nursing Assignment Papers. I am so happy I have broadened my horizon with this course and deepended my knowledge about breastfeeding in general. During training I have already managed to make a difference to some women and their babies and it was very rewarding. It feels very good to have an impact on the start a mother and baby get to their breastfeeding experience, since the first few weeks are most crucial. This training will give my career the turn I was hoping for and let me work closely with mothers and babies.NURS 3000 – Issues and Trends in Nursing Assignment Papers.
Sharon, London, UK (Doctor)

I enjoyed how much it pushed me. Learning about breastfeeding is absolutely amazing. I’m not sure I will ever be satiated with what I currently know, but always be seeking to gain more insight. The case studies really pushed me, from having a book knowledge, to applying it to real life situations. They were hard, but so helpful in understanding how to dialogue with women in various breastfeeding situations.

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Amy, Singapore

Throughout my training, I have learned how to listen better, be more compassionate, and follow a mom’s cues in supporting her and how she wants to feed her baby. As important as the informational part of this course is, the communications portion has been VITAL. That goes for all of my courses! But especially in breastfeeding, as it can be such a sensitive area, I learned that my approach really sets the tone in how a mom feels about breastfeeding. And how she feels about it truly is a determining factor in whether or not she decides to continue on or seek alternative feeding methods.NURS 3000 – Issues and Trends in Nursing Assignment Papers.
Emilie, Kansas, USA
Questions About Breastfeeding Counselor Training
Is this course accredited or recognized?
Yes!! Childbirth International Training is accredited with distinction as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. We are the only doula training organization to have been accredited with distinction by the ANCC. Your final certificate will show the continuing education hours and can be used for any organization that recognizes ANCC continuing nurse education hours. Read more about our accreditation.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Do you have discounts or scholarships available??
We do not offer scholarships at this point in time. We do, however, have a number of discounts. Existing students and graduates receive a 15% discount on all subsequent courses that they purchase. If you purchase more than one course together, a discount of 15-25% is available. We offer group discounts for friends or work colleagues who register for the same course together. Our Green option allows you to reduce the cost of training by working online. In addition, we have payment plans available to enable you to pay for your course over five months.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Do I have to have breastfed to be a Breastfeeding Counselor?
Not at all! Your training will provide you with the knowledge you need to support breastfeeding parents. We have students who have never given birth, or who chose not, or were unable to, breastfeed.

After I have finished the course, can I become an IBCLC?
You can use CBI’s Breastfeeding Counselor course for the 90 hours of lactation specific education required for IBCLC certification – many of our students have done just that! You will still need to meet the other requirements as stipulated by the IBLCE. You can read more about IBCLC requirements on the IBLCE website.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Will I be able to find a job working in a hospital or clinic?
That will depend on the requirements that the hospital or clinic determine. Many of our graduates have gone on to work in healthcare settings. Sometimes an organization will require the IBCLC designation, while others will be looking for an individual who has completed a set amount of lactation specific education.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

How much can I earn as a Breastfeeding Counselor?
That will depend on how you decide to establish your business and the clients that you work with. Generally, a Breastfeeding Counselor charges by the hour and may charge anything from $25-$100 per hour. Sometimes they might offer packages of a fixed number of visits.

Can I provide documentation of clients I supported before I started the course?
The client support that you provide (30 hours in total) must have taken place after you started your training with CBI. You can use hours on telephone and email support (up to four hours), as well as facilitating breastfeeding support groups or running childbirth classes (up to six hours).

Do I have to recertify or pay membership fees?
We don’t require you to pay membership and recertification fees in order to stay certified. We provide training – and we’re really good at it! Similar to a university program, you deserve to have your hard work acknowledged for life! We’re not going to charge you every three years to prove that you still have the knowledge and skills that you built. We also will not charge you to continue to belong to CBI – your membership is lifelong.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

If you need to show recertification in order to belong to a local organization you can do so – you just submit the required documents for proof, we will review them and reissue your certification – showing it is a recertification. And we’ll do this for a minimum fee that just covers our costs.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Since 2010, the US congress passed “Healthcare Reform: Affordable Care Act”, recent healthcare is focusing on more preventing and promoting than curative heath care. Associated with it, nursing care also gradually shifting from inpatient to outpatient an emphasizing in patient, family and community based. Scope of nursing practice has become more boarder than past. Public attitudes and views towards nurses has been also changed. Along with dynamic changes in society, many advance technologies are introducing into nursing practice as well. NURS 3000 – Issues and Trends in Nursing Essay Paper. Ongoing education and lifelong learning is needed to maintain safety and achieve better outcome with limited available resources (Blais & Hayes, 2016). Nurses are no more limited to bedside care, their roles have been changed to a leader, an educator, an advocator, a researcher. Due to increasing elder population growth and the shortage of healthcare provider health-related organization, institution, and government are encouraging nurses to go back to school again to advance their career and get more opportunity by participating in ongoing education. ‘Issues and trends in Nursing’ online course is developed for student who want to continue their education and advance degree like RN to BSN. Current issues and trends considered in terms of their impact on roles and practices. Overall objectives of the course ‘Issues and Trends in Nursing’ is addressing to investigate nursing practice that is influenced by the impact of social issues and concerns which are related to economic, demographic, technological ethical, legal, and social.

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The potential change of nursing practice in response to societal changes will be discovered as well as the new opportunities these challenges have for career development. (ASPEN, 2017) Identify strategies that promote the socialization of the nurse into a professional role, to achieve the goal, courses are divided in eight different topic modules and each module has specific goal to reach overall goal. NURS 3000 – Issues and Trends in Nursing Essay Paper

The first module ‘Nursing as a profession’ of this course focused on this module begins with an exploration of societal trends that shaped nurses returning to school and what is required to be successful. Student will also examine two role transitions models and apply these models to their current situation. Where I learned, influencing factors including challenges and difficulties for nurses to return school along with benefits and successful strategies to motivate and complete the course after enrollment by exploring phases of transitional module. Explore Professional Role Transition Models and apply the knowledge to the student’s current situation . NURS 3000 – Issues and Trends in Nursing Essay Paper

The second module ‘Legal and Ethical Issues’ focused on cares for patients, families, and communities, and in doing so must consider how the care impacts the feelings and rights of others. Nurses operate their function and role within the scope of nursing practice and law. On this module, I learned legal and ethical issues and dilemmas that may arise in nursing profession and also able to differentiate between ethical and bioethical issues in nursing especially in end of life situation by analyzing the situation along with learned nurses’ roles and responsibility and way to solve the problem. NURS 3000 – Issues and Trends in Nursing Essay Paper

The third module ‘The Nurse as a Leader, Teacher, and Healthcare Promoter’Learning is a lifelong process, as nurses we are teaching patients and families about their illnesses and treatments. Lastly, nurses are leaders and managers, and these roles will be explored. On this module I learned component of health promotion by investigating the objective of Healthy people 2020 and choose two topic ‘Diabetes and Hospital Associated Infection.’ Also able explore nurses responsibilities with focusing patient learning style to overcome barrier and issues on Diabetes and HAIs. NURS 3000 – Issues and Trends in Nursing Essay Paper

In the fourth module, founding on safety and emphasize in research with EBP (evidence-based practice) and its importance to nursing as a profession. On this module, I was able to select evidence based research articles in Catheter Associate Urinary Tract Infection (CAUTI) and wrote political letter to Texas House Representatives in regards to one current health issues in dignity of human life on demise fetus to cremate or burry. NURS 3000 – Issues and Trends in Nursing Essay Paper

Fifth Module, the importance of teamwork/ inter-professional teams, effective communication, change, and informatics. This week, the student will be utilizing effective strategies to implement a (potential) change within their workplace. Change is part of every one life, both planned and unplanned changes gives challenge. On this module learned importance of good rapport within the team to promote safety and reach the desire goal by exploring the change model framework, its steps and module with considering effective communication during change. NURS 3000 – Issues and Trends in Nursing Essay Paper

Module 6: Holistic, Cultural, & Spiritual Nursing

discussing the focus change from treating diseases to preventing diseases. Cultural and spiritual needs of a group should be incorporated into their healthcare planning. On this section, I learned more about culturally competent care including health issues and concern associated with particular culture. Also, learned nurses’ responsibility while providing to specific culture in regards to competent care and its important by choosing specific cultural group “Latino- Hispanic.’

https://classroom.aspen.edu/d2l/img/lp/pixel.gif NURS 3000 – Issues and Trends in Nursing Essay Paper

Module 7: Global Health and Violence

Focus on manage global disease and healthcare. Where discuss the recent Ebola scare within the United States and the influence of these organizations. Lastly, violence is something nurses encounter within the workplace. On this module, able to explored current global health issues in emerging new disease and health concern and nurses role in its management by researching articles in specific topics ‘Workplace Violence: Bullying and Active Shooter.’ Even though, most of shooting are not preventable, I learned common characteristic of shooter and important of drill and preparedness and how to respond crisis situation as a first responder that can help to lessen death of and the crisis situation. Also, I learned how to handle and confront in effective way if bullying occurs in workplace which is not supposed to happen in work place. NURS 3000 – Issues and Trends in Nursing Essay Paper

Module 8: Advanced Nursing Roles, Continuing Education, and the Future of Nursing, Evaluation: advanced nursing roles and the importance of continuing education for nurses and future utilizing IOM’s report. By exploring the small research on articles including Institute of Medicine report recommendation, on this module, I got opportunity to learn potential future role of nurses which are assuming different than present and past.

Conclusion

‘Issues and trends in Nursing’ online course is developed for student who want to continue their education and advance degree like RN to BSN. Current issues and trends considered in terms of their impact on roles and practice. Overall objectives of this course ‘Issues and Trends in Nursing’ is addressing to investigates nursing practice that is influenced by the impact of social issues and concerns which are related to economic, demographic, technological ethical, legal, and social. The potential change of nursing practice in response to societal changes will be discovered as well as the new opportunities these challenges have for career development. (ASPEN, 2017). Prior to enroll this course, I am not much aware about trends and issues in nursing. This course obligated to me study more and spend more time research many article regarding current issues and concern So, gave me opportunity investigate, research and learned in-depth about current issues and problem in nursing profession. Even though, the all assignments are equally important I choose module four assignment: to choose evidence based practice research article and write political letter to house representative provided me new experience to write political letter to house representative in current health issues that also affect in care and practice. NURS 3000 – Issues and Trends in Nursing Essay Paper

References

Aspen University. (2017). Syllabus N490: Issues and Trends in Professional Nursing. Retrieved from https://classroom.aspen.edu/d2l/le/content/21084/viewContent/876520/Viewhttps://classroom.aspen.edu/d2l/le/content/18914/viewContent/742879/View

Blais, K. & Hayes, J. (2016). Professional Nursing Practice Concepts and Practices (7th ed.). NJ: Pearson

Just decades ago, nurses were not required to wear disposable gloves when working with patients, syringes and catheters were reused and medical charts were handwritten. It took years before medical professionals recognized the connection between aseptic practices and disease management and sloppy handwriting and patient mortality. NURS 3000 – Issues and Trends in Nursing Essay Paper

Nursing management has changed over time as healthcare practices and regulations have evolved. The latest trends in nursing management include implementing technological advances, the need for a greater understanding of the population being served, and a renewed focus on quality-assurance practices. A study by the U.S. Department of Health and Human Services found the age 65 and older population is forecast to increase to 56.4 million people by 2020, which is nearly 18 percent over the 2015 rate. At the same time, the supply of nurses would only marginally increase, from the current 3.5 million to 3.95 million by 2020, or by about 13 percent. The shortage is compounded by the sharp increase in nurses expected to retire by 2020.

Students working toward an online Master of Science in Nursing (MSN) degree at Duquesne University are trained to manage the evolving and emerging roles in nursing. The MSN program builds on baccalaureate-level practices to prepare graduates for a comprehensive understanding of the field and strong leadership skills. NURS 3000 – Issues and Trends in Nursing Essay Paper

Medical professionals see the roles of nurses changing from exclusive caregivers to “roles in coordinating care from multiple providers, managing caseloads of patients with intense care needs, and helping patients transition out of hospitals and into the home or other settings,” experts from the philanthropic organization Roger Wood Johnson Foundation said.

“They are working as ‘health coaches’ and in other ways to prevent illness and promote wellness,” the organization stated. NURS 3000 – Issues and Trends in Nursing Essay Paper

Technology and Nursing Management
The fast-paced world of technology has dramatically changed the face of healthcare management with advancements that will require more input from nurses. Emerging technologies that will become vital to the field of nursing include:

Genetics – Scientists have found that major diseases, including heart disease, have strong genetic connections. Nurses need increased education about this connection to effectively counsel patients.
Less-invasive testing – Less-invasive testing, such as blood tests and scanning technologies, will require more input from nurses, thus greater education on the uses and implementation.
3-D printing – Usable 3D structures created with bio-ink, which contains living cells, are being used to create human tissue. Nurses who are educated in the field of 3D technology are better able to assist with patient understanding. NURS 3000 – Issues and Trends in Nursing Essay Paper
Carol Huston, director of California State University’s nursing program and author of a study published in Online Journal of Issues in Nursing that addresses emerging technology in nursing care, said nurse managers must respond to technological changes in lockstep.

Nurse managers who excel in emerging technology fields will be able to use technology, such as email, text messaging, and video conferencing, to communicate effectively with other medical professionals, Huston stated. Huston also mentioned that as nurses become masters at gathering and sharing information, they will ensure high-quality patient care. That care will be reflected by obtaining important patient information that could prove useful in genetic testing and therapies. NURS 3000 – Issues and Trends in Nursing Essay Paper

Cultural competence and nursing management
The rich cultural mix of the U.S. population includes people from around the world, bringing varied traditions and practices. The nation’s increased diversity, coupled with shifting socioeconomic factors, has brought greater attention to cultural competence in healthcare – that is, the ability of healthcare professionals to effectively meet cultural, social, and linguistic needs for effective patient/caregiver interactions.

