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nursing professions' current and future international role
1. Nursing Profession’s
Current and Future
International Role
NUR587
Team B
Dorothy Alford
Karen Coburn
Kathleen Gann
Winnie Louis
2.
3. Delivery of evidence based care
Continuing professional development
Teamwork
• Effective communication
Role awareness to decrease role blurring
Policy development
Encourage leadership development
Increased political involvement
Increased integration of healthcare services with
nursing in decision making roles
Professional advocacy
Development of standardized education and licensure
Increasing numbers of nurses with advanced or tertiary education
Promoting nursing research
4. Focus driving business is patient safety and
optimum patient care
Technology needs to increase positive patient
outcomes, decrease nursing workloads, and be
cost effective
Finances are torn between purchasing
technology and increasing nursing pay and
benefits for retention
5. Baccalaureate and
Graduate Education
Continuing Education
Focus on
Commonalities
Ethics and Values
6. Healthcare reform
Standard of healthcare
Career opportunities
Lack of education
Economic inequities
Impact of HIV/AIDS
7. Role specialization of CNS and NP
Patient care
Prescribing medications
Treatment planning
Consultation
8. Nurses Goal: Global Integration
Roles of Nurses
Delivery of EBP
Policy Development
Professional Advocacy
Global Healthcare crisis: Nursing Shortage
Compromises patient safety and excellent care
Awareness Cultural Diversity
Focus on Continuing Education
9. Christmas, K. and Hart, K. (2007). Workforce shortages are a global issue. Nursing Economics, 25(3),
p.175-177. Retrieved January 29, 2009 from EBSCOhost Database.
Cicatiello, J. S. (Apr-Jun2004). Guest editorial. Nursing Administrative Quarterly, 28(2), pp. 83-85.Retrieved
January 29, 2009 from EBSCOhost database.
Donley, R. and Flaherty, M. (2008). Revisiting the American Nurses Association first position on education for
nurses: A comparative analysis of the first and second position statements on the education of nurses.
Online Journal of Issues in Nursing, 13(2), 15p. Retrieved January 18, 2009, from EBSCOhost database.
Fullbrook, S. (2008). Professional regulation. Part 10: Professional relationships. British Journal of Nursing,
17(21), pp. 1352-1353. Retrieved January 30, 2009, from EBSCOhost database.
Hinshaw, A. (2008). Navigating the perfect storm: Balancing a culture of safety with workforce challenges.
Nursing Research, 57(1), pp. S4-S10. Retrieved January 27, 2009, from Ovid database.
Howarth, M., Holland, K., and Grant, M. (2006). Education needs for integrated care: A literature review.
Journal of Advanced Nursing, 56(2), pp. 172-182. Retrieved January 30, 2009, from EBSCOhost
database.
Jarman, H. (2007, June). Consultant nurses as clinical leaders. Nursing Management- UK, 14(3), p. 22-26.
Retrieved September 14, 2008, from CINAHL Plus with Full Text database. Kearney, G. (2008). Don’t
look back – Keep nursing moving forward. Australian Nursing Journal, 16(4), p. 56. Retrieved January
30, 2009, from EBSCOhost database.
10. Kingma, M. (2001). Nursing migration: global treasure hunt or disaster-in-the-making? Nursing Inquiry, 8: pp.
205-212. Retrieved January 29, 2009, from EBSCOhost database.
O’Conner, T. (2008). The rewards and frustrations of nursing’s top role. Kai Tiaki Nursing New Zealand, 14(9),
p. 23. Retrieved January 30, 2009, from EBSCOhost database.
Smith, C. (2004). New technology continues to invade healthcare: What are the strategic
implications/outcomes? Nursing Administration Quarterly, 28(2), pp. 92-98. Retrieved January 25, 2009,
from NUR587, week three electronic reserve reading list.
Stark, S. (2006). The effects of master’s degree education on the role choice, role flexibility, and practice
settings of Clinical Nurse Specialists and Nurse Practitioners. Journal of Nursing Education, 45(1), pp.
7-14. Retrieved January 30, 2009, from EBSCOhost database.
Thompson, P. (2004). Leadership from an international perspective. Nursing Administration Quarterly, 28(3),
pp. 191-198. Retrieved January 27, 2009, from Ovid database.
