Editor's Opinion: Working Around Current Nursing Challenges
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The Committee on the Robert Wood Johnson Foundation (RWJF) Initiative on the future of nursing at the Institute of Medicine (IOM) reported on the current crisis state of acute care nursing and the dysfunctional system in which clinicians have become “masters of work-arounds.”1,2 Those of us working outside the acute care environment were not surprised the committee heard similar messages from nurses working in the community when they met again a few months later.3 I was fortunate to attend the community nursing forum — it was impressive, listening to nurses present innovative practice models to help meet the needs of our most vulnerable populations. For example, considerable amounts of “work-arounds” and creativity are required to fund the day-to-day operations of nurse-managed health clinics. Despite the fact that 46% of patients are uninsured and 37% are on Medicaid, many of these facilities have been able to keep their doors open for many years.
Financing was a concern across the board, from the Indian Health Service to long-term care facilities. According to the committee report, “Budgets for public health and community health programs are being cut at a time when these programs are needed most to care for aging populations and when greater emphasis is being placed on prevention, wellness, chronic disease management, and moving care into the community.”3
Staffing is another important concern. Home health care, extended care, and public health agencies reported that finding nurses with the right qualifications is challenging and projected to become more difficult in the future unless we see the writing on the wall and do something about it. Health Resources and Services Administration4 (HRSA) projections suggest that between 2000 and 2020 demand for nurses will increase 18% in acute care and 34% in home care. Considering the projected increase in demand and additional current challenges, the Committee concluded that, “Nursing students need to have greater exposure to principles of community care, leadership, and care provision through changes in nursing school curricula and increased opportunities to gain experience in community care settings.”
As in acute care, technology is expected to help, especially in home health care. However, as we all know, there are no magic bullets. All potential solutions require leadership, appropriate policies, effective partnerships, and qualified healthcare professionals, the last requirement a conundrum in and of itself. Baccalaureate and graduate nursing programs include community-based and public health nursing courses but, just last year, US nursing schools turned away 54,991 qualified applicants from these programs due to an insufficient number of faculty, clinical sites, classroom space, and clinical preceptors, as well as budget constraints.5
Much of what is learned about wound, ostomy, and skin care occurs outside the classroom. You, our readers, can help prepare the future generation of nurses. As experienced leaders in this field — uniquely qualified to teach staff what they must know about the evidence for and provision of care — your work-arounds must include time to guide, instruct, and encourage. Remember how much you appreciated the solicitation of your (official and unofficial) champions and mentors? Now it is your turn to pay it forward.
1. Institute of Medicine. A Summary of the October 2009 Forum on the Future of Nursing: Acute Care. Washington, DC: The National Academies Press;2010.
2. Beitz, JM. Working smarter, not harder. Ostomy Wound Manage. 2010;56(6):6.
3. Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. A Summary of the December 2009 Forum on the Future of Nursing: Care in the Community.