Cultural competence is aimed at changing public health practices through widespread education and training. Cultural competency barriers include stereotyping, racism, and prejudice. NURS 3000 – Issues and Trends in Nursing Essay Paper

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“The goal in cultural competence education is to increase public health professionals’ cultural awareness, knowledge of self and others, communication skills, attitudes, and behaviors. Part of this process is confronting stereotypes because many students entering public health have minimal experience with ethnic minorities,” the Institute of Medicine’s Committee On Educating Public Health Professionals For The 21st Century stated in its “Who Will Keep the Public Healthy?” study. NURS 3000 – Issues and Trends in Nursing Essay Paper

Experts recommend nurse managers guide fellow nurses to make changes to advance cultural competence, including:

Addressing patients with respect, using last names or asking how they wish to be addressed.
Never making assumptions about cultural beliefs or habits.
Involving patients in their own healthcare by asking questions.
Learning more about the changing cultural demographics in the United States.
“We’re not going to be effective if we’re not responsive to different cultural groups,” stated Rosemarie Taylor, EdD, RN, BSN, MA, and director of education and development at Jackson Health System in Miami. “There are different values, beliefs, and assumptions, and the benefit of incorporating these values and beliefs is more effective patient care.” NURS 3000 – Issues and Trends in Nursing Essay Paper

Aging and Nursing Management

Thanks to advances in technology and public health, people are living longer than ever. In the United States, the average life expectancy is 78.8 years. By comparison, in 1970, the average life expectancy was 70.8 years. This aging population requires a well-trained workforce that is able to meet the complex healthcare needs of the elderly.

An estimated 90 percent of adults age 65 and older have one or more chronic conditions that must be managed by a coordinated care team, but finding providers to offer such assistance is problematic. Many practitioners say the federal healthcare program Medicare has become increasingly difficult to navigate and is slow to pay medical bills, “so those who specialize in caring for older adults often earn less than their colleagues in other disciplines,” the Eldercare Workforce Alliance reported. At the same time, few practitioners specialize in the treatment of the elderly because their needs are complex. NURS 3000 – Issues and Trends in Nursing Essay Paper

Nursing’s Role in Quality Assurance
Quality care and practices largely depend on nurses, often the most visible component of any healthcare institution. Quality-assurance nurses protect patient health and safety by following standards set by state laws and their practicing institutions. Quality-assurance nurses ensure facilities follow standards set by The Joint Commission, an independent non-profit that accredits and certifies nearly 21,000 health care organizations nationwide. QA nurses review incident reports and ensure patient and staff safety. In some cases, they research the credentials of staff medical professionals who require a license or certification. They also review programs to increase the quality of care and define measurable outcomes. With technological advances that require less human interaction, it has become increasingly important to have quality-assurance nurses to oversee healthcare practices. NURS 3000 – Issues and Trends in Nursing Essay Paper

About Duquesne’s Online Master of Science in Nursing (MSN) program
The Duquesne University School of Nursing is top ranked in U.S. News and World Report’s 2017 Best Online Graduate Nursing Programs. The MSN program offers three areas of specialization: Forensic Nursing, Family (Individual Across the Lifespan) Nurse Practitioner, and Nursing Education and Faculty Role. For more information, visit DU’s MSN program website. NURS 3000 – Issues and Trends in Nursing Essay Paper

Sources
U.S. Department of Health and Human Serviceshttps://aoa.acl.gov/Aging_Statistics/Profile/index.aspx
Georgetown University https://cew.georgetown.edu/wp-content/uploads/Nursing-Supply-Final.pdf
Robert Wood Johnson Foundation http://www.rwjf.org/en/library/articles-and-news/2015/01/nurses-take-on-new-and-expanded-roles-in-health-care.html
The Impact of Emerging Technology on Nursing Care: Warp Speed Aheadhttp://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Emerging-Technology.html#Huston
Centers for Disease Control and Preventionhttps://www.cdc.gov/nchs/products/databriefs/db267.htm
Institute of Medicine Committee on Educating Public Health Professionals for the 21st Centuryhttps://www.ncbi.nlm.nih.gov/books/NBK221190/#ddd00056
Cultural competence for the diverse. NURS 3000 – Issues and Trends in Nursing Essay Paperpopulationhttp://www.strategiesfornursemanagers.com/content.cfm?content_id=219609&oc_id=602
Eldercare Workforce Alliance https://eldercareworkforce.org/research/issue-briefs/research:qanda/
Nursing is always changing—sometimes quickly, sometimes slowly. It’s helpful to step back once in a while and look at of some of the biggest developments in the field to know what’s ahead so you can be prepared to face new challenges and continue to thrive in your nursing career.

More Outpatient Care

Outpatient care is in demand due to a number of factors, including pressure to keep down costs and more effective technologies and treatments that have eliminated the need for overnight hospital stays. Financial constraints, such as high insurance deductibles, have also caused many patients to put off elective procedures. However, these patients often still require extensive medical attention, hence the need for more outpatient facilities and care. Nurses will also find opportunities in outpatient settings such as ambulatory care clinics, rehabilitation centers, and clinics attached to assisted-living facilities, and even telehealth providers. NURS 3000 – Issues and Trends in Nursing Essay Paper

The Importance of Cultural Competency

At its core, health care is about people, and different people have different needs. That has never been more true in the U.S. health care system than today, when nurses are helping individuals, families, and groups from ever more diverse backgrounds. Nurses who are who are sensitive to the cultural habits, traditions, and beliefs of their patients will be able to provide care that takes these into account. For example, some patients may speak English as a second language, affecting their understanding of directions or medical terminology; patients from certain religions may have dietary restrictions; and some individuals come from cultures where they fare best when they are surrounded by family rather than isolated in a hospital room. NURS 3000 – Issues and Trends in Nursing Essay Paper

Preventive Health

Wellness continues to be a growing issue in health care, especially as organizations move to keep costs down as they improve outcomes. Patients are becoming savvier about maintaining their own wellness, from modifying their diets to wearing trackers that measure their activity levels. Nurses can help by focusing on measures to prevent chronic illnesses such as diabetes, slow down or mitigate the effects of aging on the body via exercise, and improve overall wellness—as well as by educating patients about what further steps they can take on their own to improve their health. NURS 3000 – Issues and Trends in Nursing Essay Paper

Increasing Consumer Sophistication

Patients are also extremely knowledgeable about where to turn for health information, often doing their own research on the Internet. Consequently, patients may come to appointments with their own possible diagnoses and suggested treatments and medications. Such awareness can be as potentially harmful as it is helpful, forcing nurses to sort through possibly flawed information and incorrect assumptions as they perform health assessments. NURS 3000 – Issues and Trends in Nursing Essay Paper

The Rise of Nurse Informatics

As technology produces more data, supports better record keeping, and allows for detailed analysis, health informatics has become increasingly important in health care. Similarly, nurse informatics can support evidence-based nursing practice and improved patient care through better data collection, information analysis, easier and faster collaboration between health care professionals, and identification of both large- and small-scale health and patient trends. As they are situated on the front lines of patient care, nurse informaticists are especially suited for playing a greater role in health care planning and decision-making. NURS 3000 – Issues and Trends in Nursing Essay Paper

Nurses with higher education levels are better prepared to meet the fast-moving and frequently challenging nature of health care today. The online RN to Bachelor of Science in Nursing and online Master of Science in Nursing at the University of Saint Mary provide you with the nursing knowledge and critical-thinking skills required to succeed in today’s nursing environment. To find out more, request more information or call us at 877-307-4915 to speak to an admissions advisor.

Sources

“Hospitals Face Closures as ‘A New Day in Healthcare’ Dawns,” Modern Healthcare, February 21, 2015; http://www.modernhealthcare.com/article/20150221/MAGAZINE/302219988

“3 Nursing Trends to Expect for 2016,” Elsevier, December 17, 2015,

http://www.confidenceconnected.com/blog/2015/12/17/3-nursing-trends-to-expect-for-2016/

“What Nurses Can Expect for 2016,” Nurses Lounge, January 5, 2016,

http://www.nurseslounge.com/home/what-nurses-can-expect-for-2016/

“Current Trends in Nursing,” Supplemental Health Care, May 10, 2016,

http://blog.supplementalhealthcare.com/patient-care-forum/current-trends-nursing-2016 .NURS 3000 – Issues and Trends in Nursing Essay Paper

There is a consensus on the fact that there has been a significant increase in traffic to emergency rooms which has resulted in rapidly growing demand on the limited resources of emergency rooms worldwide. In 1980, there were more than 82 million visit to hospital Emergency rooms in the USA, and a large percentage were for non urgent medical conditions. One reason for this trend is that people know they can get medical attention immediately in the Emergency departments without the long wait for appointments. This has led to very high load of patients visit to emergency rooms; a pattern that holds true globally for non urgent patient visits to most pediatric emergency rooms ( Wilson FO etal ).

Another reason given for overcrowding is the increase rural to urban migration of populations and also the increase in the standard of care provided in most emergency room.

However, the resulting increase in demand for emergency medical care has not been matched by availability of resources in most healthcare systems and hence there is need for emergency room managers to adopt or develop tools and protocols to prioritize the urgency and acuity of conditions to allocate appropriate level of care. If this is not done, then there is a likelihood that very ill patients may end up waiting long hours with increased risk of morbidity and some may even die as a result of delay in life saving treatment or interventions. (Mirjam van veen and Harriette a Moll). NURS 3000 – Issues and Trends in Nursing Essay Paper

DEFINITION

Triage as a term actually originates from the French verb ‘trier’, which translates ‘to sort’. It was originally used by the military as a concept to deal with large number of casualties managed by very few human and material resources. The decision is made to prioritize who had the best chance of survival, and what level of care for the survivors (LE Slay,WG Rislan ). NURS 3000 – Issues and Trends in Nursing Essay Paper

In the last 20 years, this concept has become applicable in response to the increasing traffic to the emergency rooms and several tools have been developed to assess, prioritize and sort patients coming to the emergency department according to a determined severity of illness or injury, the level of suffering, the likely prognosis and need for intervention with available resources.

It must be clarified, that triage in itself is not a diagnostic tool but a systematically structured and methodical way of assessing the severity of patients’ conditions to determine their clinical priorities using their presenting symptoms and measurable physiological parameters and it aims to optimize the provision of emergency care efficiently to produce the best outcome for every patient by channeling patients to appropriate level and quality of care. NURS 3000 – Issues and Trends in Nursing Essay Paper

Hence the factors that are considered are severity of illness, level of urgency and impact of life saving intervention to reduce mortality, as well as level of care needed baring limited resources. These factors can be measured objectively using mortality rate, number of admissions to critical care unit and wards as well as patients referred to low urgency care services.

The development of different assessment scoring systems and other pediatric-specific scales were attempts to have an objective approach to the assessment of severity acuity and to help predict illness or injury outcomes in children. Hence the Pediatric Glasgow Coma Scale, the Yale Observation Scale, the Pediatric Trauma Score, the PRISM score (Pediatric Risk of Mortality score), different pain scales and various respiratory severity scoring systems were all attempts to provide common nomenclature and standardize the assessment of severity of sickness and to predict prognosis in the pediatric age group. NURS 3000 – Issues and Trends in Nursing Essay Paper

However in practice the emergency room triage nurse needs a comprehensive, simple and efficient acuity stratificaton of the severity, to make rapid and effective decisions(Dieckmann, 2002). These led to development of various decision making tools or triage scales.

Gerber Zimmerman and McNair had tried to described triage as simply a rating of patients clinical urgency, that eventually evolved into 2 levels of urgent, and non urgent.

Triage scales are hence developed with the aim to rapidly identify very urgent cases requiring immediate or urgent life saving treatment, or efficiently direct them to appropriate level of care, and the variations of triage scales are due to functional differences in service provision as well as availability of resources.

Though there is no fail proof scale of stratification because invariably cultural adaptations, level of sophistication of data collection, personal and environmental factors do influence every measurement tool. (Christ et al 2010 as per Azeredo et al). NURS 3000 – Issues and Trends in Nursing Essay Paper

Fittzgerald in his doctoral thesis in 1989, showed it is actually a far more complex decision making tool using defined criteria to classify patients as either a simple 3, 4 or 5 level urgency scale, pioneering the objective distinction of the earlier urgency scales(Fitzgerald GT. Emergency department triage. Department of Medicine. Queensland, Australia: University of Queensland,

1989.)

TRIAGE IN CHILDREN

Laskowski-Jones and Salati (2000) had strongly elucidated that children should not be seen as ‘little adults’ and must not be treated as such by healthcare professionals. This is because of obvious anatomical, physiological, as well as emotional and intellectual differences between children and adults which directly alter the presentation of this group of patients in the emergency department[Laskowski-Jones]. NURS 3000 – Issues and Trends in Nursing Essay Paper

This makes it inapplicable to use adult triage criteria for children of pediatric age due to unique clinic-pathological characteristics that creates the potential for sudden and rapid deterioration when children present to the Emergency department, creating an absolute necesity for very accurate focused triage. There are evidence that in mixed emergency departments, adults tend to ‘be seen earlier than equally ill children resulting in unacceptable waiting times for very ill children, therefore again creating a need for specific pediatric triage scales.(Cain P, Waldrop RD, Jones J; improved pediatric patient flow in a general emergency department by altering triage criteria. Acad Emerg Med 3:65-71, 1996) NURS 3000 – Issues and Trends in Nursing Essay Paper

The UKs Manchester Triage Systems MTS, the USAs Emergency Severity Index ESI, the Canadian Triage and Acuity Scale CTAS, and the Australian(National ) Triage Scale, the most widely used triage scales and by consensus the most studied were all eventually modified to contain specific parts for children, are all also made of five level of triage urgencies (van Veen and Moll)

It is important to note that none of them had been developed ‘de novo’ specifically for the pediatric age group.

The initial three-level systems which predominated in the United States typically used either levels 1, 2, and 3 or emergent–urgent–nonurgent classification assignments. These methods are driven by the underlying question, ‘‘How long can patients wait?’’ When evaluated, these three-level methods had been found to be highly unreliable and have been criticized because they lack validation with clinical outcomes. (Travers DA, Waller AE, Bowling JM, Flowers D,). NURS 3000 – Issues and Trends in Nursing Essay Paper

The 5-level scales provided a better discriminated tool for pediatric patient triage in emergency department, which was shown to be more efficient in predicting resources utilizations including hospital admissions, length of stay, and resourse utilization.(Chang, Hsu)

Though 5-level scales are similar to the adults, but they have pediatric clinic-pathological parameters.

Level 1 is critical, level 2 is emergent, level 3 is urgent, level 4 is non-urgent and level 5 is fast track.(O’Neil KA, Molczan K: Pediatric triage: a tier, 5-level system in the United States. Pediatr Emerg Care 19:285-290, 2003)

The MTS is a five-level scale that incorporates the UK National Triage Scale. It was developed in 1996 and then revised ten years later after thorough input by various experts.(Mackway-Jones et al 2006). Though it was designed predominantly for adults, the MTS eventually adapted six flow charts that relate specifically to children and hence in 2007 it became endorsed by the Royal College of Pediatrics and Child Health. NURS 3000 – Issues and Trends in Nursing Essay Paper

WHAT IS ALREADY KNOWN?