Webber, P. (2008). The doctor of nursing practice degree and research: Are we making an epistemological
mistake? Journal of Nursing Education, 7(10), pp. 466-472. Retrieved January 30, 2009, from
EBSCOhost database.
Editor's Notes
Good day everyone. We the members of Team B are going to present about Nursing Profession’s Current and Future International Role.
Nursing’s international goal is to ensure a focus on integration: supporting the continuum of care and sustained integration of services, building a more professional image and promoting teamwork across healthcare disciplines (Howarth, Holland, and Grant, 2006). Howarth et al. (2006) conducted a meta-analysis of available studies on education needed for integrated care and noted the roles of nurses in the U.S. and internationally are similar.
Describe the Roles of Nurses in the U.S. and Internationally The roles of nurses in the U.S.A. and Internationally can be summarized in three categories namely: delivery of evidence based care; policy development, and professional advocacy. The roles mentioned have evolved as the profession has grown and has learned more from the intermingling of cultures and the result of globalization. Nursing has found a new goal that not only encompass the demographics it belongs but looks at the global aspect of the profession thus uniting the profession locally and internationally. The categories are further explained as follows. Delivery of Evidence Based Care Continuing professional development both professional and personal is required in promoting delivery of integrated care (Howarth et al., 2006). Nursing education (continuing and advanced) is the key to ensuring delivery of evidence based care, policy development, professional advocacy, and inter-professional collaboration across healthcare disciplines to provide safe, effective healthcare to the global patient population. Research defines evidence based practice and is essential to provide scientifically based nursing. Research is necessary to prove nursing’s importance in the delivery of effective healthcare. Nursing has relied on other discipline’s research findings in the past to build the nursing’s evidence based practice (Webber, 2008). Without nursing specific research nursing will continue to be overshadowed by other professional entities in the decision making process for healthcare delivery. Kearney (2008) writes, “Evidence based practice and researched outcomes and proven models of care are critical if we are to continue striving for nursing to be the hub of healthcare” (p. 56). Teamwork between nursing, other healthcare professionals and the patient population is necessary for integration of services and a continuum care. Teamwork provides efficient and safe delivery of care and healthcare administration decision making. Recent policy changes in the U.K. and Canada have promoted development of community-based services through teamwork but role awareness and communication were noted to be confusing (Howarth et al., 2006). Inter-professional education is necessary to build collaboration and promote effective teamwork through understanding of the different disciplines’ roles. Effective communication within the profession, across healthcare disciplines, and the patient population correlates with teamwork. Communication fosters respect and raises understanding of the different roles in healthcare. Role awareness to decrease role blurring is necessary to establish responsibility boundaries; further promoting effective teamwork and communication. Howarth et al. (2006) found literature supporting the concept of three individual philosophies influencing interaction impacting role awareness with peers and other disciplines: Directive – certain professionals only learn from and with their peers Integrated – individuals were prepared to share records and communicate with the wider team Elective – individual operated in an insular fashion, unwilling to share notes or discuss issues with the team (p. 151) Policy Development Encouraging leadership development at the educational level in necessary to build the leadership needed to promote nursing as a profession and be part of the decision making quorum in healthcare. Howarth et al. (2006) summarized nursing has not been prepared adequately for leadership positions and “provision of integrated health care that is reflective of population needs” (p.145). Nursing needs to ‘own’ the profession of nursing and not be subservient to other non-nursing professionals. Involvement in grassroots movements, legislature, and professional organizations is paramount in policy development. O’Conner (2008), the outgoing International Council of Nurses’ (ICN) notes the erosion of nursing numbers in leadership positions is challenging the self regulation of nursing. Without nursing leaders to develop nursing policy other non-nursing organizations will do so via umbrella government regulation. According to O’Conner fewer nursing positions then dieticians exist in the World Health Organization (WHO) due to the numbers of nurse positions in the organization being decreased. The World Health Organization had compromised healthcare in developing countries by limiting nursing influence. Integration of services between healthcare, social care, and the independent sector promoting a shared understanding of roles and responsibilities is driving policy changes in the U.K., the U. S., Canada, and Australia (Howarth, 2006). Nursing does not work in a vacuum; while nursing should not be subservient to another discipline, collaboration of inter-professionals in healthcare can provide efficient, safe, and innovative care. Professional Advocacy Development of standardized nursing education and