Medical & Health // Evolving Practice of Nursing and Patient Care Delivery Models
Evolving Practice of Nursing and Patient Care Delivery Models
Growth and Changes of the Practice of Nursing
The 2011 report of the Ad Hoc Committee formed by the Robert Wood Johnson Foundation and the Institute of Medicine delineated the growth, changes and the future of nursing practice (IOM 2011). Entitled “The Future of Nurses: Leading Change, Advancing Health,” the report’s key messages and recommendations convey the current and prospects of the practice. As a whole, the report traces and determines how nurses;’ roles, responsibilities and learning must be adjusted in responding to the ever-rising demand for healthcare by an estimated 32 Americans in prospect. The report predicts that this can be met through health care reform and the needed level of advancement or improvement of the country’s intricate health system today. The more than three million nurses comprise the biggest workforce group that is called forth to meet this demand. They are also the health care professionals who spend the largest amount of time delivering professional patient care. Their contribution in partnering with other healthcare professionals is, hence, fundamental in improving the quality and safety of healthcare set as the goal of the Affordable Care Act or ACA (IOM, 2017).
In the fervent and massive act of redesigning health care in the United States at present, nurses needs not only to more comprehensively fuse their learning and skills with fellow healthcare professionals (IOM, 2017). They must also be able to take an active leadership role in the redesigning task. Residency training for them is called for in addition to attaining the 80% bachelor’s degree goal by 2020 and twice the number of current nurses with a doctorate degree. Moreover, institutional and regulatory barriers should be dispensed with. These barriers include the traditional limits set to nurses’ practice. This radical adjustment will allow nurses to fully realize and benefit from their training, skills development and learning on patient care (IOM, 2017).
Shortages, Shortfalls in Care Projected
Increasing rated of chronic diseases and multiple morbidity present the portent of shortages in the number of healthcare professionals and imbalances in primary care delivery (Maier et al, 2016 p 1). A cross country analysis of the national nursing registries, regulatory entities and statistical as well as health professionals and population data of six OECD countries evaluated their annual growth for the 10-year cross-country study and the extent of their practice advancement. Participating OECD countries to the study were Australia, Canada, Ireland, the Netherlands, New Zealand, and the USA. Of the six, the USA had the biggest number of nurses at 40.5 for every 100,000 people. Annual growth rates of nurse professionals are high in all participants. Growth rates are highest in the Netherlands at 27.8%. The increase in the number of physicians is three to nine times higher with physicians in the participating countries. Supporting literature review to the cross-country analysis but with limited evidence also reveals that nurse practitioners or professionals in these countries provide 67 to 93% of primary care services (Maier et al, 2016 p 1).
The cross-country study concludes that nurse professionals or practitioners are the fast growing workforce sector with the highest potentials for advanced practice in providing primary care (Maier et al, 2016 p 1). It is, therefore, critical that only accurate data should be used in monitoring the workforce and in obtaining information on their educational and skills capabilities as well as workforce planning (Maier et al, 2016 p 1).
Feedback from and by Nurse Colleagues
Changes through Reflection
Reflection is a basic mental process of primary significance in all professions, particularly in nursing practice It involves self-talk or self-conversation with oneself that forms meaning. Everyone engages in self-conversation but many are limited in expressing the result or meaning of their reflections or self-talks (Okuda & Fukada, 2014). A study determined the changes that can be realized or implemented through dialogues on reflection about nursing practice. The result of the study would be of specific significance to facilitators (Okuda & Fukada, 2014).
The study had nine nurse volunteers from three institutions in a city with an estimated 200 beds in total (Okuda & Fukada, 2014). Reflections and reflection dialogues served to assess topics that proceeded from them. The participants’ depth of reflection was appraised according to three levels, advanced by Mezirow. These were content, the process, and the assumptions. They were further dvided into groups according to their achieved level of reflection. Those in the highest level could reflect on assumptions through self-reflection. The rest remained at the lowest level of reflection on processes despite the use of reflective dialogues (Okuda & Fukadu, 2014).