What is already established is that the true functional capability of an effective triage system is determined by their reliability and validity.

Reliability is measured as both inter rater reliability which is a measure of the agreement between two or more separate individuals using the same scale. It is an affirmation that the agreement is beyond that presented by chance, and this can be statistically determined and analyzed using Cohen’s kappa k. Where K is equal to 1 if the raters are in perfect agreement, and K is equal to 0 if their agreement is absolutely by chance. So k is rated from 0.1-0.9 ( as poor to excellent agreement). Intra rater reliability measures the agreement of one triage rater agreeing on the same level of urgency when two different cases of same scenario present on separate occasions. NURS 3000 – Issues and Trends in Nursing Essay Paper

Validity is a determination that a conclusion of a true urgency is in fact the true value for every clinical presentation. Whereas internal validity measures of the ability of the triage system to predict this true urgency within a system, external validity measures its reproducibility in a different setting.

Hence experts agree that any triage has to have these characteristics to be seen as a legitimate tool of assessment and to perform as intended [Fernandez C].

It is also known that the four major triage scales, the MTS, ESI, CTAS, and ATS have been studied and validated for both internal validity and reliability in adults and have been used in ED triage by different health institutions. NURS 3000 – Issues and Trends in Nursing Essay Paper

Some studies reported that the MTS and the Pediatric-CTAS both seem to be valid and reliable to triage children in pediatric emergency care. (Ma, Gafni and Goldman)This has been confirmed by van Veen and Moll in another review in 2009.

The CTAS enables rapid stratification of patients at the time of first encounter based on 5 levels of urgency (risk and symptom severity). Each level has a targeted waiting period until the patient is examined by the doctor or to be reassessed again in the triage area to consider the possibility of waiting longer or to be seen immediately by the physician. NURS 3000 – Issues and Trends in Nursing Essay Paper

The standards recommended by CTAS is that waiting time is 0 minutes for level 1, 15 minutes for level 2, 30 minutes for level 3, 60 minutes for level 4, and 120 minutes for level 5. (Murray M, Bullard M, Grafstein E; CTAS National Working Group; CEDIS National Working Group. Revisions to the Canadian Emergency Department Triage and Acuity Scale implementation guidelines. CJEM 2004, 6: 421-427.) NURS 3000 – Issues and Trends in Nursing Essay Paper

Healthcare associated infections develop in a patient as a result of their exposure to healthcare facilities or procedures. They include methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), C. difficile and other infections caused by bacteria and viruses encountered in healthcare facilities (CUPE, 2009). Hospital acquired infection can result in prolonged or permanent disability and some hospital acquired infections prove fatal (Taylor, Plowman, & Roberts, n.d.).The rates of these hospital acquired infections in the acute care setting have increased especially in Alberta. For example, in 2007, a preliminary surveillance report on MRSA in patients from 47 Canadian acute-care sentinel hospitals found that the MRSA rate was 8.62 per 1000 admissions (AHW, 2011). Also, since reporting began in 1999, a cumulative total of 1,241 VRE infected cases were reported to the Public Health Agency of Canada (Agency) through December 31, 2011 (PHAC, 2013). With the incidences of these super-infections occurring in the acute care setting, the health of the individuals being admitted in the hospital is further placed at risk. The individuals at risk include mostly children and the elderly. According to the population projections of the Alberta Treasury Board and Finance (2013), the number of Albertans aged 80 years and older would more than triple from the current level of about 115,000 in 2012 to over 383,700 by 2041 (p. 3). This means that more and more elderly individuals will be at high risk for infections such as MRSA which according to the report by AHC (2011), have infection rates highest in the elderly (70 years and older). Acquiring infections in the acute care setting can have a great impact on the affected person’s life. This might mean he can no longer go to work while being treated in the hospital which would mean financial losses which not only affect the individual, but also his family. Furthermore, treating super infections in a hospital care setting can significantly impact the country’s economy. A survey of Canadian hospitals (reported in 2000) estimated the direct costs of hospital acquired infections in Canada to be approximately $1 billion annually. In 2007, MRSA alone was estimated to be costing Canada’s healthcare system $200-250 million per year (CUPE, 2009). NURS 3000 – Issues and Trends in Nursing Essay Paper

Identifying Solutions to Prevent Super-infections

Super-infections can be costly to treat and most often than not, prove fatal for the individuals afflicted with such. However, over the years, methods have been developed to further prevent individuals admitted to in an acute care setting from contracting such infections. Such methods involve adding more healthcare cleaning and infection control staff with proper training. Knowing how to deal with a situation where infection occurs can greatly reduce the risk of certain infections from spreading further among individuals in an acute care setting. Hospitals in Canada and Europe have demonstrated that investment in more cleaning and infection control staff, training and workforce stability has brought infection rates down (CUPE, 2009). Most infections acquired in the acute care setting can be transferred through direct contact. It can either be direct contact with an infected individual or an object that has come into contact with an infected individual. Transfer of infectious bacteria can be prevented through proper hand washing. Hospitals nowadays tend to have hand sanitizers placed strategically over the entire hospital. While antimicrobial soap and water are still recommended for hands that are visibly soiled or have been exposed to bodily fluids, alcohol-based gels or rubs are now preferred for routine decontamination of hands after most patient contact. These products rapidly kill bacteria and most viruses, and actually are gentler on the hands than repeated use of soap and water (IHI, 2012). The nurse’s role is to educate, not only the individuals being admitted into an acute care setting, but also the visitors coming in and out of the hospital to wash their hands properly. NURS 3000 – Issues and Trends in Nursing Essay Paper

Nursing Care Plans

There are three nursing care plans that were drafted from this scenario which may apply to potential high risk individuals involved. First nursing diagnosis is an actual problem, fear/anxiety (see Appendix A for a breakdown of the care plan). Second nursing diagnosis is a potential problem, risk for infection (see Appendix B for a breakdown of the care plan). The last nursing diagnosis is an educational need, knowledge deficit (see Appendix C for a breakdown of the care plan). NURS 3000 – Issues and Trends in Nursing Essay Paper

Conclusion

Preventing the spread of super-infections involves team effort. Not only is this limited to the health care workers, but also extends to families and visitors in an acute care setting. The addition of more staff that are trained and knowledgeable in dealing with infection prevention certainly helps keep such infections at bay. Most of these infections are acquired through direct contact; therefore, proper hand washing should be performed before and after coming into contact with an individual or any object that is present in the hospital. Not only will it reduce the risk of contracting a super-infection towards oneself, it will also prevent the spread towards other individuals. NURS 3000 – Issues and Trends in Nursing Essay Paper

Improvement of healthcare delivery in the United States relies on many factors, such as effective nurse advocacy through politics, policy, and professional associations. But advocacy depends on the ability to fully understand current issues, systems, policies, and related contexts. In this course, students engage in a systems-level analysis of the implications of healthcare policy on issues of access, equity, affordability, and social justice in healthcare delivery.

Through policy analysis assignments students apply legislative, regulatory, and financial processes relevant to their organization and provision of healthcare services in their community. Students consider the impact of these processes on quality and safety in nursing practice environment and disparities in the healthcare system. NURS 3000 – Issues and Trends in Nursing Assignment.Through this course, students gain the knowledge and skills needed to advocate for vulnerable populations and promote positive social change.

In addition to an increasing aging population, another trend is the increase reliance on informatics. The incorporation of technology into the healthcare arena may be a challenge for many nurses. The inclusion of the digital medical record has assisted facilities in providing for a more streamlined, accessible, and accurate health history. There also continues to be variation among facilities in the initiation of informatics leading to a lack of consistency from facility to facility. NURS 3000 – Issues and Trends in Nursing Assignment.However, it is important to recognize that not all nursing professionals possess the necessary computer literacy skills needed for proficiency in understanding and utilizing informatics, especially those nurses that have been in the nursing profession for quite some time. This leads to consideration of the fact that many nurses are retiring without the numbers to replace them.

The current nursing shortage is impacted by the high number of nurses that are of retirement age coupled with the lower number of new nursing graduates. Contributing to the nursing shortage is the current nurse faculty shortage. A shortage in those nurses with advanced degrees and the ability or willingness to enter academia affects the ability of institutions of higher learning to educate more nursing students. In 2010, nursing schools denied admission to over 75,000 potential students due to a lack of adequate nursing faculty [2], without new graduates to replace retiring nurses, the burden of providing patient-centered care rests on the shoulders of those left at the bed-side. A nursing shortage then contributes to nurse fatigue and burnout, the potential for medical errors and compromised patient safety, and poor patient outcomes.

In terms of patient outcomes, the nursing profession has seen an increased emphasis on integration of evidence-based practice. The incorporation of best practices into nursing care has contributed to the individual nurse claiming more ownership in the achievement of positive health outcomes for patients. Nurses are now responsible for being a direct line in the conducting, reporting, and implementation of research. NURS 3000 – Issues and Trends in Nursing Assignment. Most importantly, this responsibility has led to a paradigm shift in the way nursing is viewed. No longer is nursing viewed as task oriented discipline content on taking orders within the medical hierarchy. Nursing can now be considered a science; contributing to the research and discovery of new and innovative approaches to improving health outcomes.

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As nursing continues to evolve, so does the current healthcare environment. Affected by a multitude of factors, nursing will forever be in a constant state of flux. Trends can be both negative and positive. Whether it is the changing face of the populations for which nursing cares for, a rapidly changing technological environment, nurse/faculty shortages, or an emphasis on evidence based research, nursing is up to the challenge and will forge ahead with vigor and accountability.

N URSING education is undergoing,
drastic changes. History repeating herself through a new social expression has kept consistently in step
with the development and progress in
related fields of life activity. The demand today for a different preparation
for the nurse, general and professional,
is a demand not of the idealist but of
the times. NURS 3000 – Issues and Trends in Nursing Assignment.
It is hardly necessary to trace the
evolution of nursing practice from an
age-old emotional expression in response
to human suffering to the present-day
three-dimensional demand that adds to
succor the technics required for curative medicine and a program of health
education for nursing in relation to
preventive medicine-the third immeasurably extending the scope of
activity and the social contribution of
the profession.
It is said that the Americans have
no plan. This I question. Consciously
and unconsciously, Americans are adhering to the slow but sound democratic
principle of social growth and development, namely, education of the entire
population as the sine qua non of
efficient citizenship, the cornerstone of
which is physical fitness.
In no country are there greater opportunities for the realization of the
“American dream-that belief in the
right and possibility of a better life for
all.” Institutions of higher education
open wide doors through which, in ever
increasing numbers, the youth of the
country seek fullest preparation for
their chosen life activity, and throughout the country highly equipped health
and social organizations and institutions
offer almost unlimited opportunities,
and enough graduates of the varied
types of social worker to provide the
personnel demanded for adequate care
and direction of the people, and for
the instruction and practical experience
of students in their related fields. NURS 3000 – Issues and Trends in Nursing Assignment.
The opportunity of the nurse in the
field of health education is now generally conceded, and for such function,
emphasis has been laid on the preparation of a special group designated as
public health nurses. Financial provision, however, for the practice of this
group, either by private philanthropy or
governmental appropriation, is entirely
inadequate to meet the needs of the
population, whether rural, urban, or
suburban. Approximately 20,000 public health nurses are now engaged in a
field that 100,000 would not adequately

NURSING EDUCATION
that might be made in the field of preventive medicine by this numerically
strongest division of health workers,
through a curriculum shaped not for a
selected group but for the entire profession.
That courses in the newer sciences,
sociology, psychology, psychiatrv, as
well as in the physical sciences, are
essential for this wider interpretation of
practice, either as prerequisites or in the
professional curriculum, is not open to
question. The content of such courses
in their application to the particular
field requires much study and experimentation. The same may be said of
the various branches of clinical medicine, some experience in each of which
is of utmost importance if the practice
of the nurse is to extend through the
field of curative medicine into that of
preventive medicine, as it obviously
should, since the opportunity of this
practitioner for health education through
her intimate and sometimes prolonged
association with the patient and the
family equals, may even exceed, that
of the public health nurse. NURS 3000 – Issues and Trends in Nursing Assignment.
This expansion of function in half
a century of organized existence presents a problem of curriculum readjustment greatly complicated by the conditions governing schools of nursing.
The first schools in this country, established on the Nightingale plan, were
conceived as separate units, though
closely allied to the institutions providing a practice field. The profession,
however, early lost its integrity and educational freedom by the establishment
throughout the country of these schools
as integral departments of the hospitals-with the asset of assured support, but the predictable result, in large
measure, and in many cases entirely, of
the subordination of the educational
program to the needs of the nursing
service rendered by the student body.
The values accruing, despite the palpable defects of the educational program, are recognized, but the insistent
and increasing demands from the
rapidly developing field of public health
for nurses equipped to meet the health
as well as the sickness needs of the
community could not be disregarded. NURS 3000 – Issues and Trends in Nursing Assignment.
The League of Nursing Education, therefore obtained a grant from the
Rockefeller Foundation that made possible the first study ever undertaken,
which was directed by Josephine Goldmark, in cooperation with a representative committee of which C.-E. A.
Winslow, Dr.P.H., was chairman. The
findings were published in 1921 under
the title ” Nursing and Nursing Education in the United States.” Originally
conceived as a study of the supplemental
subject matter required for public health
nursing, a superficial survey of the
undergraduate courses left no question
as to the need of a searching investigation of the basic professional preparation. It was determined to extend the study to include the courses offered in 15 selected schools. NURS 3000 – Issues and Trends in Nursing Assignment.
This study, a classic that will stand the test of time, was shortly followed by a more comprehensive undertaking, the purpose of which was indicated by
the designation of the advisory body as the Grading Committee. Again the
problems involved deflected the original intent into other channels. The first
report, prepared by Dr. Burgess, a highly qualified statistician, was entitled ” Nurses, Patients, and Pocketbooks.” This presented to an astonished public a yearly outpouring from 2,000 schools of nursing of a graduating body that had already brought the ratio of nurses to population in some states
as high as 1 to 300, and that would multiply by compound interest to an
astounding figure in a comparatively few years. The report further presented the low level of general education; inadequate teaching facilities as
expressed in the number and preparation of instructors; theoretical and