licensure must occur for the profession of nursing to be recognized as professional. Nursing education is in a state of flux with licensure recognized at the LVN, ADN, BSN, MSN, and several doctoral degrees, i.e. the philosophical PhD, the Doctor of Nursing Science (DNSc), and other doctors of nursing science degrees (DSN, and the DNS). Nurse practitioners in the U.S., at present a master’s prepared designation, will require a DNP (Doctor of Nursing Practice) by 2015 to continue to practice (Donley and Flaherty, 2008). Other professions such as pharmacy, physical therapy, and engineering have developed standards of education and licensure to promote professionalism. Increasing the numbers of nurses with advanced or tertiary education is necessary for nursing to be acknowledged and recognized as a professional entity; advanced nursing education is critical to be recognized as an essential element at the decision and policy making level. Suzanne Fullbrook (2008), a Senior Lecturer in Nursing Law and Politics at the Faculty of Health in London South Bank University remarks that a series of White Papers on the regulation of nursing was not produced by a nurse but by a physician. The American Associates of Colleges of Nursing (AACN) note nurses lack the educational credentials of other professional entities and are not taken seriously or compensated for nursing contributions to healthcare and patient outcomes (Donley and Flaherty, 2008). Promoting nursing research is particularly important to the professional advocacy of nursing. Currently, much of nursing’s evidence based practice is derived from other disciplines, such as psychosocial and medical research, due to a lack of advanced practice nursing research and researchers (Webber, 2008). Webber quotes Wahl “When nursing has not been clear concerning the role research and practice play in our epistemological development, the discipline has assumed the practice values of other disciplines resulting in a ‘rudderless ship,’ greatly influenced by the winds of the day” (p. 466) Globally, nursing has been seen historically as insular and parochial which does not lend to a professional identity (Howarth, Holland, Grant, 2006). Nursing must develop more professional role awareness with the emphasis on education, efficient business practices, development of policy, and professional advocacy while maintaining the caring base that is nursing personified. Education is the key to nursing’s future in the global healthcare community.
Impact of Global Nursing Shortage on the Future of Healthcare Organizations in the U.S. The nursing shortage creates patient safety issues at a time when patient safety is most important which creates a vicious cycle or a “Perfect Storm” (Hinshaw, 2008). Nurses are retiring and leaving the profession faster than ever just as the baby-boomer generation reaches elder adult status; with the elder status comes chronic problems and increased healthcare needs for the largest percentage of the population. The demand for healthcare and nursing is increasing faster than new nurses are being trained and entering the workforce (Hinshaw, 2008). Patient Safety is Focus Organizations and nursing leaders must become very aware of: how safety is affected by the nursing shortage, how to incorporate and use evidenced-based nursing practices to reduce negative incidents, and to increase patient safety and positive outcomes. Nursing leaders must be very aware of current research and promote the use of evidenced-based practice within the organization so that nurses are working “smarter not harder. ” The role of consultant nurses is emerging and the role is defined as an expert nurse who has moved into an administrative or managerial role to remain in clinical practice to influence nursing care; consultant nurses improve care through the influence of others (Jarman, 2007). Healthcare organizations may also begin to employ the nurse researcher in order to promote and influence evidenced-based practice and to ensure that their nurses are being trained by the experts and authorities in the field. Technology Technology must be judged by its ability to help both the nurse and the patient. Nurse executives must be involved in the purchase of any new technology and truly understand its impact on the quality of nursing care (Smith, 2004). Biomedical devices can now monitor patients remotely and even chart remotely through wireless transmission of data. Entire wireless networks can now link equipment, patient, and nurse (Smith, 2004). The nurse executive must understand how this truly affects the day-to-day care of each patient and the workload of the nursing staff. With fewer nurses to monitor greater numbers of patients the most acute must get the personal 1:1 nursing, while others may benefit from technology that alerts the nurse only when necessary. Finance Organizations must weigh the cost/benefit of technology implementation vs. more money going towards education and retention of nurses (to decrease turnover). There is also greater dependence on remote monitoring because of inability to have patients in direct contact with nurses. The question becomes, “What is the value of technology in proportion to its ability to enhance patient safety, retain nurses, provide more direct care time…and support costs?” (Smith, 2004, p. 92, ¶ 1). Nursing retention may take pay incentives, education benefits, and the attainment of a supportive environment for nursing practice such as the attainment of Magnet status all which compete monetarily with purchasing new technology. However, there must be a balance between the technology that will improve the nursing workload and the recruitment and retention of excellent clinical nurses.
