As you know, health care is opening to a world of opportunities, as we’ve seen sweeping changes unlike any other in the last five decades. Social, political, economic, and technological trends form a “perfect storm.” Today’s nurses are trailblazing new roads in the profession, as they adopt different roles and operate in nontraditional workplace settings.

Nurses today still care for patients, but they must also provide it in the right manner, at the right time, and in the right place. Health care organizations still seek to provide the best patient experience, but they also must cut costs, boost outcomes, and ensure safety. There is growing demand for registered nurses, both in and outside hospital doors, that demands caretakers develop a new skillset and a new mindset. Below are five ways that demonstrate how nursing has morphed and shape-shifted recently, and how nurses can make the most of tomorrow’s opportunities.

Trend #1: Jobs are moving outside of hospitals.

Inpatient units—and sometimes whole hospitals—are being closed and patients are being moved into alternative settings, such as long-term care, rehab, and subacute care facilities. Case in point: Experts estimate that today 65% of health care services are delivered in ambulatory settings, rather than hospitals. That transition from inpatient to ambulatory care settings occurred slowly over the past decade.

Why the switch? The Patient Protection and Affordable Care Act of 2010 was a major factor that hastened what hospitals were already doing: offering services outside their doors. Health care organizations want to cut down on admissions (and re-admissions), and they seek to do that by pumping up preventive care and caring for patients at home, or on an outpatient and community basis.

Andrea Higham leads Johnson & Johnson’s Campaign for Nursing’s Future, launched in 2002 to recruit and retain more nurses and nursing faculty, including minority, male, and other underrepresented groups. “Nursing is at a very exciting time, and nurses are on the frontline of health care, providing delivery of care across the board,” says Higham. “So many people are entering health care because of a confluence of so many forces, such as the Affordable Care Act and an aging population. Nurses are working not just in hospitals, but also in home health care, at clinics, as advanced practice nurses, and managing the entire health care journey. There’s a strong need for nurses in many places outside of the traditional health care setting.”

Think about opportunities outside of the hospital. For example, if you’re interested in pediatrics or working with adolescents, consider openings in pediatric long-term care, pediatric home care, pediatric rehab, or at group homes for children or teens.

According to Phyllis Quinlan, PhD, RN-BC, president of MFW Consultants to Professionals and a nursing coach, nontraditional settings, such as subacute care, are fine places to practice if applicants can overcome their preconceptions. “Long ago and far away, it was considered grandma’s nursing home, but now it’s a combination of residential care and short-term rehabilitation. It could even include pediatric or non-geriatric care,” she explains. “Hospitals are shutting down med-surg floors, and shifting patients to other, lower-cost venues for treatment. Say someone falls and breaks a hip—now they have to learn how to walk with that new hip. That’s when they need bridge care—skilled care, rehabilitation, nursing care—until they can go back home. It’s not about disease care anymore, but about preventative care and home care for managing diseases today. Hospitals soon will be only for emergency care, cardiac care, burns, traumatic injury, [and] cancer centers.”

In addition, health care organizations within the private, government, and nonprofit sectors also need qualified registered nurse candidates to fill the high demand for traditional and alternative roles.

Trend #2: New or returning nurses must develop job-search savvy and resolve to land coveted hospital positions.

“For those new graduates hoping for good med-surg experience after nursing school but can’t get a job in a hospital, don’t despair,” says Quinlan, even though hospitals have adopted stringent nurse recruiting requirements and sought to cut costs in every way without compromising care.

“Most urban area hospitals aren’t hiring, but in other areas, that’s not the case,” she explains, suggesting that new grads and nurses with some experience apply for residency or internship programs to “fast track” their careers with intensive preparation for 12 to 18 months.

“Some health care systems are rich with nursing training resources, others do it but in a more conventional way,” she adds. Another way to get your foot in the door at a hospital: “Move to [an] area where they are hiring. The State of Texas is hiring new nurses, and other states are recruiting nurses to serve a special need or a growing population.”

Nurses who are open to filling short-term temp assignments also have a leg up on other candidates; hospitals are offering six-month contracts rather than making long-term commitments they may not be able to honor.

Trend #3: Nurses must further education, clinical skills, and knowledge to keep up with complexities.

Once, a two-year associate’s program could prepare a nurse for a secure and fulfilling career. Not anymore. “Most places now will hire a nurse with an associate’s degree but ask that she sign a hiring agreement to get a baccalaureate within five years or so,” says Quinlan. “Across the 50 states, the culture varies, but independent facilities and major health systems tell me ‘we’ll only hire baccalaureate-trained nurses,’ so you need to make your peace with the fact that the minimum preparation for practice is now a bachelor’s in nursing.”

