From the Desk of...
Marilyn Chow, DNSc, RN, FAAN
The recent release of the Institute of Medicine/Robert Wood Johnson Foundation report on the future of nursing ("Leading Change, Advancing Health," www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx) calls on nurses to be on the forefront of reshaping healthcare in America as full partners with physicians and other healthcare professionals. ADVANCE recently discussed the report's finding with Marilyn Chow, DNSc, RN, FAAN, vice president of national patient care services for Kaiser Permanente, Oakland, CA. Chow is excited by the future the report holds as it provides a framework to reinvent the profession.
Chow said the report offers both opportunities and challenges, unlike any others presented to nursing before. Nurses' roles, responsibilities and education will have to change to meet the changing healthcare landscape and advance improvements. In addition, nurses will be called on to practice to the full extent of their scope of practice while continuing to learn and grow as nurses through continuing education and training.
"The report means nursing is going to have to change as a profession," Chow explained. "It will be up to us as a discipline and profession to partner with other members of the care team."
Chow said the paradigm of professional practice has become more dynamic as it responds to the evolution of healthcare and changing patient needs.
"Nurses need to be clear on their role," she said. "Hierarchy is out; it's all about teams now. Nurses are an important part of that team, not a substitution for other members. It's not about who's running the team - we need all the players to ensure healthcare moves forward in a positive way."
Nurses must be clear with role delineation - everyone has a function, Chow said.
"The only approach that works is working as a team," she said. "It's an efficiency that's effective and important. Nurses must have clarity on what their role is, and continuing education helps with that. Each of us must take individual ownership of our own educational journey, which must keep going to keep us all growing as professionals."
At the same time, factors can conspire to draw attention from the task at hand. Nurses can help to innovate and redesign healthcare from the patient's point of view.
"With the complexity of care, the growth of technology and the assessment process, nurses can get caught up in activity, the tasks that need to be done, and lose the caring part, the touch, the hands-on approach to the patient," Chow said. "It's up to us to step back and say, 'Let's look at workflow and how we care for our patients. How would it be if you designed the care plan from their standpoint?'
"Think of the patients on their journey," she continued. "Hospitalization is just a blip on that journey. What would it be like if you didn't render them helpless, but if you could use the time to teach them and get them ready to go home? The nurse's role expands to be not just a caregiver, but also a teacher, mentor and facilitator."
While she's looking forward toward the new frame of reference for nursing, Chow also takes a look back.
"Nursing's value and contributions will be highlighted in 2011," she said. "I would like to see us get back to our roots in a way. Nursing plays a critical role in care, compassion, care coordination, teaching and transition of care. It's time for nursing to re-imagine how we live that care in terms of bringing values and beliefs to nursing care.
"The IOM report is really a call to each individual who's chosen nursing as a profession to get re-energized at the core of the profession," Chow continued. "The public needs that level of care."
Candy Goulette is regional editor at ADVANCE.