Nursing Leadership Skills and Knowledge to Support Cultural Diversity in the Workplace Baccalaureate and Graduate Education Education expands views, promotes discussion and exchange, and has been linked to improved nursing outcomes. Hinshaw (2008) points to research that estimated a “10% increase in the proportion of nurses in hospitals who hold Bachelor of Science in nursing degrees decreased the risk of patient deaths due to failure to rescue by 5%” (¶ 15). If education increases the ability of nurses to think critically then it stands to reason that education can promote the acceptance of culturally sensitive care in the workplace and therefore, increase and promote respect among nurses from different cultural backgrounds. Continuing Education Nursing leadership should support the cultural education of its nursing staff through in-services and possible partnering with foreign hospitals in sisterhood-type projects which would rotate nursing staff between the two facilities without a change in citizenship. The global community of the 21 st century dictates that everyone should be culturally sensitive and the nurse leader must promote this within his or her staff. Focus on Commonalities Thompson (2004) looked at nursing leadership from an international perspective and found that leadership dimensions were the same regardless of culture/nationality. The core values of nurse leaders is the same worldwide linking the profession into a unified whole throughout the world. The dimensions found were the need for leaders to “identify integrity and honesty in work situations” (Thompson, 2004, ¶ 8), the “internal drive to continually learn” (Thompson, 2004, ¶ 10), “appreciate ambiguity” (Thompson, 2004, ¶ 14), the ability to “hold multiple perspectives without judgment” (Thompson, 2004, ¶16), the ability to look for the potential in everyone and every situation and environment (Thompson, 2004), the ability to “nurture the intellectual and emotional self” (Thompson, 2004, ¶ 21), the ability to bring life experience into the workplace and to transform life experience into a positive addition to nursing practice (Thompson, 2004), and the ability to keep commitments to oneself and others (Thompson, 2004). These are brought together and summed up as “It is in our diversity that the richness of the whole is best appreciated” (Thompson, 2004, ¶ 28). Nurse leaders must continually promote the commonalities while leading staff to appreciate the uniqueness of each individual’s cultural contribution. Ethics and Values Nurse leaders have a more culturally diverse staff because of the international shortage of nurses. Thus, many nurses from developing countries are recruited and employed in the United States. Developing countries are then affected by developed countries recruiting their nurses (Hinshaw, 2008). This recruitment allows for greater cultural diversity in the workplace in the United States and for better culturally supported nursing care of the patient population; however, it also raises ethical questions. The main question is how ethical is it for the United States to deny a developing country its human resources? Again, partnership projects can benefit both countries through the promotion of nursing education and the networking promoted through sharing.