The other source of tidal change is digital technology and big data, which make it possible for nurses to do more with their expertise and deliver care from practically any corner of the world, while enjoying the advantages of telecommuting, like other professions.

“Technology allows nurses to practice off the beaten path in more ways than ever before,” says Brittney Wilson, RN, BSN, also known as The Nerdy Nurse. “With jobs like remote case management, telephone triage, and even informatics consulting, nurses can use the clinical knowledge and technical skills to help patients from the comfort of their home.

“Opportunities to work from home and attend to patient care needs virtually do come with a price,” adds Wilson, who is a nurse expert with experience as a clinical informatics nurse. “You have to have above-average computer skills and must be able to learn new software quickly.”

There’s a big need for nurses who have a business background. Traditional nursing programs do not address business aspects of health care. Nurses who go on for a master’s degree in business administration or health administration will understand policies and procedures that are governing health care now.

Trend #4: Nurses must focus on their own personal and career development to progress in the profession.

Clinical and other technical skills are important for any nurse to develop, but so are “soft skills”—for example, effective communication and problem-solving know-how.

“New to nursing? Maybe you have great ideas, but maybe you’re missing skills in how to talk to a patient or family members or how to collaborate with others,” says Higham. “You can always access our avatar-based online program, Your Future in Nursing, on the Campaign’s website.” The cutting-edge format, a game-like simulation environment for practicing key on-the-job concepts and skills, helps a student nurse prepare to make the often tough transition to practicing nurse.

Accelerating change in the health care workplace may require that new and seasoned nurses adjust their attitude and become more flexible about new ways of doing things. According to Quinlan, author of the recently published Rediscover the Joy of Being A Nurse: A Holistic Approach to Recovery from Compassion Fatigue, there’s no point in lamenting the good old days. “Nurses are some of the most creative people on the planet; they’ll make something out of nothing on a daily basis,” she says. “Some feel that they’re expected to adjust instantly to changing conditions and expectations, and they resent it. Those nurses must make peace with the new health care environment, themselves, and their profession.”

Until then, “they’re at a crossroads, and risk starting to swing to the dark side, having lost connection with the joy of practicing,” Quinlan adds.

Trend #5: Nurses will take on expanded and pivotal roles as part of tomorrow’s health care team.

How will we prepare nurses to transition to these advanced practice roles? That question has long been central for Donna Tanzi, MPS, RN-BC, NE-BC, director of nursing education and innovation at North Shore-LIJ Huntington Hospital in New York. “Nurses are going into master’s programs early on in their careers—after getting a baccalaureate, they’re going straight into a master’s or even doctoral degrees,” she says. “They have less clinical experience prior to getting an advanced degree, so we have an obligation as a profession to support them. Entry to DNP takes seven years from entry to graduation, similar to the medical model.”

Tanzi recommends nurse residency programs or fellowship programs for an extensive, tiered approach as students make the transition into their complex new roles.

“Nurses were tending to leave a job in the first year, or to leave nursing totally, because they weren’t prepared for the demands of the role,” she explains. “The bottom line and the message that I want to get out there is go into nursing for the right reasons. Recognize it’s an art and a science and we have the ability to impact people’s lives every day. Continue learning—there [are] always new directions and avenues to explore. There’s no reason to ever become stagnate or get bored in nursing; there are too many opportunities.”

There are many areas where advanced practice nurses apply their expertise gained through a master’s (or increasingly, a doctorate) in nursing or a related field. Clinical nurse practitioners are opening independent practices, or working with an academic affiliation in hospitals, or affiliated with physicians in their practices. Administrative leadership roles usually call for an MBA or MHA. Demand for nurses continues, so we need nurses to teach in nursing schools. At a minimum, instructors must have a master’s in nursing or in nursing education. Entrepreneurship, consulting, and research and development are also growth areas for advanced practice nurses.

Everywhere we look, nurses are being called on to surf the tidal waves of a changing health care environment and the emerging opportunities that come forth from it. Tomorrow’s nurses, with the right technical skills and personal qualities, can look forward to a rewarding career where they can deliver even greater value to their patients and communities.


Photo courtesy of Johnson & Johnson

Jebra Turner

Jebra Turner

Jebra Turner is a freelance health and business writer based in Portland, Oregon. She frequently contributes to the Minority Nurse magazine and website. Visit her online at www.jebra.com.
Jebra Turner

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