2020: Further Investment and Better Care for Nurses
As we touched upon in Part III of this series, it’s clear there are actions we can take in the short term to improve the conditions in which nurses currently work, but in order to guarantee long-term change, we need to take a more systematic approach, one full of concerted investment into the nursing workforce.
National Changes to Healthcare Funding
This begins with financial investment from a federal level. The Title VIII Nursing Workforce Reauthorization Act of 2019 exemplifies one major effort to increase funding to clinical education efforts by “extend[ing] advanced education nursing grants to support clinical nurse specialist programs, and for other purposes.” Of course, adding more funding and support to students is only one side of the situation. In other words, paddling faster won’t help if the wave keeps growing.
The other side of this story entails making school more affordable. Again, certain steps can be taken from a governmental level, but more -- and certainly more responsive -- power lies in the hands of schools, major corporations, and healthcare providers. This might entail growing and extending tuition aid programs, increasing debt repayment plans at hospitals, and in some cases, even offering free schooling.
Equitable Medical Education
In 2018, New York University’s School of Medicine began waiving tuition fees for all students in order to combat the national shortage of physicians as well as assuage the incredible amounts of debt students were taking on. This past year, the Kaiser Permanente School of Medicine has taken a decisive step in this same direction with its announcement offering a free medical school program for the first five graduating classes.
Kaiser Permanente’s Nurse Scholars Academy helped set the tone for this initiative. Announced in 2015, it entails a five-year initiative to “advance professional nursing, streamline the integration of best practices, and nurture future leaders at all levels of the organization.” More specifically, this program is goaled with achieving a BSN rate of 80% or high, doubling the number of doctoral-level nurses, increasing workplace diversity, and increasing the overall number of higher-educated faculty across Kaiser facilities. Our own Dan Weberg, PhD, RN was part of the team that built the nurse scholars program and the KP School of Medicine.
As we work to keep pace with a growing -- and aging -- population, programs like these are going to become more and more common, and the early adopters are going to be the most sought after and recognized programs for their openness to facing the changing realities of our healthcare system. If these efforts and the subsequent support they provide don’t become the norm soon, we’re going to find ourselves empty handed, a dollar short, and a day late.
Expanding Scope of Nursing Practice
Another way to invest further into our nursing workforce is to expand the scope of practice for both RNs and NPs. Nurses are usually the first point of contact for patients and are equipped in both skill and professional focus to best address and care for a growing population. However, school debt is crushing some nurses, and the trend to support them financially in learning is needed.
“Nurses have the opportunity to play a central role in transforming the health care system to create a more accessible, high-quality, and value-driven environment for patients. If the system is to capitalize on this opportunity, however, the constraints of outdated policies, regulations, and cultural barriers, including those related to scope of practice, will have to be lifted, most notably for advanced practice registered nurses.”
Currently, only half of US states allow full practice authority for nurse practitioners, meaning they can perform tasks including "ordering and interpreting diagnostic procedures, certifying disability, and prescribing, administering, and dispensing controlled substances." For these states, this is a huge benefit, especially with an aging Boomer population and a growing demand for health care. One place this authority makes a huge difference is in New Mexico, where rural health care faces challenges in the supply of physicians. An influx of NP residency programs is currently being used to combat this shortage. Moreover, with legislation on the line in California, now is the time to show how effective full practice authority can be.
Investing in the Individual Nurse
Investing into the nursing workforce comes full circle, of course. Yes, we need to invest in system-level components to drive the field forward, but we also need to address the human side of nursing; and by this, of course, I mean nurses themselves.
With suicide rates consistently (too) high, burnout all too common, and conditions that are less than ideal for optimum health, our efforts must simultaneously address the individual. The American Nurses Association has made a big push with Health Nurse Healthy Nation, but this is only the very beginning of what we can -- and should -- be doing.
We must do more to make sure nurses are prepared for what they might face on a daily basis. This includes dealing with the stressors of work once they’re home at the end of a shift. We must ensure that nurses feel safe at work, whether that’s through more de-escalation training or scenario roleplaying. We must also ensure that nurses receive the physical, mental, and emotional support they need to take care of themselves so that they can best take care of their patients.
In the end, nursing is about more than just caring; it’s about doing something with that empathy. However, as times change, so do the drivers of job satisfaction along a nurse’s career. Two ways we can address this are more flexible scheduling to promote more manageable working hours and career ladders premised on accomplishment over tenure. The first component is a testament to how incredibly important effective staffing (something we’re changing) is in such a demand-driven industry.
While it may seem like we’re facing a lot of challenges in nursing today, we have indeed accomplished much. If Florence were still alive today, celebrating her 200th birthday, she would be proud to see where we stand and even more so where we have to go from here. 2020 is the Year of the Nurse and Midwife. Let’s show the world why.
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