AMERICAN JOURNAL OF PUBLIC HEALTH
clinical content of curriculum and teaching equipment; and other factors
bearing directly or indirectly on the preparation of workers for a field of
acknowledged social importance. Under the caption ” Nursing Schools
Today and Tomorrow,” the Grading ommittee published in 1934 a report
on its further findings, but did not feel it possible to fulfil the complex task. for which it was created. It is a
reasonable question whether, without changes acknowledged as essential but far from achieved, grading or accrediting of the schools on so unstable a basis as now exists is advisable, despite the
obvious need of reliable information for candidates. The National League of Nursing Education, through its
Standards Committee and in conference with experts in education, medicine,
and nursing, is studying the problem and will undoubtedly develop a plan which will clarify the situation through some form of classification.
The influence of these reports was evidenced by a steady decrease in the number of schools, and the advancement of the educational requirement for admission to completion of high school,
reported as 90 per cent in the second and last publication of the Grading
Committee.
concurrently with the studies of the
Grading Committee in this country,
studies of nursing and nursing education were conducted in England by the
Lancet Committee, and in Canada,
under the supervision of the Canadian
Medical Association and the Canadian
Nurses Association, by G. M. XVeir,
Professor of Education in the University of British Columbia. The latter
brought out the most comprehensive,
sympathetic, and constructive discussion
of the subject that has yet appeared. NURS 3000 – Issues and Trends in Nursing Assignment.
It is not necessary to discuss in detail the defects revealed in the present
system of nursing education. The
number of schools still existing, approximately 1,500, is suggestive of the
situation, without the very definite evidence of inadequate instruction, inadequate clinical experience, and hours of
physical and mental output generally
conceded as detrimental to health-in
short, an educational interpretation
out of step with present-day social conditions, educational methods, and scientific conclusions.
Through these several studies the
profession now has a foundation of
facts and analyses upon which to base
future plans and programs, and through
which the values intrinsic in the traditional type of nursing education may not be lost, but deepened and
broadened by the vitalizing current of
scientific findings bearing on the human
organism. NURS 3000 – Issues and Trends in Nursing Assignment. To these studies also must
be attributed the very definite tendency
to effect connections between schools
of nursing and institutions of higher
education. NURS 3000 – Issues and Trends in Nursing Assignment.
This trend in the United States
toward a higher level of general education and a more comprehensive professional preparation, supported by the
unequivocal pronouncement of the
Canadian Survey of Nursing Education,
and the trends in several countries on
the European Continent, leave little
question as to the ultimate release of
the hospitals from a burden that should
never have been imposed. The curriculum. in preparation for nursing in
the new- field of preventive medicine
demands that these schools find their
place in the educational system of the
country, and that as definite a relation
to the institutions of higher education
is imperative as obtains for the allied
branches of medicine, nutrition,
pharmacy, dentistry, and social service.
No less than for the education of the
community should the State assume responsibility for its health. Privately
endowed or supported schools or departments would still continue but, as in the
case of other professional and voca766 Aug., 1936
NURSING EDUCATION
tional courses in these institutions,
tuition fees would be required, while
working scholarships, as in other
branches of the arts and sciences, could
and should be made available for desirable candidates during their clinical
and field experience. NURS 3000 – Issues and Trends in Nursing Assignment.
Though as early as 1910 the University of Minnesota had authorized the
establishment of a school of nursing as
a department of the School of Medicine,
this control, unfortunately, hardly less
than that of the hospital, subordinated
the students’ program of study to the
demands of the affiliated hospitals for
nursing service. Had the principles and
provisions clearly defined by Richard
Olding Beard, M.D., to whose vision
this step was attributable, been adhered to, the university relationship
would have had even greater significance, for it would have established
as essential for sound practice the right
of schools of nursing to the academic
freedom accorded other professions in
the development of their program of
study, and through the provision of an
adequate graduate nurse staff for the
affiliated hospitals, insured the student
the educational value of the clinical
experience. NURS 3000 – Issues and Trends in Nursing Assignment.
In 1934 the League of Nursing Education published a list of 136 schools
connected with universities. It is understood that 165 of the 400 Catholic
schools of nursing are affiliated with
Catholic colleges. In many cases, both
from the academic and professional
standpoints, the connection is but in
‘name. While a number of schools
have been accepted as integral units
of universities or colleges, the variations in the entrance requirements and
the professional curriculum are great.
For instance, 2 university schools require a Bachelor’s degree from an accredited college for the basic course
which leads to a degree of Master of
Nursing; a number of the schools require 1 or 2 years of college work for
admission’ while others still adhere to
the completion of 4 years of high
school.
Highly desirable as is the movement,
the effecting of the connection of
schools of nursing with institutions of
higher education calls for study and
direction, and to meet this demand the
Association of Collegiate Schools of
Nursing was recently created, the objects of which, as set forth in the constitution, are as follows:
1. To develop nursing education on a professional and collegiate level
2. To promote and strengthen relationships
between schools of nursing and institutions of
higher education
3. To promote study and experimentation
in nursing service and nursing education
In order to extend its usefulness as
widely as it consistently could, provision was made by the Association for
two classes of membership, active and
associate. Briefly stated:
Active membership is open to an accredited school of nursing established
as a constituent part of an accredited
college or university. NURS 3000 – Issues and Trends in Nursing Assignment.
Associate membership is open to accredited schools of nursing, the curricula of which meet the standards set
by the Association of Collegiate Schools
of Nursing, and that maintain a relationship with accredited colleges or
universities through which their resources and facilities are available for
the students.
This association, now accepted as a
constituent member of the American
Council on Education, has on its list the
following schools and departments of
nursing:
ACTIVE MEMBERS OF THE ASSOCIATION
OF COLLEGIATE SCHOOLS OF NURSING
Skidmore College School of Nursing, Saratoga, N. Y.
Yale University School of Nursing, New
Haven, Conn.
Catholic University Department of Nursing
Education, Washington, D. C.
1, ol. -96 767
AMERICAN JOURNAL OF PUBLIC HEALTH
George Peabody College for Teachers, Department of Nursing Educaticn, Nashville,
Tenn.
St. Louis University School of Nursing, St.
Louis, Mo.
Syracuse University, Department of Public
Health Nursing, Syracuse, N. Y.
Teachers College, Columbia University, Department of Nursing Education, New York,
N. Y.
University of Oregon, Department of Nursing Education, Portland, Ore.
University of Virginia, School of Nursing
Education, Charlottesville, Va.
Washington University School of Nursing,
St. Louis, Mo.
Simmons College School of Nursing, Boston,
Mass.
University of California School of Nursing,
Berkeley, Calif.
University of Washington School of Nursing, Seattle, Wash.
Vanderbilt University School of Nursing,
Nashville, Tenn.
Western Reserve University School of
Nursing, Cleveland, Ohio
ASSOCIATE MEMBERS
Duke University School of Nursing, Durham, N. C.
Rochester University School of Nursing,
Rochester, N. Y.
St. Louis University School of Nursing, St.
Louis, Mo. NURS 3000 – Issues and Trends in Nursing Assignment.
University of Michigan School of Nursing,
Ann Arbor, Mich.
University of Oregon, Department of Nursing Education, Portland, Ore.
Washington University School of Nursing,

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St. Louis, Mo.
Be the selected field of her practice
where or what it may, every nurse
needs, as an individual, as a citizen,
and as a practitioner of vital social importance, a liberal education in the
fullest interpretation of the term. It
is frequently asserted that so prolonged and comprehensive a preparation is not justified by the rewards in
nursing as expressed in financial returns,
satisfactions accruing through the services rendered, and the hours of physical
output. To all these arguments the
reply, based on any study of human
responses, should be that the higher
educational level, through the stimulation of the social and physical sciences,
brings an inquiring and resourceful
mind to the task-a type of mind that
” seeing that which is invisible ” overlooks-often too greatly overlooksconditions that early become unbearable to the arid mind of the mechanized
product of a program of education that
limits knowledge to the required technics. The stultifying influences of the
sometimes unpleasant procedures, repetitive almost to the point of revolt,
can only be overcome by an interest
and purpose that holds the attention
above the drudgery of the means
through which the desired end must
be achieved.
But is there any life activity of which this is not the case? Furthermore, in any activity in which science is concerned-and there are few in which it
is not-these very procedures often assume undreamed of significance. The failure to admit the desirability of a scientifically oriented individual for the part assigned the nurse-this connecting
link between the investigator and the organism with which they are mutually concerned-is difficult to understand in the light of present-day scientific knowledge and social conditions.
In view of the unemployment of the country’s greatest asset, her youth,
now expressed in millions; the unemployed qualified teachers; the unemployed graduate nurses; and the
ever shortening span of working years; there is little excuse for the failure to require for all workers a program of education through which the country may be better served, and their own lives enriched. In the field of nursing itself there is a wealth of dormant interest awaiting the specialists who will soon supplant the outmoded classification of private duty, institutional, and
public health nurse. I refer to the
specialists in nursing in surgery, medicine, nervous and mental diseases, obstetrics, and pediatrics, branches which again fall into sub-divisions requiring
for the nurse, no less than the physician, a highly specialized body of
knowledge and skills. NURS 3000 – Issues and Trends in Nursing Assignment.
The syntheses demanded for efficient result in the field of health can be
achieved only through the intelligent, collective will of the army of health
workers, specialists in their own field,
but all versed in scientific concepts, scientific methods, and scientific terminology, motivated by a unified objective. That such coordinated, cooperative programs be developed was the pronouncement of the Committee on
Medical Care for the American people.
An important step, and one that
further emphasizes the need of broadening the content of nursing education,
is the effort to persuade nurses, professionally so highly organized, to organize for service through local
community programs based on the needs
of and open to the entire population.
To this end the national nursing organizations have recently appointed a
committee that has outlined as basic
the following principles: NURS 3000 – Issues and Trends in Nursing Assignment.
1. That a responsible group, representing
the nursing profession, the medical profession,
and such lay groups concerned with nursing
as hospital boards, schools of nursitia committees, boards of public health nursing
agencies, etc., work out plans in each community for a community nursing program.
2. Analyzing community nursing problems
include:
a. How much nursing care is needed for
different types of situations
b. What are the present facilities
c. What are the gaps and duplications as
shown by ” a ” and “b”
3. Meeting community nursing needs involves:
a. Reducing the number of agencies which
distribute nursing service to as few agencies
as possible and providing one coordinating
agency through which all types of nursing
service may be obtained
b. An understood relationship and division
of responsibility between the various nursing
facilities
c. A concerted effort to fill in gaps and eliminate duplication
d. The establishment in every community
of some type of machinery for supplying nursing service In the Canadian Survey of Nursing
Education will be found a comprehensive and suggestive consideration of
municipal support and administration of community nursing service.
Of wider significance than is at first
apparent are these 2 progressive stepsthe attainment for schools of nursing of the rights and privileges of higher
education; and the integration, for local community service, of the contributions of the members of the nursing profession.
The national and international significance of the health movement, to the
furtherance of which throughout the
world American citizens have so greatly
contributed, cannot be overestimated,
and not only through the prevention of
disease that takes no cognizance of
national boundaries, but through the underlying emphasis on the value of
every human life- as such, provided only that through heredity and environment the organism shall be well
born.
Through an International Council of
Nurses, American nurses have long
since established professional relationships on all continents. Through the
Division of International Studies of
the Rockefeller Foundation, nurses from
many countries have been enabled to study-through undergraduate and
graduate courses, and through visits to American institutions and organizations-nursing education and nursing service in the United States. It is eminently fitting that the International
Council of Nurses and the League of Red Cross Societies should unite to
establish a Florence Nightingale VIemorial Foundation, and that this memorial
should take the form of courses for international students under the auspices
of the University of London in cooperation with the hospitals and social orVol. 26 769 organizations of the city in which was offered the first and world renowned
professional program of nursing education. Never in the history of the world
was there a more timely moment to
further a project so consistently expressive of the potential value of every
human life. NURS 3000 – Issues and Trends in Nursing Assignment.
As in all professions, the responsibility for the interpretation of function, and the acquirement of the educational content demanded for the fulfillment of such function, rests upon nurses themselves. However obscured may be the public’s understanding of the part of nursing in social reconstruction, nurses themselves, to whom n inalienable right, should demand the educational content through which their most effective service may be rendered and the means through which such service may be universally available. Not less than for their educational needs should the country assume responsibility for the health of her children.

The Medical Profession I SAID our profession was a holy office on the same level as that of the priest if not higher, where surplus money-making should be forbidden by law. The doctors should be paid by
the State and well paid like the judges in England. Those who did not like this arrangement should leave the profession and go on the Stock Exchange or open a shop. The doctors should walk about like sages, honoured and protected by all men. They should be welcome to take what they liked from their rich patients for their poor patients and for themselves, but they should not count their visits or write any bills.
What was to the heart of the mother the value in cash of the life of her child you had saved? What was
the proper fee for taking the fear of death out of a pair of terror-stricken
eyes by a comforting word or a mere stroke of your hand? How many
francs were you to charge for every second of the death-struggle your morphia syringe had snatched from the
executioner? How long were we to dump on suffering mankind all these expensive patent medicines and drugs with modern labels but with roots sprung from medieval superstition? We well knew that our number of efficacious drugs could be counted on the ends of
our fingers and were handed to us by benevolent Mother Nature at a cheap
price.-Axel Mlunthe,

Healthcare organizations have responded to healthcare trends and managed care in a
variety of ways. Unfortunately, some institutions were unable to maintain their financial viability and did not survive decades of economic turmoil. From 1990 to 2000, 208 rural hospitals (7.8% of national rural hospitals) and 296 urban hospitals (10.6% of national urban hospitals) were forced to close (U.S. DHHS, 2003). Many of these closures were attributed to a low census, mergers or relocations, and competition (U.S. DHHS, 2003). According to the American Hospital Association’s (AHA’s) annual survey of U.S. hospitals, similar shifts in hospital closures continue to occur with a decrease of 37 registered hospitals (5,723 down to 5,686) reported from 2012 to 2013 (AHA, 2014, 2015). Similar declines were noted among rural (1,980 down to 1,971) and urban (3,019 down to 3,003) community hospitals (AHA, 2014, 2015). More recent data from the North Carolina Rural Health Research Program
(2015) indicated that 54 U.S rural hospitals have closed their doors between January 2010 and June 2015. NURS 3000 – Issues and Trends in Nursing Assignment.

