NUR 3805 DQ Challenges The Future of Nursing is Faced With
NUR 3805 DQ Challenges The Future of Nursing is Faced With
First of all ~ What area do you work in
now, and where do you see yourself in 5 years. (This is not to imply you are
unhappy, only to challenge you to examine your position and your options~ which
I expect you have already done, as here you are!)
After reading through the learning plan and
completing your reading/PPT, choose one of the identified challenges the future
of nursing is faced with. Find a peer reviewed journal article that addresses
this problem to summarize and give your perspective on where we, as nursing
professionals, should go from here ~ what is our role, as nurses, in looking
forward on the issue. Please attach the article as a PDF for your peers if
possible, but certainly include the reference.
Challenges facing nursing education
2.1. Aligning education with the practice environment
Nursing education has a significant impact on the knowledge and competencies of nurses, all health care providers. Nurses with Bachelor of Science in Nursing (BSN) degrees are enabled to meet various patients’ needs; function as leaders; and advance science that benefits patients and the capacity of health professionals to deliver safe, quality patient care (Institute of Medicine, 2011).
The Lebanese healthcare system is becoming progressively more complicated; prospective nurses will encounter a highly challenging healthcare practice environment. The 20th century has been marked with various health care system modifications; due to recognized failures in Healthcare System as the Lebanese health care system is varied and unrestrained with disintegrate funding (El-Jardali et al., 2014).
Utilization of healthcare information technology (IT) is predicted to persist in expanding considerably. Medical schools, institutions, practitioners and students will all need to cultivate techniques for dealing with the abrupt amount of new information, concepts and skills (Jamshidi et al. 2012). It might assist with safer care when technology is used, but it will also demand monitoring, synthesizing and managing larger volumes of data for the patients allocated to their care. The challenging role of the prospective nurses will demand that a Registered Nurse acquire a widened knowledge base, command of skills and proficiencies that will enable the delivery of a highly complex patient care in cooperation and collaboration with an inter-professional team (Reinhard & Hassmiller, 2012).
2.2. Curriculum enhancement
Continuous curricular modifications are an essential phenomenon in nursing academia in order to level learning with the rapidly evolving professional practice. Faculty members gain insight on the students’ feedback on their clinical placements by the end of each semester through individual and group discussions using Interpretive Descriptive qualitative research methodology. Nursing programs aim to prepare nurses who are able to deliver safe and high quality care and would be able to adapt to the evolving environments of practice. Nursing pedagogues endeavor to expose the students to various learning experiences to make sure that they receive their information through multiple channels and would have access to the best available evidence. This strategy takes a lot of time and energy from the nurse educators, and might face multiple challenges (Landeen et al., 2016).
2.3. Nursing as part of an integrated healthcare workforce
There is proof that inter-professional healthcare training methods can be powerful in enhancing patient health results and decreasing healthcare expenses; Scientific research proclaims that inter-disciplinary cooperation results in various positive consequences, in both acute and primary care settings (World Health Organization, 2010). Powerful cooperation and team harmony yield higher patient contentment, lesser hospital retention, reduced medical errors, enhanced patient health results among individuals with chronic illnesses and a diminished mortality rate of hospitalized patients (World Health Organization, 2010).
Yet, there are various obstacles to instituting effective incorporated teams, including a lack of shared perception of tasks and inter-professional practice among providers. To function coherently as members of these teams, students need to be prepared to deliver inter-disciplinary care and to take part in inter-professional teams (Bridges, Davidson, Soule Odegard, Maki, & Tomkowiak, 2011).
Moreover, the healthcare system must be capable of expanding promptly beyond feasible capacity. Providing effective healthcare services to populations demands a well-trained and collaborative healthcare workforce. Because nurses make up the density of the group of professionals within the healthcare workforce, they are essential to the efficient conveyance of all healthcare services. Meeting the necessities for nurses during public health emergencies would be difficult today because of a wide gap of nurse shortages and would be increasingly burdensome in the future, when considerably greater shortages are expected.
