Whether you are an experienced nurse practitioner with years of clinical practice already under your belt, or you’re a student preparing for a fulfilling career devoted to helping people, you’re likely to face some unexpected challenges and some exciting opportunities in the work you have chosen. The role of the nurse practitioner is rapidly evolving, responding both to changes in the health care industry and to the evolving needs of the communities you serve. This article explores some of the most significant trends nurse practitioners are facing today.
An Expanding Role
The global health care shortage is not news, but what is news, perhaps, is how significant and widespread it is. In fact, in the United States alone, it is estimated that the shortfall in the number of physicians needed by 2033 will approach 140,000.
And that reality is rapidly and dramatically expanding the role of and the demand for skilled nurse practitioners. Where nurse practitioners might have once worked primarily in collaboration with a physician, increasingly, nurse practitioners are taking the lead in patient care. In many states, this includes overseeing and implementing treatment plans and even coordinating end-of-life care.
In addition to operating more independently than ever before, nurse practitioners are also finding themselves drawing on an array of skills, resources, and knowledge to provide more comprehensive care.
For example, as demand and cost pressures on the system mount, health care providers and patients alike are seeking more holistic strategies to promote wellness and prevent disease. This often includes, for instance, an emphasis on fitness and nutrition, constituting a significant shift in standard medical practices.
Historically, health care providers have been dissuaded or even prohibited from offering nutritional advice, as it may have been considered outside of the clinician’s scope of practice.
In addition to cultivating specialized knowledge to provide higher quality and more comprehensive care, nurse practitioners are also increasingly being looked to as multigenerational health care providers. In such cases, nurse practitioners may provide many of the services of a primary care physician, general practitioner, or family physician.
For this reason, a large number of nursing schools are offering students the opportunity to train as family nurse practitioners (FNP), enabling them to offer optimal patient care across all stages of the lifespan, from birth to death. Licensure as an FNP can be a particularly attractive option for those who seek to develop long-term, trusting relationships not only with individual patients but with an entire family.
Serving At-Risk Communities
Disparities in access to consistent, affordable, and high-quality health care have long been known and lamented. However, health care systems are increasingly turning to nurse practitioners to stand in the breach, filling a desperate need for health care providers in underserved communities.
That means that nurse practitioners may routinely find themselves asked to serve in remote, rural communities or impoverished urban areas where the need for qualified health care providers is greatest. In fact, nurse practitioners who have pursued specializations in community or public health can find themselves in particularly great demand and may build rewarding careers as traveling nurse practitioners, serving communities in need for weeks or even months at a time before moving on to the next post.
When it comes to both training and practice, nurse practitioners have more options and opportunities than ever before. In addition to choosing specific areas of specialization, such as adult or pediatric care, nurse practitioners can also select from an array of subspecialties which will increase their marketability.
However, the degree of clinical autonomy nurse practitioners enjoy will vary from state to state. In some U.S. states, licensed nurse practitioners enjoy what is known as full-practice authority (FPA), meaning that they can prescribe medication, order tests, and define and implement patient care strategies without requiring a physician to sign off on the plan. In other states, though, nurse practitioners still need a physician’s authorization before a treatment plan can be implemented.
Nevertheless, the opportunities for nurse practitioners to earn FPA are growing. For instance, attaining an Advanced Practice Registered Nurse designation can give you full practice authority in many states, including some states where a physician’s sign-off would otherwise be required. Most exciting of all, organizations such as the American Association of Nurse Practitioners are working to establish a nationwide certification protocol to enable qualified nurse practitioners to enjoy full practice authority in all U.S. states and territories.
It is an exciting time to be a nurse practitioner, a time of high demand, increasing independence, and tremendous opportunity. Nevertheless, the challenges are significant, principally due to an ongoing labor shortage and continuing disparities in health care access. In a time when both the need and the reward are great, nurse practitioners are perfectly positioned to fill the gap.
As a woman with a successful nursing career, you know that there is nothing more important in life than the health and safety of your child. Whether you are expecting a new baby or you have a bunch of kids already running around, it is essential to cultivate balance within your life so you can successfully manage motherhood and your career while also protecting your own health and well-being.