Shi and Singh (2015) reported that the U.S. healthcare delivery has been shifting its focus
over the past two decades from individual health within an inpatient, acute care, and illnessoriented context to the health of a community, framed within an outpatient, primary care, and
wellness perspective. Hospitals also are transitioning from being independent institutions with
fragmented care and duplicated services to integrated systems with managed care and a continuum of services (Shi & Singh, 2015). Health promotion combined with cost reduction has
been the impetus for these healthcare changes (Shi & Singh, 2015).
Insightful healthcare organizations have survived these restrictions by reexamining the ways
they have internally functioned. These organizations constantly strive to develop cost-effective
means to maintain or attain quality and safe patient care outcomes. Numerous changes have
occurred within healthcare organizations, but six come to the forefront: financial streamlining,
organizational integration and realignment, new models of patient care delivery, work redesign and role changes, safety and quality performance indicators, and health IT.
Copyright by Oncology Nursing Society. All rights reserved.
6 Nursing Professional Development for Clinical Educators
Financial Streamlining
Past managed care and healthcare reimbursement changes forced many healthcare administrators to review their existing financial policies and procedures. Managers who dealt with
patient care services and clinical divisions, such as nursing, were asked to streamline their
operating budgets, control unnecessary expenses, seek untapped sources of revenue, and
determine return on investments. Major budgetary expenditures, such as salary and other personnel costs associated with healthcare workers, were targeted as expenses that needed to be
controlled. Departments were examined based on operating costs and ability to generate additional revenue for the organization.
In addition to reducing direct labor costs, these reimbursement changes forced organizations to closely examine expenses related to patient care services, consumer services, and the
approach used to deliver these services. Many low-risk surgeries and treatments and invasive
diagnostic procedures that were traditionally inpatient practices were modified using a more
cost-effective outpatient approach (Shi & Singh, 2015). In fact, outpatient surgeries increased
by nearly 50% from 1980 to 2010 (Shi & Singh, 2015; U.S. DHHS, 2013a).
This shift in healthcare services resulted in a different inpatient profile. For example, individuals admitted to acute care agencies (hospitals) possessed higher acuity levels than in past
years, requiring skilled and intensive nursing care. After a shortened length of stay in the hospital, some patients were discharged to other healthcare agencies that offered subacute, intermediate, or extended nursing care. Healthcare workers employed in these transitional units
provided much of the nursing care previously performed in the acute care environment. In
fact, some organizations added new clinical services, such as transition units, within their own
systems to help patients change from acute care to a home setting. Other patients were discharged with or without homecare services. Attention was paid to reducing patient readmission shortly following discharge.
Organizational Integration and Realignment
Beginning in the late 1990s, hospitals underwent organizational integration in an effort
to remain viable by becoming cost-effective and diversifying operations with new services or
products (Shi & Singh, 2015). Integration strategies included acquisitions, mergers, alliances,
joint ventures, and virtual networks (Shi & Singh, 2015). NURS 3000 – Issues and Trends in Nursing Assignment.
Many chief operating officers dealt with these financial constraints by focusing on the internal structure of their organizations and the allocation of resources. Some completely reorganized or realigned their structures, whereas others chose to implement minor changes in
their existing organizations. Low utilization rates and competition over decades influenced
organizational downsizing or rightsizing, often resulting in major changes in or elimination
of divisions and departments (U.S. DHHS, 2003). In some instances, services, such as laundry, dietary, and education, were outsourced or contracted through external companies. Many
healthcare organizations closed patient units and reduced their number of beds. Some departments that were non–revenue generating or advisory in nature, such as staff education, often
faced negative consequences.
Healthcare organizations, confronted by the influence of managed care, focused their
efforts on securing their share of the healthcare market. Many agencies diversified services
in an attempt to obtain more patients or clients (Shi & Singh, 2015). In an effort to compete
with other healthcare organizations for customers, some hospitals expanded or shifted serCopyright by Oncology Nursing Society. All rights reserved.
Chapter 1. Healthcare Trends and Changes in Nursing Professional Development 7
vices from inpatient admissions to include outpatient, subacute care, homecare, long-term
care, ambulatory care, and community-based efforts.
New Models of Patient Care Delivery
Related to financial and organizational reforms, new models in organizing and delivering care
have emerged in an effort to improve primary healthcare services for Americans in settings such
as physician offices and community health centers (Agency for Healthcare Research and Quality [AHRQ], n.d.-b). According to AHRQ and the National Committee for Quality Assurance
(NCQA), the patient-centered medical home (PCMH) should be viewed as a “model of the organization of primary care that delivers the core functions of primary health care” (AHRQ, n.d.-
a, para. 1). In a PCMH, the primary care physician leads a collaborative team of healthcare professionals in providing access to coordinated care services based on the needs and preferences of
patients and their families (Caudill, Lofgren, Jennings, & Karpf, 2011).
A PCMH also aims to advance how consumers and healthcare providers perceive their
healthcare experience (NCQA, n.d.). A PCMH comprises five elements: comprehensive care,
patient-centered (relationship-based) care, coordinated care, accessible services, and quality
and safety (AHRQ, n.d.-a). Practices that choose to become PCMHs can apply for NCQA Recognition (NCQA, n.d.).
Similar PCMH models have been created in clinical specialty practices. For example, the
Centers for Medicare and Medicaid Services (CMS) (2014c) recently developed an Oncology
Care Model (OCM) to address the current state of cancer care in the United States because of
the increasing number of older adults diagnosed with or surviving cancer. OCM is a cancer
payment model that offers financial incentives to physician practices that increase the quality
and coordination of the cancer care services they provide while also decreasing costs. Oncology practices that deliver chemotherapy enter into payment arrangements that include financial and performance accountability for episodes of care (CMS, 2014c) and are evaluated on
more than 30 quality measures (Clark, 2015). Practices are expected to offer 24-hour outpatient clinics where patients can receive treatment for their chemotherapy-associated symptoms
rather than seek such care at hospital-based emergency departments (Clark, 2015). Scheduled to begin in 2016, OCM is intended to decrease both hospital and pharmacy costs (Clark,
2015). NURS 3000 – Issues and Trends in Nursing Assignment.
Work Redesign and Role Changes
Efforts to restructure and downsize in healthcare agencies also compelled healthcare
administrators to examine how work was being accomplished. Managers were encouraged
to redesign work in a manner that was cost-saving, efficient, and effective. Frequently, all but
essential financial and human resources were trimmed from budgets. Employees in these
departments were encouraged to rethink their responsibilities and develop innovative ways
to perform their jobs. They were asked to “work smarter, not harder” and “do more with
less.”
New paradigms or models that resulted from these work redesigns often changed the
roles and responsibilities previously assumed by employees of these healthcare organizations.
Although some workers could easily adjust to their new roles by making minor modifications
in their daily activities, others needed to be cross-trained or retrained to gain the knowledge
and skills required to function in their new roles.
Copyright by Oncology Nursing Society. All rights reserved.
8 Nursing Professional Development for Clinical Educators
Safety and Quality Performance Indicators
In concert with cost-effectiveness and efficiency, healthcare organizations focused their
efforts on measuring and managing outcomes related to healthcare services, such as patient
care (Shi & Singh, 2015). Healthcare workers were challenged on a daily basis to provide quality patient care with fewer resources. Managers were encouraged to make decisions using datadriven outcome measurements (Shi & Singh, 2015). Hospitals focused attention on landmark
reports, performance indicators related to patient safety, and ACA-mandated improvements in
safety, quality monitoring, and reporting (U.S. DHHS, 2015).
Existing systemwide quality control programs that focused on quality and effectiveness of
clinical services were enhanced within healthcare organizations (Shi & Singh, 2015). Managers were encouraged to improve quality and safety goals and reduce associated costs. Outcomes
management initiatives, referred to as total quality management (TQM), gained popularity (Shi
& Singh, 2015). Because the primary focus of TQM is continuous improvement in all organizational processes, managers and employees were encouraged to improve their performance daily.
For example, suppose the nursing staff on your unit wanted to improve their performance
related to patient admissions. You would begin by breaking down your existing admissions
procedure into its smallest components. While reviewing this process, you decide what steps
are essential, who should perform them, and how they can be implemented more efficiently
and effectively. During this process, you discover your staff repeated many steps without reason, or perhaps you uncover omissions in other departments that prevented your agency from
reaching the best outcome. While working on this problem, you decide to investigate how
other healthcare organizations excel in the process, referred to as benchmarking (Shi & Singh,
2015). This information is used to refine the admission procedures at your workplace.
The significance of cost-effective, quality patient care has led to the development and implementation of patient-centered and outcome-based tools, such as critical pathways and clinical practice guidelines (Shi & Singh, 2015). These items, developed with input from nurses, are
useful in guiding practice and reaching clinical outcomes within prescribed time frames. Innovative patient care delivery models, such as case management, evolved and emphasized meeting patient outcomes within specific time parameters (Shi & Singh, 2015).
Reimbursement for patient care services is negatively affected if a hospital does not adhere
to national quality performance standards. Since 2008, CMS has stopped reimbursing to hospitals that experience preventable hospital-acquired conditions (e.g., stage III and IV pressure
ulcers, falls and trauma, blood incompatibility) (CMS, 2014a). CMS also includes patient situations referred to as never events, such as surgery conducted on the wrong body part, an infant
discharged to the wrong individual, and death or disability associated with a medication error
(CMS, 2014b).
In an effort to gain national recognition for nursing excellence, some healthcare organizations have sought status in the American Nurses Credentialing Center (ANCC) Magnet
Recognition Program®. This program, developed in 1994, is based on national standards of
nursing practice and quality indicators and recognizes healthcare organizations that support
professional nursing practice in their settings and offer excellent nursing care (ANCC, 2014).
Advancing Information Technology
Hospitals are expected to advance IT initiatives that affect healthcare providers, consumers,
and others who engage in healthcare delivery services. To support and expedite this goal, hosCopyright by Oncology Nursing Society. All rights reserved.
Chapter 1. Healthcare Trends and Changes in Nursing Professional Development 9
pitals receive financial incentives to facilitate the adoption of electronic health records (EHRs)
within their organizations (Shi & Singh, 2015). These enticements were enabled under the
Health Information Technology for Economic and Clinical Health Act in 2009.
In addition to implementing EHRs, Medicare and Medicaid also offer incentives if hospitals
demonstrate meaningful use of health IT (Centers for Disease Control and Prevention [CDC],
2012), particularly in quality, safety, efficiency, reduction of health disparities, patient engagement, care coordination, and security of health information (Halamka, 2010; Shi & Singh,
2015). Healthcare organizations are penalized financially if they do not comply with meaningful use expectations (DesRoches, Worzala, & Bates, 2013).
Such IT advances are expected to facilitate daily operations of healthcare organizations and
foster information sharing among hospitals for continuity of patient care. Consumer portals
offer patients the opportunity to communicate with their clinicians, access health resources
and information, and review results of tests and procedures. These advances enable consumers to be active participants in their own care (Shi & Singh, 2015). Further IT advances are still
needed, such as comprehensive applications used by providers to manage patient healthcare
needs (Conn, 2013). NURS 3000 – Issues and Trends in Nursing Assignment.
The use of health-related technology by healthcare providers and consumers has been steadily
increasing, as devices and applications used by both groups are becoming increasingly similar (Conn, 2013). Some consumers access their healthcare information from electronic sources,
such as the Internet, social media, mobile applications, and patient or survivor portals.
Although healthcare organizations have developed patient portals in response to the meaningful use of health IT, Whitehurst (2014) advised that these organizations rethink their
approach and create a comprehensive communication plan to engage patients and consider
patient preferences. He offered several suggestions to providers as they revise their technology
plan: assess the current state of patient communication, identify the communication needs of
specific populations, respect patient preferences, experiment with different methods and tools,
be flexible and aware of new technology, and strategically consider the message.
Justice (2014) described several technological sources that chronic cancer survivors can
access to stay informed about their healthcare needs and any evolving treatment options. These
resources include disease-specific websites, such as the National Cancer Institute (www.cancer
.gov); Facebook groups that focus on issues such as myeloproliferative neoplasms; and patient
opinion leaders sponsored on social media channels. Justice (2014) also emphasized the value
of social media in empowering patients with cancer in managing and understanding their
chronic cancer care needs.
Researchers have investigated the influence of technology use on patient outcomes. Gnagnarella et al. (2015) conducted a randomized six-month intervention with social media that
aimed to increase the knowledge of healthy eating habits among cancer survivors. Although
knowledge levels increased in both the treatment and control groups with no statistically significant differences, studies such as this provide researchers with insight into designing intervention studies to measure patient outcomes related to technology.
Given the technological advances that provide direct access to consumers, patients may find
themselves being recipients of direct-to-consumer advertising from businesses, such as pharmaceutical companies (Pharmaceutical Research and Manufacturers of America [PhRMA],
2013). These businesses promote services or products, such as information on diseases and
current treatments, directly to consumers (e.g., print advertisements, television spots or commercials, radio spots or commercials) rather than through traditional advertising avenues
(e.g., through communication with healthcare providers). PhRMA (2008) has published guiding principles for companies to follow when implementing direct-to-consumer advertisements about prescription medications.
Copyright by Oncology Nursing Society. All rights reserved.
10 Nursing Professional Development for Clinical Educators
Responding to Changes in Health Care
NPD has also undergone major changes over the past two decades. It was presented as a
clinical practice specialty in 2010 by the American Nurses Association (ANA) and the National
Nursing Staff Development Organization (NNSDO, now called the Association for Nursing
Professional Development [ANPD]) in their publication Nursing Professional Development:
Scope and Standards of Practice (ANA & NNSDO, 2010). This document presented a systembased NPDS model with inputs, throughputs, and outputs that reflected a major expansion,
with changes in the roles, responsibilities, and clinical practices in what was previously known
as nursing staff development (ANA, 1992, 1994, 2000, 2015).
Beginning in the 1990s, the restructuring of hospitals brought changes in the structure and
function of NPD departments and nurse educators (Lockhart, 2004). These divisions, previously referred to as nursing staff development departments, nursing education and research
departments, or NPD departments, were downsized, restructured, or eliminated. Changes also
included the redesign of departmental priorities and the shifting and expanding of educator
roles (Lockhart, 2004). Whereas a department’s core functions were often retained by nurse
educators who remained in NPD departments, other services needed to be decentralized and
assigned to other nurses, often clinical RNs who worked on patient care units. Some professional development responsibilities were shifted to other nurses within the organization. As
Chapter 1. Healthcare Trends and Changes in Nursing Professional Development 11
and seek clarification as needed. Network with colleagues in professional organizations related
to your role, such as ANPD.
Next, conduct a self-inventory of the knowledge, skills, and attitudes expected in your professional role and determine any new skills that you will need to develop. For example, you
may need to strengthen your skills in information and educational technology, EBP, or writing
for publication. If you are having issues in educational technology, you are not alone. A survey
of more than 1,300 ANPD members revealed that educational technology was underused in
practice, citing a need for NPDSs to “assume responsibility for personal competence” (Harper,
Durkin, Orthoefer, Powers, & Tassinari, 2014, p. 247) related to technology.
As you conduct your assessment, heed the recommendations made in IOM’s The Future of
Nursing: Leading Change, Advancing Health (IOM, 2010). If appropriate, consider pursuing a
PhD or DNP and seeking additional learning activities to develop leadership competencies,
manage change, and support staff. NURS 3000 – Issues and Trends in Nursing Assignment.
Seek experienced NPDSs who can serve as mentors in your professional development.
These mentors may be local or accessed through professional organizations.
Assume a Leadership Role Within Your Organization and Profession
Leadership is among the core competencies of an NPDS and encompasses a variety of behaviors, from serving as a change agent and advocate of NPD offerings to being an ethical decisionmaker and problem-solver (ANA & NNSDO, 2010). In fact, leadership comprises the largest portion (24%) of the 2014 test content outline designed for NPD board certification (ANCC, 2013).
More specifically, the leadership content focuses on topics such as “organizational principles, concepts, and structures; leadership principles and practice; the workplace environment; professional development; and managing resources” (ANCC, 2013, pp. 2–3). Gaining an understanding of these leadership priorities can help you focus your personal development needs and identify
appropriate leadership opportunities within your healthcare organization.
Westphal and McNeil (2014) emphasized the important role that nurses who are engaged in
continuing education can play by serving in a boardroom. The authors identified nine competencies essential for nurses to be effective in this setting: open communication, planning, active
engagement, collaboration, decision-making skills, financial stewardship, organizational skills,
advocacy, and visionary skills.
IOM recommendations can guide you in developing a competent staff of nurses and other
healthcare professionals that are able to provide safe and quality patient care, lead change, and
advance health in your organization. NPDSs are responsible for creating a learning environment that welcomes innovation and supports lifelong learning and continuing competence.
NPDSs need to help nurses understand trends, national expectations, and healthcare changes,
which will develop them in new roles that align with the current and future directions of
healthcare delivery.
Align Priorities With Evidence-Based Sources
Nursing Professional Development: Scope and Standards of Practice (ANA & NNSDO, 2010)
details the responsibilities that NPDSs and unit-based educators are expected to assume in their
roles. Understanding the mission and goals of your healthcare organization as they correspond to
recent and future healthcare trends can help you develop and prioritize goals for the NPD department and educators in alignment with the organization and various evidence-based sources.
Copyright by Oncology Nursing Society. All rights reserved.
12 Nursing Professional Development for Clinical Educators
The beginning of this chapter described several sources of evidence that NPDSs can use to
address educational priorities. As an NPDS, remember that your ultimate goal is the “acquisition of knowledge, skills, and attitudes that support safety and contribute to the protection of
the public and provision of quality care” (ANA & NNSDO, 2010, p. 7). Given this charge, various sources of evidence exist to guide you in determining your educational priorities. Especially valuable are the national regulations and standards for quality care and patient safety
previously mentioned in this chapter.
For example, NPDSs can use the Joint Commission’s sentinel events and NPSGs (Joint
Commission, n.d.-b, n.d.-c) and CMS’s preventable hospital-acquired conditions and never
events (CMS, 2014a, 2014b) to focus educational activities on helping nurses understand these
issues, prevent and report incidents, and gain vital competencies. In addition, these sources
can help NPDSs and staff educators in conducting a gap analysis to identify essential continuing education programs and support practice initiatives, such as patient hand-off (changeof-shift) reporting; Situation, Background, Assessment, and Recommendation (SBAR) techniques for communication (Narayan, 2013); the use of rapid response teams; and root cause
analysis (Connelly, 2012). Also, the “meaningful use” expectation for hospitals provides the
rationale for staff education and learning using information technology such as EHRs and
other portals. Finally, IOM (2010) recommendations provide support and future direction
(see Figure 1-1) for nursing regarding lifelong learning and continuing competence, leadership development, residency programs, continuing education, and practice at the highest level.
Focus on Cost-Effective Results-Oriented Outcomes