Reflective thinking is material to nurse professionals in their struggle to accept their respective experiences (Okuda & Fukada, 2014). It also appears to be linked with their capability question and examine themselves about their own perceptions and judgments about their practice (Okuda & Fukada, 2014).
Feedback from Colleagues
The IOM-Robert Wood Johnson Committee Report weaves around the four themes of improvement and increase of nursing education, assisting nurses reach the fullest extent of their training and education, culture and systems within an environment of partnership between nurse practitioners and other healthcare professionals, and improve collection data on the nursing workforce (Brooks, 2011). One nurse colleague who commented on the report was Dr. Steven Wartman, alumnus of the John Hopkins School of nursing and President and CEO of the Association of Academic Health Centers. He was not surprised by the recommendations of the report. But he focused on the workability of the report’s context on a national scale. He referred in particular to the goal of 80% baccalaureate nurse graduates by 2020. At present, only 50% of nurses reach this figure. He elaborated that the goal to increase nursing education is desirable but not realistic. Nursing is considered a fractured profession. He spotted the obstruction between the current two-year program and the baccalaureate programs. He thus did not think that the objective was achievable (Brooks, 2011).
Dr. Karen Haller did not agree. She said that the fractured or divided image of the nursing profession is no longer existent (Brooks, 2011). Dr. Haller is vice president of Nursing and Patient Care Services of the Hospital. She noted that one appendage of the report is the consesus model on licensure, accreditation, certification and education requirements. She said that all of 50 state boards and all nursing organizations were unanimous in supporting baccalaureate –level education. They all signed the consensus model. She believed that current nurse professionals are able to measure up to the challenge with 78% of them possessing a bachelor’s degree. She also expected the figure to increase by 2% the succeeding years. She added that the majority of the School’s students comprised more than 80% who already possessed a college degree when they apply at the Hospital (Brooks, 2011).
Dean Martha Hill of the School remarked on more than one topic in the report. One was about increasing education as useful except for the institutional policies and government regulations, which step on the nurses’ way and prevent them from using their best potentials and performing at optimum level (rooks, 2017). She pointed to the unevenness of state regulations that also deterred nurses to reach their highest potential. She specified laws that either allow or prohibit advanced practice nurses from independently examining patients, order medicines, interpret laboratory results, make prescriptions, admit patients into the hospital and other services that vary among states (Brooks, 2017).”
She proudly attested to the ability of the Hospital’s nurse workforce to help bring about the changes enumerated by the IOM report (Brooks, 2017). While she noted the challenge of an enclosed and guild-like work environment that will prevent or delay the introduction of the kinds of changes listed at the IOM, she is hopeful that the necessary steps may be taken at Hopkins to reduce this restrictive environment. As it is, the Hospital had become quite collegial and cooperative. She emphasized that the School’s faculty would move in that direction as they know and fully understand that a changed environment would be the best science for them. The Hospital’s different calendars create huge problems for the Hospital. And she said she did not know if management would confront this huge problem with coolness of mind. She said that the chronic problem would be a “sword” that no one would want to fall into. And lastly, Hopkins was described as quite permissive and tolerable (Brooks.2017).
Varying Perspectives
Nurse colleagues at Hopkins had varying perspectives on the do-ableness or suitability of the recommendations in the IOM report. #
WORKS CITED
Brooks, K. (2011). The future of nursing. John Hopkins Nursing: John Hopkins School of
Nursing. Retrieved on September 16, 2017 from http://magazine.nursing.jhu.edu/2011/04/future-of-nursing/
IOM (2011). The future of nursing: leading change, advancing health. Robert Wood Foundation:
Institute of Medicine. Retrieved on September 16, 2017 from
https://www.ncbi.nlm.nih.gov/pubmed/24983041
Maier, C. B. et al (2016). Descriptive cross-country analysis of the nurse workforce in six
countries: size, growth, physician substitution potential. British Medical Journal: BMJ
Publishing Group. Retrieved on September 16, 2017 from http://bmjopen.bmj.com/content/6/9/e011901
Okudam R. and Fukani, M. (2014). Changes resulting from reflections, dialogues on nursing
practice. Yonago Acta Medica: Yottori University Faculty of Medicine. Retrieved on
September 16, 2017 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110690/
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