Unfortunately, that is not always as easy as it sounds. As it is, minority women are already at risk of subpar medical care, as studies have shown that many minorities, including black patients, are not even prescribed the medication that their white counterparts are provided on a routine basis. Because of all this, you must take good care of yourself as a pregnant nurse or a nurse with children. Let’s talk about some great ways to create the balance you need during this exciting time in your life.
Inform The Hospital If You’re Pregnant
As soon as you discover that you are pregnant, you must inform the hospital, and one reason why is because it makes it easier for you and your employer to prepare for the future. Inform them of your due date so they know when you will be taking your leave and will no longer be available. A good tip is to save your paid time off (PTO) for when you take your leave as you may need more time than your maternity leave will provide.
The other reason you want to inform the hospital of your pregnancy is so that you are not put in any dangerous situations that could harm you or the baby. According to federal regulations, your employer must make reasonable accommodations for you if your job puts your pregnancy in jeopardy. For instance, if you typically work in an area where there is constant radiation exposure, you may want to ask for a transfer. Also, it’s a smart idea to stay away from any section of the hospital where patients are dealing with contagious infections so you aren’t put at risk. On that note, with COVID-19 still being a factor, you will still want to wear your mask during this time.
As all nurses know, hospital shifts can create their fair share of stressful situations, but stress can be very dangerous for pregnant women as it can lead to health risks such as high blood pressure and heart disease. To prevent unneeded stress, you might request to work in the recovery area or a department within the hospital with fewer high-risk patients. The same goes for when you return from maternity leave. You’ll want to tell them how you are feeling and potentially adjust your schedule so you can still support your family and your new baby at home.
Take Care of Yourself
If you are expecting, it is also important to practice self-care while you work so you stay healthy and protect the well-being of your child. It is essential to drink a lot of water during your shifts so you can stay hydrated and prevent fatigue. It is also important to have healthy snacks throughout the day to maintain your energy through long shifts. Almonds are a great go-to because they provide nutrients for you and they help to regulate the weight of the baby.
Many pregnant women also feel symptoms of morning sickness, and nurses are no exception. While it is not typically dangerous, you may experience nausea and vomiting, so if you are feeling sick, make sure to take a break. Also, eat plenty of chicken and bananas, which are rich in pyridoxine (vitamin B6), which has been proven to reduce the chance of nausea in pregnant women.
It is also important to know your limits, especially as you get closer to your delivery date. A work/life balance will be essential at this point. You may not have the stamina to work 12-hour shifts and that is okay. You need plenty of rest, especially if you have other children living at home. You do not want to neglect your family. If your company values you as an employee, they will be perfectly understanding of this modified schedule.
Change Your Profession
When you have children at home, the demands of working in a hospital may just be too much to allow you the quality time you need to have with your family. If you are in this boat, then it may be time for a career change that will still keep you in the health field but will also provide the time you need to be with your children. For example, you could become a school nurse where you can still provide healthcare but in a less stressful atmosphere. If you can become a nurse in the school where your children attend, that is even better.
There is also the opportunity to become a home health nurse. In this profession, you go to the homes of patients who are ill, elderly, or disabled, or otherwise lack mobility. The great aspect of this job, especially for working mothers, is that you can often set your own hours and you can choose to work with patients that live close to your home so you can tend to your children quickly in the case of an emergency.
For a chance to really be close to home, you could also opt to become an at-home nurse who stays at home and helps patients via a telehealth platform. Again, you can often set your own hours and be with your family all day. It is also great for pregnant nurses as it allows them to sit for their shift instead and avoid constant standing and walking.
If you are a nurse with children or you are expecting, follow the tips above and learn to balance work and motherhood. By giving your family and your patients equal care, you are making a real difference in your home and community, which should make you very proud.
The COVID-19 pandemic is undoubtedly one of the most trying and difficult things that many of us have had to endure in our lives. Nearly everything we care about was disrupted from child care to going to work to visiting friends and family. Many became socially isolated, even more are dealing with stress and anxiety from the virus. To some degree, all of our economy was impacted, with many businesses still struggling to reopen and many employees cautious about their options moving forward.
