Great expectations: Today's nursing students, programs prepare for tomorrow's challenges

By Josť Alaniz Courtesy

Motivated. Savvy. A team player. The nursing student will have to have these qualities after graduation. She Ė or, increasingly, he Ė can speak several languages and, just as important, intimately understands the cultures from which those languages spring; has mastered the Web and how to navigate its roiling seas of information to instantly find the precise data needed; feels at ease with all the latest medical technology as well as the intricacies of insurance policies, legal and ethical codes (state and federal), and the human psyche; and maintains crystal-clear lines of communication with colleagues, doctors and patients, defusing all interpersonal conflicts in a flash.

The nurse of the future is clairvoyant, anticipating health care trends 10 years away and training for them today. She is married, raising a family, coaching Little League, caring for aging parents, and using those free evenings to finish up a Ph.D. and keep abreast of all the latest research Ė when not contributing some of her own, that is. Lastly, she is starting a cutting edge Internet/telemedicine venture, and consults on several others.

Sleep? "Hah! I havenít slept since the í90s," this nurse says. "Sleep is for sissies."

All right, maybe that last part is a slight exaggeration. But this composite picture provides some idea of the exciting challenges and daunting pressures that nurses will face in the 21st century. Some statistics may further clarify the picture:

The Bureau of Health Professions, U.S. Department of Health and Human Services, estimates that by 2010 the country will need 1.4 million nurses with a BSN, but will have only 635,000. Of 532,000 nursing positions requiring a masterís or Ph.D., only 250,000 nurses will actually be there to fill the demand.
The Census Bureau reports that, although they represent 28 percent of the population, racial and ethnic minorities make up only about 10 percent of the nationís 2.5 million RNs. Hispanics, who comprise about 11.7 percent of all Americans, represent less than 2 percent of RNs.
Although the Bureau of Labor Statistics predicts a hefty 21 percent job growth rate among registered nurses by 2006 (the largest among all professions), the American Association of Colleges of Nursing points out that enrollment in bachelorís degree nursing programs has steadily declined during the past five years, dropping 4.6 percent in 1999, on top of a 6 percent decrease in 1998.
These and other trends related to the nursing shortage have prompted nursing programs nationwide to become creative, forging alliances with hospitals for tuition reimbursement and other financial aid, setting up "shadow programs" for high school students to come and see for themselves what nursing is like, and opening their doors to more immigrant and minority students.

"In the 21st century health care environment, you must have an understanding and appreciation for cultural differences," said Phyllis Graham-Dickerson, Ph.D., RN, an assistant professor at the Colorado University School of Nursing in Denver. "Itís a fact that our society is becoming more and more diversified, and you as a caregiver have to understand where the patient is coming from. Thatís why multiculturalism courses are threaded throughout our curriculum. Diversity, both in terms of recruitment and awareness of our student body, is a real goal at our school."

But other experts warn that todayís nursing education system needs even deeper changes to meet the new centuryís challenges.

"Thereís a gap between the way we educate and actual practice," said Beth Brooks, MS, RN, adjunct faculty at Lewis University College of Nursing in Chicago and director of patient education at InLight Inc., an e-health care firm. "We donít emphasize high-tech clinical settings, computerized documentation, the latest equipment. In some nursing schools, they still have crank beds. In todayís environment, we have all sorts of managed care issues driving health care. We donít talk enough about those realities."

Brooks "fought tooth and nail" to set up a case management program at her school, only to see it languish for lack of support. Medicine, one of the more conservative educational fields, tends to lag behind the times, she said.

"Nurses are often not as savvy as they could be about how to use the Internetís resources for charting, sending e-mails, research. Many are just drowning in information that they havenít yet learned to master and maximize. Nurses today need to develop Web sites, to get involved in content," Brooks said.

"Weíve had a long history of compromising things in the way we educate, and itís not been for the good of nursing or care of the patient," agrees Linda Aiken, Ph.D., RN, FAAN, professor of nursing and sociology at the University of Pennsylvania School of Nursing. "Nurses need to be educated for 10 years from now. With the ever-increasing body of knowledge in the health sciences, they need a better education. They need to learn expert clinical care. Specialization is a partial answer, but ultimately nursing programs need to focus on producing good generalists."

With half of todayís nursing workforce expected to retire within 15 years, the nursing student Ė the nurse of the future, that is Ė may not necessarily be a superman/woman, but the challenges to come will certainly require superhuman resources.

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