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Given these educational priorities, you are expected to provide educational activities that lead
to “cost-effective, results-oriented outcomes” (Harper et al., 2014, p. 247). Although it is expected
that you deliver the throughputs described in the NPDS practice model (ANA & NNSDO, 2010),
it is also important that you “evaluate the benefits in relation to costs when both are expressed
in dollar terms” (Shi & Singh, 2015, p. 577). Given the current cost-conscience healthcare environment, limited resources, and multiple work priorities, it is important for NPDSs to calculate
the return on investment of their professional development efforts and communicate the value of
their department and role (Bjørk, Tørstad, Hansen, & Samdal, 2009).
To manage cost-effective, results-oriented outcomes, you need to be familiar with quality
improvement, evidence-based projects, and research (see Chapter 12). It is also important to
understand the sources of data within an organization and how to collect, manage, analyze,
and interpret these data.
NPDSs and staff educators should be able to disseminate the results of their efforts (ANA &
NNSDO, 2010). In addition to producing an executive summary of efforts to a manager or other
stakeholders within an organization, it is important to share educational efforts through peerreviewed journal articles and professional oral presentations and posters. This responsibility may
require the development of new writing and presentation skills (see Chapter 9).
Anticipate Future Directions and Opportunities for Improvement
Keeping abreast of trends and issues that affect healthcare systems needs to be a priority for
NPDSs and unit-based staff educators. Understanding these changes and their potential influence on an employer can help you anticipate the future directions that the healthcare organization
Chapter 1. Healthcare Trends and Changes in Nursing Professional Development 13
For example, you can identify new opportunities to improve educational processes in providing safe, quality patient care. Understanding changes in the preparation of future nurses
can help you anticipate changes in how your NPD department will orient and prepare newly
hired nurses. A proactive approach can be taken to anticipate and manage potential barriers
or threats. Although anticipating change within a dynamic healthcare environment may pose
a challenge, it can offer you time to develop new skills and competencies in your nursing staff.
To lead change, it is vital that nurses engage in lifelong learning opportunities.
Although predicting the future of health care is a tremendous challenge, Shi and Singh
(2015) identified eight forces of future change: social and demographic, political, economic,
technological, informational, ecological, global, and anthro-cultural (Shi & Singh, 2015).
While the authors advised healthcare leaders to use these forces to guide their strategic planning efforts (Shi & Singh, 2015), gaining insight into these forces may also offer benefits for
NPDSs and staff educators.
Summary
Recent healthcare trends have resulted in the restructuring of healthcare organizations.
Major changes have also occurred in the scope and standards of NPD. These alterations have
resulted in multiple role adjustments for nurses employed in clinical practice settings, such as
professional development and unit-based education. Changes in both organizations and NPD
departments have also affected the roles and responsibilities of clinical staff nurses. NPDSs
and unit-based clinical nurse educators need to take a proactive approach and assume these
responsibilities, acquiring the knowledge, skills, and attitudes needed to function effectively in
a vital new role. NURS 3000 – Issues and Trends in Nursing Assignment.
Helpful Websites
• Association for Nursing Professional Development: www.anpd.org
• Centers for Disease Control and Prevention—Meaningful Use: www.cdc.gov/ehrmeaningfuluse
• Centers for Medicare and Medicaid Services—Hospital-Acquired Infections: www.cms
.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/Hospital-Acquired
_Conditions.html
• Centers for Medicare and Medicaid Services—Never Events: www.cms.gov/SMDL/down
loads/SMD073108.pdf
• Joint Commission: www.jointcommission.org
• Quality and Safety Education for Nurses Institute—QSEN Competencies: http://qsen.org/
competencies
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Chapter 1. Healthcare Trends and Changes in Nursing Professional Development 15
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Institute of Medicine. (2013a). Delivering high-quality cancer care: Charting a new course for a system in crisis. Washington, DC: National Academies Press.
Institute of Medicine. (2013b). Improving the quality of cancer care: Addressing the challenges of an aging population.
Washington, DC: National Academies Press.
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about_the_joint_commission_main.aspx
Joint Commission. (n.d.-b). National Patient Safety Standards. Retrieved from http://www.jointcommission.org/
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Juraschek, S.P., Zhang, X., Ranganathan, V., & Lin, V.W. (2012). United States registered nurse workforce report card
and shortage forecast. American Journal of Medical Quality, 27(3), 241–249.
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NURS 3000 – Issues and Trends in Nursing Assignment.

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Trends in nursing are closely tied to what is happening to healthcare in general. Trends are fascinating phenomena, but they do not exist in vacuums. Most are interrelated; one trend often spawns another. Although trends are more than fads, they are far from money-back guarantees. We watch to anticipate the direction that a particular trend will take us, to remove the element of surprise. When we look back on trends, however, some will have heralded permanent changes, but others might have been no more than blips on the radar screen. NURS 3000 – Issues and Trends in Nursing Essay Paper

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Improvement of healthcare delivery in the United States relies on many factors, such as effective nurse advocacy through politics, policy, and professional associations. But advocacy depends on the ability to fully understand current issues, systems, policies, and related contexts. In this course, students engage in a systems-level analysis of the implications of healthcare policy on issues of access, equity, affordability, and social justice in healthcare delivery.

Through policy analysis assignments students apply legislative, regulatory, and financial processes relevant to their organization and provision of healthcare services in their community. Students consider the impact of these processes on quality and safety in nursing practice environment and disparities in the healthcare system. Through this course, students gain the knowledge and skills needed to advocate for vulnerable populations and promote positive social change. (Prerequisites: NURS 3000) Note: Students must take this course first in their sequence. NURS 3000 – Issues and Trends in Nursing Essay Paper

Current Trends in Nursing and Care: Status of the Profession

The nursing profession continues to evolve and progress at a meteoric pace. The current trends in nursing and care are multi factorial including: the increase in the aging population, a transition to informatics, a nursing shortage, and an overarching emphasis on specific frameworks for the guiding of nursing practice, including integration of evidence based practice.
It is estimated that 26% of the United States (U.S.) population are “Baby Boomers” [1]. As the “Baby Boomer” population ages, so does the increase in aging adults with complex health issues. Nurses today must be more adept than ever at caring for the aging adult while the healthcare environment struggles to accommodate this rapidly increasing population.
In addition to an increasing aging population, another trend is the increase reliance on informatics. NURS 3000 – Issues and Trends in Nursing Essay Paper The incorporation of technology into the healthcare arena may be a challenge for many nurses. The inclusion of the digital medical record has assisted facilities in providing for a more streamlined, accessible, and accurate health history. There also continues to be variation among facilities in the initiation of informatics leading to a lack of consistency from facility to facility. However, it is important to recognize that not all nursing professionals possess the necessary computer literacy skills needed for proficiency in understanding and utilizing informatics, especially those nurses that have been in the nursing profession for quite some time. This leads to consideration of the fact that many nurses are retiring without the numbers to replace them.
The current nursing shortage is impacted by the high number of nurses that are of retirement age coupled with the lower number of new nursing graduates. Contributing to the nursing shortage is the current nurse faculty shortage. A shortage in those nurses with advanced degrees and the ability or willingness to enter academia affects the ability of institutions of higher learning to educate more nursing students. In 2010, nursing schools denied admission to over 75,000 potential students due to a lack of adequate nursing faculty [2], without new graduates to replace retiring nurses, the burden of providing patient-centered care rests on the shoulders of those left at the bed-side. NURS 3000 – Issues and Trends in Nursing Essay Paper A nursing shortage then contributes to nurse fatigue and burnout, the potential for medical errors and compromised patient safety, and poor patient outcomes.
In terms of patient outcomes, the nursing profession has seen an increased emphasis on integration of evidence-based practice. The incorporation of best practices into nursing care has contributed to the individual nurse claiming more ownership in the achievement of positive health outcomes for patients. Nurses are now responsible for being a direct line in the conducting, reporting, and implementation of research. Most importantly, this responsibility has led to a paradigm shift in the way nursing is viewed. No longer is nursing viewed as task oriented discipline content on taking orders within the medical hierarchy. Nursing can now be considered a science; contributing to the research and discovery of new and innovative approaches to improving health outcomes.
As nursing continues to evolve, so does the current healthcare environment. Affected by a multitude of factors, nursing will forever be in a constant state of flux. Trends can be both negative and positive. Whether it is the changing face of the populations for which nursing cares for, a rapidly changing technological environment, nurse/faculty shortages, or an emphasis on evidence based research, nursing is up to the challenge and will forge ahead with vigor and accountability. NURS 3000 – Issues and Trends in Nursing Essay Paper
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The Recent Surge In Nurse Employment: Causes And Implications

Registered nurse (RN) employment has increased during the current recession, and we may soon see an end to the decade-long nurse shortage. This would give hospitals welcome relief and an opportunity to strengthen the nurse workforce by addressing issues associated with an increasingly older and foreign-born workforce. The recent increase in employment is also improving projections of the future supply of RNs, yet large shortages are still expected in the next decade. Until nursing education capacity is increased, future imbalances in the nurse labor market will be unavoidable.