With all of the crazy things that COVID brought into the lives of everyday people, it can be hard to realize the even more significant toll it has had on health care providers, particularly nurses. Nurses have been on the front lines of the pandemic since the beginning and most have been put into situations that nobody outside of the profession can imagine. Understandably many are dealing with burnout and ready to leave nursing altogether.
One recent report from Business Insider stated: “Many nurses on the front lines of the pandemic are burned out and mentally and emotionally tired. A significant portion of nurses in a Trusted Health survey said they were considering a new career. Of those who said they felt less committed to nursing, 25% were looking for a new job or planning to retire.”
This high rate of burnout and apathy are concerning and ultimately beg the question: What are hospital administrators to do?
Put Trauma Care Front and Center
Our nurses have seen a lot this past year. Many have been put into positions where hospitals were at capacity and whole units had been converted to treating COVID patients, yet it still wasn’t enough. Supplies became limited and many watched as an uncountable number of patients died without the comfort of family from a disease most people knew nothing about and couldn’t do much to treat.
That kind of trauma is typically reserved for horrific places such as war zones.
Yet our nurses showed up day after day to care for the sick. Some gave up going home to their families for months to protect them from the virus. Others faced prejudice for “risking the lives of others” by going to the grocery store after a shift. Sooner or later, it is all enough to break a person.
One survey conducted by the International Council of Nurses laid out the serious mental and physical health impacts that the pandemic is having on nursing professionals. Perhaps the single best thing that hospitals can do to support their nurses is to provide on-site, free mental health support and treatment. This type of initiative could give nurses an outlet and help them work through some of the difficulties they have faced in the past year.
Assist with In-Hospital Moves
Unfortunately, regardless of the support and treatment options that become available, many nurses have still seen too much and will leave. Though COVID-19 has pushed many strong-willed nurses past the breaking point, a significant number were there already. Even before COVID, there were plenty of legitimate reasons that good nurses left the bedside for other opportunities.
In these instances, it may be possible for hospitals to help keep quality people on staff just in a different position. For example, perhaps a nurse would be willing to stay but in a more administrative role. Moving into something such as medical billing and coding could allow them to continue to serve the community they care about but shield them from the traumas the stress brought on by the pandemic.
Hospital administrators can also help nurses who don’t want to be at the bedside any longer move up into more specialized nursing roles. Some nurses may be willing to stay on staff with the promise that they won’t have to interact with COVID patients and can, instead, focus on specific diseases like GERD and provide the medication and treatment help with them.
Focus on Work-Life Balance
For those nurses who do stay, we can hope that mental health counseling and treatment will be available when needed. We can also hope that there will be a renewed focus on work-life balance from hospital administrative staff.
During the pandemic, many nurses were encouraged, if not forced, to work longer shifts or to pick up extra days. Unfortunately, once again, this behavior wasn’t exactly uncommon before the pandemic. It just became more apparent. Being overworked and underappreciated in this manner can lead to extremely high rates of burnout and ultimately more turnover, a less productive workforce, and a negative culture that permeates the entire workspace.
There are about a thousand studies out there that explain the incredible benefits of a strong work-life balance. These positives can range from significant improvements in personal mental and physical health to increases in workplace productivity, retention, and satisfaction. Though there is an undeniable need to fill a shortage of nurses, treatment of the folks already working should be paramount.
The bottom line here is that our nurses have worked hard to do what they can to protect our nation during a global pandemic. Now, they need help. Changes that hospital administrators can make to help curb the number of nurses leaving are not necessarily small and easy ones, but they are critical to the long-term care of some of the most important caregivers.
The role of the health care professional has seen its fair share of evolution throughout history. Shamans and healers in ancient societies paved the way for modern medical professionals, who have a duty to society as a whole that spans well beyond diagnosis and healing. Medical doctors today are expected to exhibit professionalism as well as effectively communicate with patients and colleagues, and conduct plenty of research.
And for optimal patient care, that research isn’t confined to information directly related to the health care industry. Health care professionals must also remain on top of current events, and be aware of the various societal issues that can shape both medicine and public policy, such as immigration. In this regard, health care workers often double as agents of societal change.