2.4. Faculty development challenges
Quality education relies largely on well-trained and competent faculty members. Faculty development and faculty vacancies are demanding challenges in nursing education. Inadequate capacity in nursing schools, increasing requirements to take part in non-academic university activities and relatively low pay are a primary contributing factor to the deficit of nurses and the lack of nursing faculty is a primary causative factor of the capacity restrains. Educators need practice to allow them to integrate theory into practice through synchronization of theoretical themes with the practice courses as well as evidence-based educational strategies more effectively and equip nursing students with the competencies demanded in the 21st century’s healthcare environment. Nursing schools demand faculty members who are experts in nursing education and have the knowledge base to function in an advanced practice role. Furthermore, deans of schools of nursing are demanded to applaud these experts and act to cultivate systems that celebrate and reward expertise in nursing education (Bvumbwe, 2016).
2.5. Technological challenges for nursing education
Technology has significant influence on our lives, on practice, education, management and research. In nursing education, outcome-oriented education is currently being highlighted rather than process-based learning, for instance through skill-based techniques; evidence-based techniques in education; providing students a rich learning journey unlike former models of formal lecturing; and incorporating evolved learning technologies in many programs. All these styles share one major challenge: how we merge the art and science of caring together with the easily accessible technology, so that caring persists to be converged on humans.
Educational technology is the employment of evolved models of technology to ease the educational journey and for the former decade, this has incorporated using web-based education in both live classes and classes uploaded to the internet for later access by learners (Huston, 2013). It also involves electronic references, such as e-books, a multitude of internet-hosted material, computer access and broadband internet services within class and IT rooms, smart-boards, video-conferencing and so on. Educators have a double-edged role: to include the appropriate employment of technologies in education and train nurses to employ technology in clinical practice. Despite the changes taking place in the nursing milieu, nurses still serve at the center of health care system. Therefore, nurses must be properly trained to care for the human spirit, cultures and societies, educated in both the scientific and technical aspects of care and who provide holistic caring.
2.6. Cultural diversity in nursing education
There is a need for enhancing the diversity within the nursing profession in light of the increasing influx of immigrants, minorities and the expanding globalization, in order to satisfy the demands of our evolving community. Yet, various obstacles face the accomplishment of diversity outcomes within the nursing educational programs. As Quintana and Lightfoot (2016) have proposed, diversity stimulates educators who are attempting to enhance student learning and achievement. Some nurse educators hold that diverse students demand excessive energy and time.
Dealing with diversity can also be depicted as an opportunity where working with the demands of diverse students can be an educational venture as well as a prospective advancement in the future of nursing. Knowing how to properly deal with diverse students is actually time and energy efficient and promotes the advancement of knowledge through assessment and conforming course objectives and strategies to satisfy the variable acknowledged demands of the students. As student needs are evaluated and addressed more effectively, less time will be needed to clear up confusion and anger, less time will be spent in remediation and less energy will be spent on frustration.
Thinking “out of the box” in order to accommodate the necessities of the diverse students is demanding, where there is no ideal thinking methodology. Yet, the advancement lies in actually realizing that there is a cognitive barrier that we want to cross. When the necessities of some students are tackled creatively and innovatively, the academic climate is predicted to be enhanced. Nursing educators have to socialize the students into the cultural context of the nursing practice system. Addressing the advantages, disadvantages and benefits of dealing with a diverse group of students, depicts a profound impact on the prospects of nursing practice (Bednarz, Schim, & Doorenbos, 2010).
2.7. Economic challenges
Tuition fees pose obstacles to prospective candidates where the economic depression in the US and regression in financial aid programs have changed the student’s study plans. In 2009, 15% of post-graduate nursing academic programs have recognized financial status and costs of the programs as barriers of enrolling in such programs (National League for Nursing, 2011). Moreover, program location can be a hindrance to nurses who are place bound by responsibilities to support family and provide income. Nursing programs are less available in rural areas despite the increased and crucial necessity of such programs in such areas, where nurses have to be satisfied with longer shifts for less pay (Fitzgerald, Kantrowitz-Gordon, Katz, & Hirsch, 2012). Furthermore, nurses who are employed in hospitals find it difficult to continue their educational career and specialize in certain areas of nursing, as employers usually have to pay replacement fees to in order for them to attend their classes thus posing an added economic challenge.