Impact of Global Nursing Shortage and Migration Nurses have migrated for years from hospital-to-hospital, to home health, offices, clinics, specialty areas, and some have gone from town-to-town, state-to-state, or country-to-country. Reasons for migrations have varied from more money, better working conditions, better education opportunities, and ability to use their skills especially coming from the under-developed countries. The nurses are going to the more developed countries like; the United States, United Kingdom, Australia and Great Britain. Many countries have enticing advertisements that nurses are interested in what incentives are offered and following some of those job offers. “ Nurse migration is motivated by the search for professional development, better quality of life and personal safety. Pay and learning opportunities continue to be the most frequently reported incentives for nurse migration, especially by nurses from less-developed countries (Kingma, 2001, p. 205).” Migration has had a major impact on global nursing shortage, part due to the aging of baby-boomers going into retirement while the younger nurses are branching out to more specialty type nursing. Very few are doing hospital based patient care. Changes to healthcare cost are another reason for the migration of the nurses. “ Healthcare reform is a prevalent issue in all developed countries as services continue to increase in cost. The United States is at the forefront of healthcare reform initiatives with diminishing government reimbursements for care, such as Medicare reimbursements, commercial health plan, managed care, and other legislative mandates related to healthcare (Cicatiello, 2004).” According to Cicatiello healthcare standards from country to country are inconsistent and uneven. “ In Botswana, many of the healthcare professionals are trained outside the country because of a lack of university or clinical programs (Christmas & Hart, 2007, p.175).” “Once training is complete from first-world nations that have the latest technology and equipment, they return to practice in poor, rural areas that maybe without running water. The dichotomies are great and many leave out of sheer frustration. The developed nations welcome these professionals with open arms (Christmas & Hart, p. 176).” “ Economic inequities are another reason why professionals leave their homes and migrate to developed countries. These professionals were unable to obtain positions or living wages in their home countries, they migrate to enhance their standard of living or continue their education (Christmas & Hart, 2007, 176).” International professionals from less developed countries support their home economy by sending monies back home to help their families. According to Christmas and Hart (2007) in the Sub-Saharan region the prevalence of HIV/AIDS has caused a dramatic decline in average life expectancies from 60 years of age down to 29 years of age. In Sub-Saharan Africa 25.8 million people have been diagnosed with HIV/AIDS as compared to 1.2 million people in North America (Christmas & Hart).
Impact of Being Master’s Prepared Nurses Advanced nursing practice has been occurring over a long time requiring a higher education to practice in specialty nursing. Registered nurses (RN) began practicing as diploma nurses and proceeded to an associate degree. A baccalaureate degree is required to be considered a professional nurse. A master’s degree in required to go into advanced nursing practice. Nurse practitioners, mid wives, and CRNAs require master’s degree to practice. “ Master’s level education is the predominate preparation for nationally certified clinical nurse specialists (CNSs) and nurse practitioners (NPs) in the United States. Educational standards for master’s advanced practice nursing (APN) education incorporate a graduate core that includes research, policy, organization and health care financing, ethics, professional role development, human diversity and social issues, health promotion and disease prevention, and nursing theory, as well as an APN core that includes pathophysiology, advanced health and physical assessment, and advanced pharmacology (American Association of Colleges of Nursing [AACN], 1996), (Stark 2006, p. 7).” “ Nurse practitioners roles included a higher degree of direct patient care, prescribing medications, treatment planning, and patient teaching; NPs were also involved in management of patient health/illness status, consultation, safe care issues, and patient referral to medical specialists (Stark, 2006, p. 8).”
In conclusion, nursing has adapted to the growing globalization of the world’s population. The profession aims to unify the goals of all the nurses internationally. The common goal is the focus on integration which involves supporting the continuum of care and sustained integration of services, building a more professional image and promoting teamwork across healthcare disciplines (Howarth, Holland, and Grant, 2006).For the following reasons nursing must develop more professional role awareness with the emphasis on education, efficient business practices, development of policy, and professional advocacy while maintaining the caring base that is nursing personified. Education is the key to nursing’s future in the global healthcare community. Nursing shortage is considered by most as one of the global crisis we are now facing. The globalization and ease of migration has made it worse for the underdeveloped countries. Nurses have been migrating to and from different places for a long time. Many reasons for nurse migration have been mentioned such as; better pay, better working conditions, better positions, some to help the their families back home and some to get a better education. The under-developed countries are losing nurses because when they have sent students to other countries for better education often students who complete their training do not desire to return to their country because of poor working conditions, lack of opportunities to advance, no running water, and patients who are sicker with HIV/AIDS. One good thing about the situation is it has increased the cultural awareness of most individuals due to intermingling of cultures. Other reasons for the nursing shortage includes nurses of the baby-boomer era are retiring leaving few nurses at the bedside and the younger nurses have branched out into the different nurse specialties and non-hospital jobs. The focus on continuing education has diversified nursing in multiple advanced level specialties. Nurse Practitioners and Clinical Nurse Specialists are master’s prepared nurses. Each specialty has different educational requirements to practice. Some of these educational requirements are: policy, organization and healthcare financing, human diversity, research, social issues, nursing theory, and pathophysiology. Some advanced nursing roles are in direct patient care, prescribing medications, treatment planning, and patient referrals.