As the Hippocratic oath remains a crucial part of modern medicine, ethical considerations are of paramount importance in the health care arena. Whether you’re a primary care provider, registered nurse, anesthesiologist, or another type of health care worker, you’re in a prime position to advocate for immigrant families. You may be unequipped to help immigrant families in a legal or political capacity, but your direct health care efforts may ultimately catalyze societal change.
Medical Care for Immigrant Families
It’s important to note that the needs of immigrant families may differ drastically based on the citizenship status of family members. And the terminology itself doesn’t necessarily tell the entire story: Children who were born in the U.S. but have at least one foreign-born parent are typically identified as children in immigrant families (CIF). As of 2019, an estimated 1 in 4 children in the U.S. can thus be considered CIF, but their social determinants can vary considerably.
For instance, immigrant family members who are legal U.S. citizens can access the same health care benefits afforded to all Americans, including Medicaid and Medicare. Undocumented immigrants, however, are much less likely to have any type of health coverage. These individuals are subsequently more vulnerable to chronic health issues and contagious viruses including COVID-19.
According to the American Medical Association (AMA), approximately 11 million undocumented immigrants are living in the United States. What’s more, “physicians and other health professionals should be aware of how to advocate for these patients, including through self-education, education of trainees, in the exam room, and on Capitol Hill.” A large number of undocumented immigrants tend to avoid seeking medical care, even if it’s urgent, due to fear of deportation or the intervention of government agencies.
Politically speaking, the subject of illegal immigration is a contentious one. Yet it’s crucial to remember that, for many families and individuals, immigrating isn’t exactly a choice. Many immigrants to the U.S. are refugees seeking asylum, or humanitarian protection, from persecution or war in their home countries. Asylum seekers are subject to a lengthy immigration process, and there is a governmental cap on the number of refugees admitted on an annual basis.
The Importance of Immigrant Health Care Workers
As a health care worker, it may behoove you to learn a little bit about the immigrant families that you serve to better address their needs. But you should also look to your colleagues for guidance and inspiration: Plenty of immigrants are gainfully employed in the health care industry. According to the Migration Policy Institute (MPI), about 2.6 million immigrants are employed in various health care fields, including approximately 1.5 million doctors, registered nurses, and pharmacists.
Unfortunately, immigrant health care workers tend to be underappreciated, yet this segment of the workforce is invaluable in the realm of disaster response. In 2021, disaster response is heavily focused on curbing the spread of COVID-19, but the discipline encompasses much more, notably natural disasters like earthquakes, hurricanes, and wildfires. Within disaster response, the humanitarian side of health care is heavily emphasized, as disaster survivors often require social services — to access food and emergency housing, for example — in addition to medical care.
Similarly, immigrant families may have similar psychological and humanitarian needs, even far removed from disaster response scenarios. Health care professionals from immigrant families are well-equipped to address these sorts of needs among their patients, especially if they have personal experience in seeking legal asylum, or securing stable housing and job opportunities.
Looking to the Future: From Telemedicine to Health Care for All
No matter your background, as a health care professional, you’re likely well-versed in the various social determinants that can influence one’s health and well-being. The conditions and places that one is born and raised in, widely known as social determinants of health, overwhelmingly correlate to individual health, as well as that of entire communities.
Even those social determinants that are directly related to economics and education can have a significant impact on individual health, and the COVID-19 pandemic has only exacerbated the situation. In regards to social determinants, the Centers for Disease Control and Prevention (CDC) reports that “for many people in racial and ethnic minority groups, living conditions may contribute to underlying health conditions and make it difficult to follow steps to prevent getting sick with COVID-19 or to seek treatment if they do get sick.”
The good news is that, as a health care provider, you can help bridge the gaps among your minority and immigrant patients, and telemedicine is an ideal starting point. In a world under the threat of a deadly pandemic, telemedicine has become a crucial component of health care. While you can’t treat serious conditions solely via telehealth, the platform is extremely versatile. Telemedicine can streamline patient monitoring as well as the appointment setting process, reducing the need for multiple visits or a lengthy commute to a hospital or clinic. Further, simple tests such as vision exams can be conducted safely and easily using telehealth.