Since 1998, hospitals in the united states have reported a shortage of registered nurses (RNs). The shortage peaked in 2001, when hospital nurse vacancy rates reached a national average of 13 percent and an estimated 126,000 full-time-equivalent (FTE) RN positions were unfilled, forcing many hospitals to close nursing units and restrict operations. 1 Throughout the current decade, concerns about the nurse workforce increased, driven in part by increasing evidence that low hospital nurse staffing was associated with an increased risk of patient complications, and in part by projections of a large shortage of RNs developing over the next decade. 2 NURS 3000 – Issues and Trends in Nursing Essay Paper

The nation has experienced two recessions since the current nurse shortage developed more than ten years ago. The first recession, in 2001, lasted eight months, and resulted in the average national unemployment rate peaking at 6.3 percent. The second recession began in December 2007 and by January 2009 had already lasted longer than the average (ten months) of all previous recessions since World War II. 3 During the last four months of 2008, 1.9 million people lost their jobs, which increased the total to 2.5 million since the beginning of the recession and drove up the unemployment rate to 7.2 percent in December 2008. 4 Although job losses and the unemployment rate have continued to increase since then, the health care sector has actually added jobs. 5 NURS 3000 – Issues and Trends in Nursing Essay Paper

In this paper we examine the recession’s impact on current RN employment and on projections of the future size of the nurse workforce. Clarifying the effect of the recession on RN employment can help employers and policymakers anticipate the possibility that the long-standing nurse shortage is finally winding down. But before concluding that it is safe to turn attention away from the nurse workforce, we examine trends in the composition of the RN workforce that lie underneath the recent employment changes. This assessment suggests the need to strengthen the current workforce before the recession lifts and imbalances in the supply and demand for RNs reappear. Next, we focus on the future workforce and project the age and supply of RNs through 2025, noting the impact of the recession on these projections. We conclude with policy implications to support the current nurse workforce and remove barriers that are blocking efforts to expand the long-term supply of RNs. NURS 3000 – Issues and Trends in Nursing Essay Paper

Study Data And Methods

Data.
We used data from 1973 through 2008 from the Current Population Surveys (CPS) annual May surveys for 1973–1978 and the Outgoing Rotation Group Annual Merged Files for 1979–2008. The CPS is a household-based, nationally representative survey of more than 100,000 people, administered monthly by the U.S. Census Bureau. It is used extensively by the U.S. Department of Labor to estimate current trends in unemployment, employment, and earnings; also, we have used CPS data in our prior work to estimate employment trends for RNs and project the age and supply of RNs. 6 The CPS data contain information on demographics, earnings, hours worked, industry sector, and employment of more than 3,000 RNs employed in nursing each year.

The data we analyzed included individuals between ages 23–64 who reported their occupation as RN between January 1973 and December 2008 (N = 94,395). For consistency with prior work, we assigned RNs reporting fewer than thirty hours worked in a typical week as one-half FTE. To make estimates representative of the U.S. non institutionalized population, we weighted observations by sampling weights provided by the CPS. NURS 3000 – Issues and Trends in Nursing Essay Paper

Methods.
Details of our forecasting model are described elsewhere. 7 Briefly, the model used a regression analysis where the dependent variable was the logarithm of the number of FTEs produced by RNs of every age in the 23–64 age group, for every year between 1973 and 2008 (for example, 42 years of age times 36 years equals 1,512 total observations), divided by the total U.S. population in that given year-age cell. The independent variables were dummy variables for each single-year birth cohort (for example, RNs born in 1955), each single year of age, and an interaction term that captured the shift toward older ages of first entry into the workforce by cohorts born after 1965. After being estimated on observed data, the forecast model applied the observed pattern of workforce participation by age to future cohorts and assumed that future cohorts would have the same propensity to become RNs as the five most recently observed cohorts. NURS 3000 – Issues and Trends in Nursing Essay Paper

Impact of the recession on RN employment.
Exhibit 1 provides data on boom and bust periods in the economy since 1980, along with changes in FTE RN employment. During boom periods the economy grew faster, as reflected by the higher real growth in gross domestic product (GDP) (3.7 percent versus 1.6 percent in bust years) and lower average unemployment rates (5.5 percent versus 6.6 percent in bust years). Strikingly, during the lower-GDP-growth bust periods, average annual FTE RN employment increased faster than in boom years, particularly in hospitals, where employment increased at more than five times the annual rate (5.3 percent) of that during the boom years (1.0 percent). This result may seem counter intuitive, but it reflects the impact of real or anticipated losses of household income as many RNs’ spouses either lost their jobs or feared that they might during the bust years, when unemployment rates were increasing (70 percent of RNs are married). This decrease in spousal income would stimulate an increase in RNs’ participation in the labor market by some of those not working and an increase in hours worked by those already participating in the labor market. 8 These responses are shown by the increase in total and hospital FTE RN employment during bust periods relative to boom periods (the bottom two rows of Exhibit 1 ). NURS 3000 – Issues and Trends in Nursing Essay Paper

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Exhibit 1 also shows that these counter cyclical trends appear more extreme in recent years. For example, with each succeeding boom period, RN employment grew more slowly, and negative growth was observed in hospitals during 2003–2006. Conversely, with each successive bust period, RN employment grew more rapidly. During 2002 and 2003, hospital RN employment increased by 184,000 FTE RNs; in 2007 and 2008, it increased by an estimated 243,000 FTEs (18 percent)—the largest two-year increase in our data set. 9 This stunning increase in hospital RN employment (employment in other settings did not grow in 2008) increased the proportion of all FTE RNs employed in hospitals to 64 percent in 2008 from 60 percent in 2006. The apparent preference for hospital-based employment likely reflects a combination of higher average earnings compared with non hospital settings ($27.60 per hour versus $24.63 in 2008), more-generous fringe benefits (particularly health insurance), favorable work hours (twelve-hour shifts commonly offered by hospitals enable an RN to work three days per week, receive full-time benefits, and still have ample time to work overtime hours or a second job), and RN layoffs among non hospital providers associated with the recession-induced decreases in revenue. NURS 3000 – Issues and Trends in Nursing Essay Paper

Changing composition of the RN workforce.
Although the recent flows into and out of the labor market can be largely accounted for by economic booms and busts, this analysis does not reveal information about the demographic composition of the RNs in the labor market. Further examination not only shows how nursing is changing but suggests issues that employers and policymakers may need to address.

Most of the employment increase in recent years is from RNs over age fifty, some of which reflects large cohorts of baby-boomer RNs aging into their fifties (Exhibit 2 ). Between 2001 and 2008, employment of older RNs increased by an estimated 368,000 FTEs, or 77 percent of the total increase in RN employment. Although hospitals employed more older RNs (230,000, or 59 percent of the total growth in hospital employment) compared to non hospital settings (138,000) over this period, older RNs account for essentially all of the growth in RN employment in non hospital settings. In contrast, during these same years the net employment growth of middle-aged RNs (ages 35–49) was negative, with the estimated decrease in non hospital settings (–55,000) overwhelming the increase in hospital employment (31,000). NURS 3000 – Issues and Trends in Nursing Essay Paper

Younger RNs in the workforce (under age thirty-five) account for 28 percent of the total increase in RN employment (33 percent of the growth of hospital RN employment and only 6 percent of the growth in non hospital settings). A closer examination of this age group shows at least two components of this increase. First, the total number of RNs ages 23–25 surged to a level in 2008 (130,000) not seen in more than two decades, suggesting that nursing may be an increasingly attractive career option for young women (Exhibit 3 ). Second, there was a large increase (about one-third over the level in 2007) in 2008 in the number of FTEs contributed by RNs ages 21–34 with children under age six (data not shown). That appears to be a recession-related phenomenon, as mentioned earlier. Overall, most of the increased employment of younger RNs (under age thirty-five) from 2001 to 2008 occurred during 2006–08, particularly in 2008, when employment among this group increased by 74,000. NURS 3000 – Issues and Trends in Nursing Essay Paper

The second trend shaping the composition of the workforce is the increased employment of foreign-born RNs. Because the CPS asks respondents to identify country of birth, we use “foreign-born” rather than “foreign” or “internationally” educated to describe the growth of such RNs in Exhibit 2 . 10 In 1994, 9 percent of the total RN workforce was composed of foreign-born RNs, but by 2008, this percentage had increased to 16.3 percent (or an estimated 400,000 FTE RNs, using CPS data). Of those 400,000, roughly 10 percent indicated that they had immigrated to the United States within the previous five years.

The increasing proportion of foreign-born RNs is particularly noticeable in this decade: from 2001 to 2008, the total FTE RN workforce increased by 476,000, and fully one-third (155,000 RNs) of this increase was supplied by foreign-born RNs. In 2008 alone, the number of foreign-born FTE RNs increased by a record 48,000. Three times as many foreign-born RNs worked on FTE status in hospitals (approximately 119,000) compared to non hospital settings (35,000). The increasing proportions of older and foreign-born RNs in recent years provide a more complete picture of how the nurse workforce is changing, suggesting that employers and policymakers will be dealing with these trends for many years. NURS 3000 – Issues and Trends in Nursing Essay Paper

Long-term changes in the workforce.
Since 2000 we have published projections of the future age and supply of RNs. As noted earlier, our projection model uses RN data from the CPS to estimate cohort, age, and population effects to yield information needed to generate projections. As new information about the nurse work-force becomes available, such as changes in employment or an increase in numbers of younger RNs entering the workforce, we have re estimated the model using the most recent data available. This has allowed an ongoing assessment of whether progress is being made in increasing the long-term supply of nurses. We and other workforce analysts have consistently projected a large shortage of RNs in the coming decade, but there is much variation in the timing and size of the projected shortage as a result of differences in assumptions, methods, models, and data sources. 11

Projections of the future age and supply of RNs.
Our new projections find that the surge in entry into the workforce in recent years, particularly among younger RNs, affects the future age and supply of the RN workforce. Our projections rest on two assumptions. First, we assumed that future cohorts will enter the nurse workforce at the elevated rate of the most recent cohorts who are now ages 23–25. This assumption might not hold if this entry is a temporary surge driven by the economic downturn, as noted above. However, this seems unlikely, because many of these RNs began nursing education programs and entered the labor market before the current recession started. A more likely explanation is that the increased entry of younger RNs into the workforce results from efforts to promote nursing as a career. NURS 3000 – Issues and Trends in Nursing Essay Paper

Second, we assumed that these recent cohorts would follow the same life-cycle pattern that we have observed in previous cohorts, where large numbers enter nursing in their late twenties and early thirties. But this might not be the case if, in fact, we are observing a shift from late entry into nursing to early entry (that is, a reversal of the change we saw in the 1990s toward later entry into nursing). More important, if there is a reversal in the age of entry into the workforce, or if many new RNs leave the workforce permanently soon after entering because of changing economic conditions, then our model’s assumption that large additional numbers from these recent cohorts will enter nursing in their late twenties and early thirties will be overly optimistic, and our projections of the size of the future workforce will be too high. NURS 3000 – Issues and Trends in Nursing Essay Paper

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Given these assumptions and the uncertainty surrounding them, Exhibit 4 reflects the recent increase in numbers of younger RNs and our new projections indicating that the average age of the RN workforce will not increase as rapidly as our earlier projections suggested. 12 The average age of FTE RNs (now at 43.8 years) is projected to increase slowly over the forecast period, peaking at 44.1 in 2014 and returning to 43.7 by 2025, whereas earlier projections indicated the average age increasing to nearly 46.0 years by 2020. Our new projections also indicate that the supply of FTE RNs will be greater in 2025 compared to our earlier projections—reaching nearly 2.8 million FTE RNs (compared to the 2.5 million in the workforce observed today). Yet despite the recent swell in RN workforce entry, our projections indicate a shortfall of RNs developing around 2018 and growing to about 260,000 by 2025. These deficits are based on a comparison of our projected supply to the Health Resources and Services Administration’s (HRSA’s) most recent estimates of RN requirements shown in Exhibit 4 . 13 Although this represents a notable improvement compared to earlier projections, the magnitude of the 2025 deficit would still be more than twice as large as any nurse shortage experienced since the introduction of Medicare and Medicaid in the mid-1960s. NURS 3000 – Issues and Trends in Nursing Essay Paper

The projected shortage and slower growth in the size of the future workforce is driven by large baby-boom RN cohorts retiring during the next decade and being replaced by smaller cohorts of RNs following them (those born in the 1960s). Larger cohorts born in the 1970s and 1980s will prevent the workforce from shrinking but are still not large enough to add enough RNs to meet the projected demand. Finally, if these projected shortages develop (which, of course, depends on how much future demand increases), then they will fall upon a much older RN workforce than did shortages that occurred in prior decades.

Discussion And Policy Implications

Given the impact of the current recession on RN employment, the changing composition of the RN workforce, and projections of a large shortage of RNs during the next decade, what actions can be taken to strengthen the current nurse workforce and expand the long-term supply? NURS 3000 – Issues and Trends in Nursing Essay Paper

Strengthening the current workforce.

As the recession continues and results in national unemployment rates’ remaining high or increasing in 2009, employment among existing RNs is likely to persist at current levels and may even increase during 2010. Consequently, a mix of outcomes are expected: real RN wages are unlikely to increase, as employers (particularly hospitals) will not need to offer pay hikes to induce employment; vacant RN positions will be filled, and many hospitals will report an end to the nurse shortage; some new nursing graduates will experience difficulty finding jobs; nursing education programs could experience an increase in demand, as some people who are attracted by the relative job security and earnings offered in nursing seek to become RNs; and the capacity of some education programs could be affected negatively by state budget reductions. 14 Recent evidence indicates that the recession could also result in the loss of RN jobs as hospitals face losses in investment income, increases in numbers of uninsured patients, and decreases in elective procedures. 15 Because some employers and policymakers may interpret these outcomes as indicators that the “nursing problem” is over, attention could shift away from the nursing workforce and toward other matters. This shift in attention could be unfortunate, because an easing or end to the current shortage brought about by the recession gives employers and nurses a chance to “catch their breath” and focus their efforts on addressing the implications of the changing composition of the RN workforce. NURS 3000 – Issues and Trends in Nursing Essay Paper

Because our projections suggest that the proportion of older RNs in the work-force will continue to increase for several years (the proportion of the workforce that will be ages 50–64 is projected to peak in 2015, at 36.4 percent), efforts should be made to improve the ergonomic environment of the clinical workplace. Relative to younger RNs, older RNs possess greater knowledge and clinical experience, which can be particularly valuable in detecting patient complications and intervening to prevent the complication from worsening the patient’s condition or even causing death. NURS 3000 – Issues and Trends in Nursing Essay Paper Patient surveillance is likely to become an increasingly important nursing function, as the number of aging baby boomers with multiple chronic conditions and comorbidity increases in the years ahead. 16 But because older RNs are more susceptible to injury and take longer to fully recover once injured compared to younger nurses, now is the time to concentrate on improving the ergonomic environment and invest in building up nurses’ physical health. 17 Not only will retaining older RNs in the workforce bolster the overall supply of RNs, but their continued presence could make an important difference in the quality and safety of patient care. Once the recession ends and unemployment rates begin to fall, an improved ergonomic environment may help retain many older RNs, who otherwise are likely to withdraw from the workforce.

