Nursing Today and Beyond
Introduction
There are revolutionary changes in the global health systems, and these changes are affecting the future of the nursing profession. In clinical settings, healthcare workers are at the forefront in performing many roles and responsibilities. Nurses are expected to provide patient satisfaction yet, they face professional changes that brings physical and emotional exhaustion. Challenges such as stress and burnout, providing mental health in a community setting, challenges in using telehealth technology, and challenges in cultural competency. An important point to note is that it is important to explore and understand the challenges and implement strategies to help nurses overcome the challenges they encounter. Another important point to understand is that the Institute of Medicine (IOM) has a positive impact on nursing in that it implements recommendations towards improving healthcare. It is also important for nurses to explore and understand the key message of 'Future of Nursing" for them to implement the best practices in nursing professionals. Furthermore, the Institute of Medicine has also developed five core competencies to help nurses improve health care. The committee found that patients experience many challenges merely because health care professionals do not provide optimum care. Thus, when these core competencies are applied together, nursing profession will change greatly and work toward a common vision. However, it is important to explore the obstacles that may hinder nurses achieve the core competencies and help them overcome to continue providing better care. Overall, nurses are expected to provide quality care and positive patient outcome but numerous studies have confirmed that various pressing challenges need to be addressed and create a bright future of nursing.
Challenges in nursing
Nurse burnout
In the nursing profession, nurses are working in complex organizational settings and working environment's which are rapidly changing. An important point to understand is that the global health system has changed to address the epidemics. Nurses are working in challenging situations such as lack of support from executive-level managers, lack of material respires, lack of quality improvement, lack of relationship between nursing professionals, among other issues. Dall 'Ora et al (2020) assert that in 1974, Freudenberg observed that mental health clinicians lacked motivation and commitment. Malachi introduced six theories of burnout and assert that burses experience burnout due to excessive workload, lack of sufficient resources to complete the task, lack of reward, lack of social support and connection with the manager, inequality, and limitations in employing own values. Vahey et al (2004) add that burnout is associated with mental problems and psychological distress. For example, nurses develop psychological problems and behavioral problems such as drug abuse. Health care organizations suffer from employees' absenteeism, and unable to retain staff. Nurses also are unable to provide proficient care hence lower patient satisfaction. Note that nurses feel emotionally exhausted, they became unwilling to care for patients, or in other words, they offer poor quality care. An important point to note is that according to the Institute of Medicine, performance characteristics are measured based on effectiveness, efficiency, patient-centeredness, and more (Vahey et al. 2004). Also, patient satisfaction is not achieved by looking at the effectiveness or efficiency but it is measured by looking at all aspects of care. Nurse burnout indicates that nurses will be unable to achieve the performance characteristics merely because the work environment is not favorable.
How to overcome this challenge
One way to successfully overcome this challenge is through leader empowering behavior. Mudallal et al (2017) assert that leaders should be at the forefront to create structural and psychological empowerment which will in turn lead to nurses' job satisfaction and decrease burnout. Note that nurses cannot solve the problem by themselves since they do not have control over the work environment. Thus, it is the role of the leaders to create a positive work environment. Mudallal et al (2017) assert that head nurses have the role and responsibility to manage nursing functions, create positive work environment and empower nurses. To reduce burnout, leaders should provide autonomy, they should help nurses achieve organizational goals by proving the required resources, they should recognize employees' ability and higher performance, and they should allow them to express their opinion as well as to make contributions.
Technology and telehealth nursing
Another challenge that nurses are facing today is the use of new technology known as telehealth technology. In the Journal for Nurse Practitioner, Balestra (2018) assert that nurses are using telehealth technology to provide long-distance care. On a positive note, technology has brought clinicians and patients together. Note that health care providers are meeting the needs of patients in both rural and urban settings and hence the practice is improving health care. However, nurse practitioners are facing challenges that expose them to liability issues. First, nurses have full authority within a state. However, telehealth technology allows nurses to move out of state to offer medical service (Balestra, 2018). Note that when a nurse with a single-state license moves out of a state, the regulatory authority of the new state will take legal action if the nurse lacks an appropriate license. Another challenge is reimbursement. According to the telehealth reimbursement policies, not all services are reimbursed or in other words, specific services receive reimbursement while others do not especially those performed in rural areas. The third challenge is fraud and abuse. According to the anti-kickback law, health care providers should not receive bribes or in other words, they should not have financial interests while providing services (Balestra, 2018. If a nurse receives compensation, he or she faces legal action such as imprisonment and fines.
How to overcome this challenge
To avoid the potential liability issues, one way a health care providers should do is to understand the Nurse Practice Act (NPA) not only in the state they offer services but also in other states. Note that NPA differs and thus, it is important to become familiar with the different standards of care (Balestra, 2018). On the same note, before moving across states, the healthcare provider should have the appropriate credentials. In using telehealth technology in all states, the provider should adhere to the legal requirement to avoid the risks and liabilities.