And signs indicate that telemedicine is likely here to stay, post-pandemic, as it can help generate revenue in health care facilities ranging from major research hospitals to local clinics and private practices.
Although revenue is certainly relevant in every corner of the health care industry, caring for patients is still the ultimate goal. As a health care professional, you may find that advocating for your patients is just as important as administering quality health care. Determining the individual needs of your patients, whether immigrants or natural-born citizens, can ultimately serve to improve public health overall, and give you greater satisfaction that you’re truly making a difference in the world.
At its core, nursing is an inherently humanitarian career path: The job can’t be done without compassion and a willingness to advocate for patients, by any means necessary. As a nursing professional, you’re also likely to be unwittingly thrust into the political arena, treating both injured protesters and law enforcement officials following a violent clash.
Nursing Professionals on the Front Lines of Social Justice
As such, for modern nursing professionals, the lines between individual health care and politics often collide. Along with treating injured protestors at medical facilities and hospitals, many nursing professionals are volunteering their time on the front lines. In many cases, nurses at protests simply show their support to the cause.
But, if a nonviolent protest escalates into a dangerous situation, having a nursing professional on the scene is vital. You may be able to provide emergency care, of course, but even more importantly, nurses on the front lines of protests have a unique insight into police brutality. This sort of information is an invaluable tool for fueling the conversation about systemic racism in the health care industry as well as everyday life.
So, once you’re aware of the current landscape of protests and the tactics used by police, however, what will your next steps be? There are various ways that you can get involved and take a stand against police violence, on both a professional and social level. Here’s what you need to know about the consequences of police violence and how you can help protesters, no matter if you’re on the front lines or working in the ER.
Racism, Police Brutality, and Public Health
The COVID-19 pandemic had already altered daily life around the world long before May 25, 2020. That night, George Floyd lost his life in the hands of law enforcement officials, and U.S. citizens flooded city streets in response. These widespread protests didn’t dissipate overnight — in fact, they only grew larger, and the violence that escalated in several cities left health care workers in a dire situation.
Already under the threat of the pandemic, nurses from all walks of life suddenly found themselves working to balance public health considerations with the reality of police violence. As a patient advocate in these politically charged times, you should thus be aware of the unique needs of your patients. Victims of police violence and brutality, for example, may fear for their safety.
Discretion is a key factor in situations involving institutional racism and police brutality. Further, the provider-patient confidentiality agreement is especially vital if a protestor in your care wishes to pursue legal action against a law enforcement official or organization.
Patient Privacy in the Modern Health Care Landscape
Privacy is an important consideration in 2021, as so much of our everyday lives can be easily found on the internet. Protesters further put themselves on display, and the plethora of camera phones, as well as professional cameras wielded by the media, make anonymity nearly impossible. If you participate in a protest, whether as a curious observer, an active participant, or in a care-related capacity, it should be expected that your image will be captured on camera.
For example, even masks and costumes couldn’t hide the identities of countless right-wing protestors who stormed the U.S. Capitol on January 6. Thanks to the internet and social media, identifying the Capitol rioters was a simple endeavor. While this sort of facial recognition may represent a slippery slope scenario, at least where personal privacy is concerned, the tech proved crucial to holding the rioters responsible.
In the age of telehealth, patients should be afforded more privacy considerations than the protesters, yet various challenges exist when it comes to protecting patient information. To ensure that you’re properly adhering to patient privacy laws, as well as protecting vulnerable patients such as victims of police violence, you must take every possible precaution when collecting, accessing, and storing patient data. You may also want to stay up-to-date on relevant laws and HIPAA regulations, which can change without warning.
There’s No Place for Violence in a Caring Society
As long as police violence remains prevalent, the minority nurses of the future are likely to face unprecedented challenges while on the job. Whether you find yourself in a position of mentor or you’re working directly with patients injured during a protest, your voice is powerful. In the wake of a global pandemic and continued racial disparity, nurses may be inspired to stand up for their patients and actively address police violence, for the sake of both public health and social justice.