Role of foreign-born RNs.
Continuing pressures to increase the quality and safety of health care are likely to eventually raise questions about the relationship between RNs who immigrate to the United States and the quality and safety of patient care. NURS 3000 – Issues and Trends in Nursing Essay Paper Because it is well known that lapses in patient safety are linked to communication breakdowns, and because it is acknowledged within some nursing circles (if quietly) that some internationally educated RNs have difficulty with communication because of language or cultural differences, questions may arise over the safety of care provided by RNs educated in other countries. However, there is currently a gap in knowledge about the relationship between nurses’ communication skills and patient safety, and we are unaware of any comparative assessments between U.S.- and internationally educated RNs on care outcomes and safety. Thus, more research is needed to investigate these relationships. Should results suggest a reason for concern, then interventions can be developed to improve communication skills among both U.S.- and internationally educated RNs. In light of projections of a large nurse shortage developing during the next decade, it is likely that the demand for RNs educated in other countries will increase; the easing of the current shortage provides a good opportunity to investigate this potential safety concern. NURS 3000 – Issues and Trends in Nursing Essay Paper

Expanding the long-term supply.

We attribute the improved outlook for the future and the large 2008 increase in hospital employment to the following: (1) the economy-driven boosts in hours and reentry among RNs who might have otherwise not participated in the labor market (for example, the percentage of RNs working part time in 2008 was 17.4 percent, the lowest observed in our CPS data set); and (2) the increased entry of young RNs, some of whom recently finished their nursing education. The career choices for this latter group predated the recession and thus can be attributed not to the recession but to initiatives to encourage nursing as a career. 18 Yet the ability to expand the long-term supply of RNs is in doubt. Since 2002, nursing enrollments have increased so briskly that each year approximately 30,000 or more qualified applicants have been turned away from nursing education programs. Thus, barriers are blocking the needed expansion of the long-term supply.

We believe that an objective analysis of the structural barriers that restrict capacity (for example, reports of shortages of faculty, inadequate classroom space, lack of clinical education sites, and budget shortfalls) would be beneficial to policymakers. 19 Specifically, a national study conducted by a respected, independent body such as the Institute of Medicine (IOM) could investigate these and other possible capacity constraints to determine their prevalence and severity. Also needed is a careful assessment of the private- and public-sector options that are the most likely to effectively expand capacity rapidly, can be implemented quickly, and are the least costly. Then specific actions for public and private policymakers can be undertaken to implement recommendations. NURS 3000 – Issues and Trends in Nursing Essay Paper

Men and Hispanics are a readily available source of prospective nurses who could take advantage of an expansion of educational capacity. Currently, an estimated 9 percent (218,000) of the RN workforce is male and 5 percent (125,000) is Hispanic. Both groups are greatly underrepresented in nursing relative to their proportion in both the population and the overall labor force. Whereas African Americans were once underrepresented, they now account for roughly 11 percent of the RN workforce, which is equal to their proportion in the overall workforce (in contrast, Asians are not underrepresented in the nurse workforce). The stigma of nursing as a traditionally female-dominated profession is believed to be one of the major factors discouraging men from becoming nurses, and the stereotype of RNs as white women may discourage women of color from choosing a nursing career. NURS 3000 – Issues and Trends in Nursing Essay Paper In addition, there is also a lack of role models and mentors for men and Hispanics considering nursing as a career. Financial and educational barriers may also discourage Hispanics from becoming RNs. However, if these barriers could be removed, then it is not unreasonable to expect that men and Hispanics could add enough new RNs into the workforce to avoid the projected deficit through 2025. 20 Until both the structural and social barriers to increasing the capacity and output of education programs are removed, it will be difficult to expand the long-term supply.

W e anticipate that the continuing recession will ease or even end the current shortage of RNs in many areas of the country. Relief from the shortage provides an opportunity to strengthen the current workforce by improving ergonomic environments and addressing the potential safety-related implications of relying on increasing numbers of internationally educated RNs. However, some employers and policymakers may find the easing of the current shortage an irresistible temptation to look away from the nurse work-force and spend their time on other issues. As the public hears reports that the current shortage is ending or that nursing positions are harder to find, interest in the nursing profession may wane, and some people may be less inclined to enter nursing during the next decade, when they will be needed most. To meet growing long-term demand, these anticipated responses need to be countered by messages directed at employers indicating that relief from the current shortage is temporary and driven by the recession; the public must hear messages that emphasize the long-term opportunities in nursing; and policymakers and educators need to hear messages that reinforce the need to preserve budgets for nursing education and remove the barriers to rapidly expanding the size of the future RN workforce. NURS 3000 – Issues and Trends in Nursing Essay Paper

Emerging trends in nursing
What are the current trends in nursing?

Seun Ross

There continues to be substantial movement to community-based care; increasing numbers of RNs are in public and community health and practicing care coordination in the community. Nurses are opening businesses to help manage patients and working for Fortune 500 companies like Coca-Cola. More nurses are innovating—Johnson & Johnson has a great program, and ANA is advancing nurse-led innovation. It’s also exciting to see that more nurses are stepping into the political arena.

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What brought about these changes?

Community-based nursing and the tech boom began ramping up in the late 1990s and early 2000s. To counter nursing shortages, electronic intensive care units (E-ICUs) were established, mostly in rural areas, to enable out-of-state nurses to monitor patients remotely via video camera. That’s when hospitals and other healthcare facilities started to look to robotics and machines for some nursing tasks, like stocking rooms and even monitoring patients. NURS 3000 – Issues and Trends in Nursing Essay Paper

Nursing is always changing—sometimes quickly, sometimes slowly. It’s helpful to step back once in a while and look at of some of the biggest developments in the field to know what’s ahead so you can be prepared to face new challenges and continue to thrive in your nursing career.

More Outpatient Care

Outpatient care is in demand due to a number of factors, including pressure to keep down costs and more effective technologies and treatments that have eliminated the need for overnight hospital stays. Financial constraints, such as high insurance deductibles, have also caused many patients to put off elective procedures. However, these patients often still require extensive medical attention, hence the need for more outpatient facilities and care. Nurses will also find opportunities in outpatient settings such as ambulatory care clinics, rehabilitation centers, and clinics attached to assisted-living facilities, and even telehealth providers. NURS 3000 – Issues and Trends in Nursing Essay Paper

The Importance of Cultural Competency

At its core, health care is about people, and different people have different needs. That has never been more true in the U.S. health care system than today, when nurses are helping individuals, families, and groups from ever more diverse backgrounds. Nurses who are who are sensitive to the cultural habits, traditions, and beliefs of their patients will be able to provide care that takes these into account. For example, some patients may speak English as a second language, affecting their understanding of directions or medical terminology; patients from certain religions may have dietary restrictions; and some individuals come from cultures where they fare best when they are surrounded by family rather than isolated in a hospital room. NURS 3000 – Issues and Trends in Nursing Essay Paper

Preventive Health

Wellness continues to be a growing issue in health care, especially as organizations move to keep costs down as they improve outcomes. Patients are becoming savvier about maintaining their own wellness, from modifying their diets to wearing trackers that measure their activity levels. Nurses can help by focusing on measures to prevent chronic illnesses such as diabetes, slow down or mitigate the effects of aging on the body via exercise, and improve overall wellness—as well as by educating patients about what further steps they can take on their own to improve their health.

Increasing Consumer Sophistication

Patients are also extremely knowledgeable about where to turn for health information, often doing their own research on the Internet. Consequently, patients may come to appointments with their own possible diagnoses and suggested treatments and medications. Such awareness can be as potentially harmful as it is helpful, forcing nurses to sort through possibly flawed information and incorrect assumptions as they perform health assessments. NURS 3000 – Issues and Trends in Nursing Essay Paper

The Rise of Nurse Informatics

As technology produces more data, supports better record keeping, and allows for detailed analysis, health informatics has become increasingly important in health care. Similarly, nurse informatics can support evidence-based nursing practice and improved patient care through better data collection, information analysis, easier and faster collaboration between health care professionals, and identification of both large- and small-scale health and patient trends. As they are situated on the front lines of patient care, nurse informatics are especially suited for playing a greater role in health care planning and decision-making. NURS 3000 – Issues and Trends in Nursing Essay Paper

Current Nursing Trends and Issues

Apart from the population that is aging, there is a steady transformation towards bioinformatics. This is another trend in nursing whereby there is dependence on bioinformatic due to the changing technology.For instance the use of technology when it comes to recording medical information for accuracy and accessibility. This challenges most of the nurses because some may lack knowledge in technology. Additionally, the shortage of nurses is also a current issue because of lack of degrees and program mes that are advanced. This is an issue as it affects the patient especially when errors are made. NURS 3000 – Issues and Trends in Nursing Essay Paper The outcomes of the patients have also been affected by the introduction of evidence-based practices in the nursing profession. This encompasses the positive outcomes that promote the sense of ownership by nurses (Linda, Geraldine, & Katherine, 2012).

The paper aims at identifying one current nursing trend or issue that has had an impact on healthcare. The issue I intend to discuss is the implementation of evidence-based practices in the nursing profession. Evidence-based practices have enables the patients to have more positive results when receiving health care.

Background of the current trend or issue

According to Stevens (2013), implementing evidence-based practice (EBP) has had a huge impact on nursing as a profession. EBP has ensured that knowledge is applied in healthcare so that there can be improved outcomes for the patients. EBP is described as the integration of evidence that is dependent on research from the clinical expertise that ensures that the values of the patients are upheld. Through EBP, the preferences of the patients are included in healthcare. The definition of EBP touches on the clinician’s experience so that more knowledge is impacted in healthcare. NURS 3000 – Issues and Trends in Nursing Essay Paper

The process of EBP entails application of what has been researched in nursing as well as healthcare. This element ensures that advanced forms of evidence are obtained. The healthcare system is able to create new roles as well as teams. Shojania and Grimshaw (2005) affirm that EBP leads to other fields of sciences that help in building more evidenced-practices.

The introduction of EBP into the nursing arena has brought a major shift thus considered as a current trend or issue. The shift was seen in how nurses approach research in a bid to change healthcare in general. They have contributed significantly in discovering new approaches that help in creating positive results for the patients. Nurses have become owners of their individual achievements as they are more involved in implementing, reporting and conducting various aspects in healthcare. NURS 3000 – Issues and Trends in Nursing Essay Paper

National experts have called for other recommendations that will transform healthcare. Through this, more nurses have directed their efforts towards initiatives that make them more valuable such as engaging in research developing models and theories and adopting various practices.

Impact of EBP

EBP has affected the nursing practice as well as education and research. For successful implementation of EBP, healthcare professionals and nurses need to ensure the adoption of policy makers and providers of individual care. The policy makers include state, federal, local and other regulatory bodies.

After its introduction, nurses have revealed a positive attitude towards EBP because of the desire to acquire more skills and knowledge about healthcare. Nurses have continuously led inter-professional teams so that the systems of delivery may be competent and with EBP, they have been able to change healthcare. The competencies they consider ensure appropriate use of their knowledge in making clinical decisions. Thus research on EBP mainly provides the evidence of various interventions to other providers. The main competencies for professions in healthcare include the following: NURS 3000 – Issues and Trends in Nursing Essay Paper

Provision of care that is centered on patients-The differences, needs and preferences of the patients should be identified. This will help the professional to communicate effectively with the patient as well as their families.
Utilizing interdisciplinary groups-Working in teams is helpful when it comes to integrated care since it ensures continuity and reliability.
Use of evidence-based practice-The values of the patients should be considered thus use of the appropriate research that can be integrated into practice.
Use of informatics-This entails using technology to gather information and knowledge.
Improvement of quality-Medical errors should be noted from time to time so that safety principles become applicable such as simplification and standardization.
EBP has helped in minimizing the issues of safety of the patients. However, there are certain challenges that are experienced when it comes to its implementation into nursing practice. First and foremost, a complex plan for implementation is required before the full adoption of evidence-based practice. Although a policy of agency can be set, sustaining it may bring more challenges.

Recommendations for managing evidence-based practice in nursing

There are various models that were developed earlier when EBP was first introduced. The models were created by nursing scientists so that the different aspects regarding EBP could be understood. Also, the models are crucial in designing the approach towards making decisions when it comes to evidence-based practices. There are forty-seven EBP models that are prominent. NURS 3000 – Issues and Trends in Nursing Essay Paper

One important aspect is the Ace Star Model of Knowledge Transformation. According to Stevens (2004), the model was established to provide an easier approach for evidence to be translated into practice. This encompasses comprehending how EBP is transformed into nursing.

Conclusion

Nursing practice has continued evolving from time to time. The environment of healthcare has been affected by various factors thus the need for the improvement in practices of healthcare. The trends experienced may be negative or positive or both. The changes are seen in the populations, technologies, shortages of nurses and integration if evidence-based research.

3 Current Trends in Nursing

The field of nursing is rarely static. Being aware of the driving forces in any field helps individuals find a competitive edge in research, academics and their careers. Three current trends in nursing relate to technology, preventive care, and nursing education, all of which are interconnected and interdependent. NURS 3000 – Issues and Trends in Nursing Essay Paper

Technology

To improve patient outcomes, many hospitals have launched their own clinical decision support systems (CDSS) to provide appropriate, relevant, person-specific data. The CDSS is a tracker that improves the administration of pharmaceuticals, allows faster reactions time to adverse effects, and keeps better track of outcomes to inform future decisions. Such gains in technology affect many aspects of nursing, including the methods healthcare professionals use to prevent the spread of disease, keep data secure and protect patient privacy.

Prevention

Prevention has been especially popular for U.S. policymakers for its ability to cut costs. With a relatively low upfront cost and a long-term ability to reduce chronic illness, preventive healthcare is one of the biggest trends in nursing. Today, technology has become one of the leading factors for disease prevention. Wearable technology and CDSS come together to give healthcare professionals the information they need to prevent an acute problem from becoming chronic. Nurses will need to understand the value of this technology, how to use it, and how to protect patient privacy. NURS 3000 – Issues and Trends in Nursing Essay Paper

Education

The introduction of the Affordable Care Act brought additional patients into the healthcare system; patients who may have once relied on the emergency room for help can now schedule regular visits with a primary care provider. These changes are placing greater demands on the healthcare system, which will therefore require a larger labor force, making nursing education more important than ever. NURS 3000 – Issues and Trends in Nursing Essay Paper

The current trends in nursing are interconnected; to be a truly successful nurse, one must understand each trend and the underlying dynamics. The changing demographics of the patient population have put a strain on the healthcare system, increasing the demand for solutions. Improved nursing education teaches nurses how to use new technology and protect patient privacy. Ultimately, the use of technology to improve patient outcomes along with preventive healthcare measures are some of the best vehicles for reducing healthcare costs. NURS 3000 – Issues and Trends in Nursing Essay Paper