Mental health in the community
Another challenge that nurses experience today is that the community mental healthcare setting has affected the role of nursing. First, the creation of new structures in the community has introduced more role requirements. This means that nurses are working in a new nursing environment where they are exposed to emotional burnout. For example, nurses report that mental health nursing within the hospital nursing is associated with a positive working environment, support, autonomy, and emotional burnout. However, in mental health nursing within the community settings, nurses report poor colleague relationships, organizational problems, and work pressure (Farmakas et al. 2014). In Western countries, mental illnesses have increased and patients seek help from primary healthcare providers (PHC). However, the PHC is unable to meet their needs merely because they have a negative attitude towards people with mental illness. Health care provider fears that people with mental illness are violent. However, the challenge of unable to meet the needs of mentally ill people arises from a lack of theoretical knowledge (Farmakas et al. 2014). For example, in Sweden PCN lack knowledge on how to interact and communicate with the mentally ill patient and this means that the patients receive inadequate care.
How to overcome this challenge
Farmakas et al. (2014) assert that nurses need to work in a supportive work environment while working in the community setting. Note that the community environments differ from the hospital environment in that the former has more work pressure. Even though nurses enjoy independence and autonomy, they lack attractive work environments. Another way to overcome the challenges is to provide the mental health nurses with the proper knowledge for them to have confidence in their work. Nurses need more competence and clinical experience for them to develop a positive attitude and provide quality care.
Cultural competence
Cultural competency is important within the healthcare setting as it allows the healthcare providers to meet the needs of all people including racial/ethnic minorities. In other words, cultural competency allow healthcare providers to work in a different cultural environment meeting the needs of minority groups (Shepherd et al. 2019). However, nurses are facing challenges merely because they lack cultural knowledge. In other words, cross-cultural training is inadequate since nurses’ work in a complex environment where some cultural groups have different concepts about heath. Some even rely on folk health beliefs yet nurses use conventional methods (Shepherd et al. 2019). This makes it difficult to engage with patients. However, nursing attests that these challenges arise from limitations of knowledge hence they are unable to address cultural needs.
How to overcome this challenge
To improve cultural competence, there should be cultural competence training. From the study, participants recommend that the training should be performed by speakers from different cultures (Shepherd et al. 2019). Thus, the main point about cultural diversity is employing multi-cultural staff to offer training. Apart from staff diversity in cultural training, there is a need for staff diversity in providing care so that staff can speak the language to different cultural groups.
Future of Nursing Report
Key Message #3
Message #3 is very important as it states that nurses should work as a team with physicians and other health professionals. A point to note is that nurses are not only required to provide high-quality care to patients but they should go beyond and bring a positive impact to the U.S healthcare system (Shalala. 2011). To bring a positive change in the system, nurses should be adaptive- this means that they should have the capability to work in a challenging environment and also adapt to changes. Second, nurses should continue with lifelong learning because the nursing practices are changing and the curricula are updating. Thus, they should develop new knowledge and understanding to meet the changing practices. Another important point about this message is that nurses should take full responsibility not only in care provision but also in identifying problems, proposing solutions, and implementing plans (Shalala. 2011).They should also participate in decision making and express their opinions for improving care. In general, this key message #3 require leaders to develop leadership qualities and play the role of solving problems, making decisions, and adapting to the changes. This message is important to the nursing profession in that as the nurse takes a leadership role and collaborates with other professionals, they can identify problems, implement strategies, and make everything move smoothly (Shalala. 2011). Another point is that as nurses expand their roles, they will bring wide-reaching changes that will transform the healthcare system and create a positive work environment.
Institute of Medicine's five core competencies
Provide patient-centered care
This competency means that health care providers should put the patient first. This is because, many patients have developed chronic convictions and it is predicted that half of the population will develop a chronic condition (Knebel & Greiner, 2003). Recent researchers have found that health care providers treat disease but they do not put into concern patient's cultural background, job, environment, and other factors. Thus, clinicians should consider psychological and social factors during an encounter to develop a positive experience for the patient. To meet this competency, nurses should communicate effectively with the patient and allow him or her to participate in the decision making of the care plan. During the communication, the nurse should listen to the patient's views including self-management activities, individuality, and values (Knebel & Greiner, 2003). The nurse should provide care strategies as well as comfort and emotional support.
One barrier to patient-centered care is language difference. Note that while providing patient-centered care, health care providers need to interact with all patients including minority populations. If the nurse does not have language competency, he or she will not understand the patient's needs. Language barriers will cause misunderstanding and both the patient and the nurse will not be able to make decisions related to care. To overcome this barrier, there should be training for nursing staff. The training will help the nurse understand language differences and gain language competence, and more importantly, will learn how to address aggressive behaviors when handling patients from different backgrounds.
Work in interdisciplinary teams
Health care providers should collaborate with other health care professionals. Working as a team will allow the team to combine knowledge and skills hence improve care delivery. Today, the health care system has changed and nurses are working in a complex environment. Patients are suffering from chronic illnesses that demand quality care. Working as a team will address the complexities, share ideas on using the technology, and develop relative solutions. Nurses should promote teamwork through working collaboratively with other workers, participate in decision making, and propose a solution to issues.
