Nurses often begin their careers with a shared vision - to make a difference.
Historically, that difference has been made almost exclusively at the bedside, where nurses serve as their patients' confidant, advocate, teacher and most-trusted caregiver.
But, today, the nurses' role is expanding to keep up with the evolving healthcare market, and nurses are seeking the higher education and expanded knowledge they need to challenge the status quo and transform their profession.
The timing has never been more urgent. The Patient Protection and Affordable Care Act is about to add more than 30 million people to America's already stretched healthcare system.
The confluence of these individuals, along with the reality of people living longer and a graying society, portends that in the next decade the U.S. will face a shortage of at least 40,000 primary care doctors.
Nurses are viewed by many as the best resource to fill that void.
Along with new patients, advanced diagnosis and treatment of more critically ill and injured patients has also significantly increased in the past couple of decades. Combined with the explosion in technology and pharmaceutical treatments, these factors have created a much higher demand for critical thinking, advanced degrees and specialized certifications for nurses.
"Just a generation ago, there was little science backing the practice of nursing," said Courtney Lyder, ND, ScD (hon), FAAN, dean of the UCLA School of Nursing. "Nurses relied on instinct and trial and error. But today, the practice of nursing is being redefined. Nurses are exchanging ideas and forging collaborations globally. They are addressing important health challenges and they are pushing the scientific frontiers as never before."
To support the changing role of nurses, forward-thinking hospitals across the country are developing innovative programs to provide the necessary training and education nurses now need to meet these challenges.
Institute for Nursing Excellence & Innovation
Huntington Memorial Hospital recently launched the Institute for Nursing Excellence and Innovation, designed to further enhance training and preparation of its nurses.
The 625-bed Magnet hospital located in Pasadena, CA, is renowned for its programs in neurosciences, cardiovascular services and cancer care.
"The goal behind the new Institute for Nursing Excellence and Innovation is to offer a solid infrastructure that will provide advances in nursing innovation, evidence-based practice and nursing research," said Bonnie Kass, MBA, BSN, RN, vice president of patient care services and chief nursing executive at Huntington Memorial Hospital.
The institute's Nurses Scholars Program will bring together new nurses with seasoned hospital nurses for one-on-one mentoring, counseling and support. In addition, the institute will offer 25-week specialty training programs in critical care, emergency medicine, obstetrics, neonatal intensive care, surgery, pediatric intensive care and other areas.
"We work in a complex environment and it can be overwhelming for a newly hired or a novice nurse. Every hospital has its own formal and informal rules, customs, culture and workplace norms," said Kass. "Our preceptors are going to be experienced staff nurses who will serve as role models and trusted advisors. We want to create an environment that promotes learning, an environment where new nurses are not afraid to ask questions."
The institute also includes an on-site BSN program in collaboration with Western Governors University, in which students will have access to Huntington-based faculty through a combination of online classes, lab work and bedside clinical rotations.
The institute also hopes to fund nurses wishing to present research projects at regional and national conferences, and already funds a doctoral-prepared nurse researcher and a nursing research fellowship.
"Our goal is to reach out to every member of our nursing staff," said Kass. "For the new nurses, we want to provide additional clinical support and mentors to help them develop their abilities and their confidence as they transition from student to a professional nurse. And for our veteran nurses, we want to empower them to continue to learn and strive for excellence."
In October 2010, the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation published a landmark report, The Future of Nursing: Leading Change, Advancing Health. The report makes eight recommendations for developing a highly trained nursing workforce ready for a leadership role in the evolving healthcare system. Of particular note, the report emphasizes the need for healthcare organizations to support and sponsor nurse residency programs designed to smooth the transition from the school setting to clinical practice.
"By nurturing our young nurses and providing them with a strong education and post-graduate education, we are ensuring a nursing team that's poised to play a key role in providing patient care, implementing national health policy and creating the science that will make an immeasurable impact on the nation's health," said Lyder.
The Versant RN Residency, prominently featured in the IOM report's call for mandatory nurse residencies for new graduate nurses, was founded at Children's Hospital Los Angeles to better prepare recent nursing school graduates for the complex patient needs of the pediatric Magnet hospital and to address an ongoing shortage of qualified nurses. Today, Versant's yearlong residency is offered nationwide with more than 11,000 nurse resident graduates.
"Our fundamental mission is to develop and sustain the professional nursing organization's ability to provide safe, efficient patient care," explained Larissa Africa, MBA, RN, vice president and chief operating officer of Versant Holdings, LLC, who began her nursing career in the first RN Residency class at Children's Hospital Los Angeles. "We employ our residency-based model to assist hospitals in transitioning new graduate nurses to practice, assisting experienced nurses as they transition to new specialty areas and departments, and to address specialty strategic staffing challenges, such as developing operating room nurses."
Recommendations & Changes
The Carnegie Foundation for the Advancement of Teaching is also calling for changes in the education of nurses, noting the profound changes in science, technology and the nature and settings of nursing practice. The authors of the 2010 report Educating Nurses: A Call for Radical Transformation - which draws from three national surveys and extended site visits during a multiyear study - recommend changes in both policy and curriculum. One of the major findings from the study is that today's nurses are undereducated for the demands of practice.
NYU Lagone Medical Center in New York requires all baccalaureate new graduate nurses to participate in a 1-year program designed to promote professional practice through specific clinical and educational activities. Special educational activities are scheduled throughout the year, including seminar days, mentorship, clinical observation and support.
Nurses in many medical settings are already increasing access to health services, organizing complex care plans, preventing medication errors, reducing infection rates and transitioning patients from the hospital to home. As American Nurses Association President Karen Daley, RN, recently said in an article (Hospitals & Health Networks, March 12, 2012), "nurses have so much to contribute to patient care by means of quality and efficiency. . we haven't begun to tap even a small percentage of their potential."
Elena F. Epstein is a contributor to ADVANCE.