Barriers may arise from failure to recognize other professionals' roles, hierarchical administrators may implement top-down policies, members may disagree on the opinion and rely on different goals, and members may be influenced by traditional and cultures. However, members should resolve conflict and focus on a mechanism of negotiation until they arrive at a common goal. They should develop a positive attitude toward other's opinions or in other words respect other’s values and cultures.
Employ evidence-based practice
For nurses to achieve clinical effectiveness, they should use evidence-based practice at the point to care. Evidence should be incorporated in all aspects of care including intervention, prevention, and diagnostics. For example, nurses should come up with new findings, consider the source of evidence, and connect the findings to the clinical decisions, and share the knowledge with clinicians about the available evidence.
However, nurses may face barriers to employing evidence-based practice due to lack of time to conduct research and find new practices. Time is not the only barrier but factors such as lack of nursing journals and lack of internet access may hinder nurses from gaining knowledge. However, clinicians can overcome the barriers through researching the online database and Web sites such as the Evidence-based Nursing and apply the latest evidence.
Apply quality improvement
The Institute of Medicine states that nurses should provide services that align with current professional knowledge. Nurses conduct various quality problems such as duplications of services, errors in patient safety, harm to patients, useless tests, and delay in diagnosis, among other problems. Quality improvement means that health care providers should focus on quality rather than task completion that does not bring effectiveness. Nurses can achieve this competency by putting all things into consideration that is; patients, process, outcomes, and more. They should also use the current practices, be aware of the errors and hazards, and conduct self-assessment.
However, nursing may face obstacles such as lack of information infrastructure and lack of supportive leadership. Leaders may fail to help nurses strategize on quality improvement and nurses may find it challenging. A quality improvement system is needed but nurses may lack resources for planning and implementing. Thus, the health care system should be at the forefront creating quality improvement methods so that nurses can stay on track.
Utilize informatics
Lastly, nurses should use information technology in the clinical realm. Technology such as telemedicine, e-mail, order entry systems, and other tools help nurses in making health-related decisions, communicating effectively, reducing errors, among other improvements. To achieve this competency, nurses should use tools such as data analysis software, and email.
However, nurses may face barriers such as poor usability, organizing data, lack of technical support, software challenges, and lack of training and, more. All the same, nurses should have training in technologies and ensure compliance to avoid legal issues while dealing with patient-based information.
Conclusions
Nursing is an important profession that brings positive changes in individual’s life as well in society. Nurses not only provide care but they also act as leaders and employ the managerial and technical skills in nursing quality care. Despite their positive roles, nurses face many challenges such as burnout, cultural challenges, lack of technical knowledge, and other problems that hinder them from meeting their goals. However, the paper recommends ways in which the nurses should overcome the challenges, and reminds nurses to apply the Institute of medicine core competencies and key messages in nursing practices. Another point is that nurses should apply core competencies described by the Institute of medicine to provide better care. They should be aware that to manage the ever-changing environment within the health care system, nurses need to be skilled. The competencies are the foundation of quality care and this means that these competencies will improve their practices. Overall, the health care system should sustain nurses by combating their challenges and empowering them.
References
Vahey, D. C., Aiken, L. H., Sloane, D. M., Clarke, S. P., & Vargas, D. (2004). Nurse burnout
and patient satisfaction. Medical care, 42(2 Suppl), II57.
Dall’Ora, C., Ball, J., Reinius, M., & Griffiths, P. (2020). Burnout in nursing: a theoretical
review. Human Resources for Health, 18(1), 1-17.
Mudallal, R. H., Othman, W. A. M., & Al Hassan, N. F. (2017). Nurses’ burnout: the influence
of leader empowering behaviors, work conditions, and demographic traits. INQUIRY:
The Journal of Health Care Organization, Provision, and Financing, 54,
0046958017724944.
Balestra, M. (2018). Telehealth and legal implications for nurse practitioners. The Journal for
Nurse Practitioners, 14(1), 33-39.
Balestra, M. (2018). Telehealth and legal implications for nurse practitioners. The Journal for
Nurse Practitioners, 14(1), 33-39.
Farmakas, A., Papastavrou, E., Siskou, O., Karayiannis, G., & Theodorou, M. (2014).
Challenges in mental health nursing: working in institutional or community
settings?. Journal of psychiatric and mental health nursing, 21(1), 39-45.cuture
Shepherd, S. M., Willis-Esqueda, C., Newton, D., Sivasubramaniam, D., & Paradies, Y. (2019).
The challenge of cultural competence in the workplace: perspectives of healthcare
providers. BMC health services research, 19(1), 135.
Shalala, D., Bolton, L. B., Bleich, M. R., Brennan, T. A., Campbell, R. E., & Devlin, L. (2011).
The future of nursing: Leading change, advancing health. Washington DC: The National
Academy Press. doi, 10, 12956.
Knebel, E., & Greiner, A. C. (Eds.). (2003). Health professions education: A bridge to quality.
National Academies Press.