3. Options for Addressing challenges
The gap between education and the approach of practice for the 21st century has been rapidly widening. Education shall follow the scope of practice transformations and other alterations in the healthcare delivery system. Education favors the incremental adoption of change whereas the practice setting is more agile and thus can swiftly incorporate change.
3.1. BSN – quality and safety
There are multiple various educational approaches a student may undertake to become an RN. There is a disagreement over the required educational context demanded for novice practitioners contributing to the field. The decision concerning the proper recognition of RNs with prominent educational levels is a conflict that is yet to be solved. The same degree, an RN, is granted to alumni of both Bachelor and technical programs.
There are currently two approaches of nursing education accredited by both the Lebanese Ministry of Health and the Ministry of Education. The first is the academic track leading to a Bachelors of Nursing (BSN) degree (3 years training after 13 years of basic education) and the second is the technical track leading to either the Technique Superior (TS; 3 years training after 13 years of basic education) or to the Baccalaureate Technique (BT; 3 years training after 10 years of basic education). All three approaches are offered in English or French. According to the Order of Nurses in Lebanon, BSN and TS graduates are both identified as professional registered nurses i.e. registered nurses (RNs) whereas BT alumni are recognized as practitioner nurses.
A dispute has risen within the members of the profession and among policymakers, pedagogues and employers regarding whether the Technical Nursing programs offers an RN with the requirements of substantial educational context for the advanced problem-solving demanded of nurses, or if the bachelor nursing program is a more favorable approach into the practice environment. Research has proven that bachelor education in nursing to have wider theoretical base than technical education in resulting in lower mortality rates of hospitalized patients in hospitals having more bachelor RNs than Technical RNs.
Kutney-Lee, Sloan and Aiken (2013) revealed that expansions in a hospital’s rates of nurses certified with a bachelor degree in nursing were greatly related to decrease in percentages of surgical patient deaths and failure to thrive. Revelation of a notable mortality advantage related to enhanced nurse education in hospitals amplifies the significances of public policies to aid in the direction of a notable shift toward the preparation of nurses with bachelor degrees in nursing. One particular proposition that has been argued is to aim at all new public financing of nursing pedagogy to graduating nurses with bachelor degrees, through multiple alterations such as granting bachelor degrees by community colleges (Aiken, 2011).
The Ministry of Education and Higher Education (MEHE), in collaboration with the Order of Nurses (ONL), agreed that a bachelor degree in nursing is the academic license that optimally produces nurses apt for the demands of the work environment. MEHE agrees on improving the quality and safety in Lebanon healthcare, MEHE and ONL promote the aim of increasing the education of all registered nurses to a BSN level or higher. To accomplish this objective, policymakers should investigate unconventional tracks that enable students to be certified with a BSN.
3.2. Implementation of bridging programs
The Ministry of Education and Higher Education (MEHE) in Lebanon developed a decree which enables universities to provide bridging programs for students who are certified with a Higher Technical (TS) Degree in nursing (with a GPA of 12/20 or above) to attain a university baccalaureate degree. In accordance, the Faculty of Health Sciences- Nursing Department inaugurated, with the advisory of the Order of Nurses in Lebanon and the Ministry of Education and Higher Education in Lebanon, the “Nursing Bridging Program” to interest those students which the Ministry’s decree targets. This articulate program entails a curriculum with 54 credits which extends over three semesters at the least. Thus, bridging arrangements between BS programs and TS programs at 2-year institutions facilitate pursuing bachelor-level nursing education for such students. These arrangements between the two and three year institutions distinguish which course credits transfer across schools and contribute to an integrated education track to the BSN. The bridging program was starting based on Order of Nurses in Lebanon (ONL) recommendations to maintain quality nursing education, which allow students who hold Technique Superieur (TS) with a minimum average 12/20 to complete at least 50% of required university credit hours to upgrade his/her degree from TS to BS. The complete bridging nationwide arrangement enables credits to be transmittable among all institutions in the country. MEHE accords on improving the quality and safety in Lebanon healthcare, MEHE and ONL promote the aim of increasing the education of all registered nurses to a BSN level or higher. To accomplish this objective, policymakers should offer proper financing and promote partnerships among institutions (EP-Nuffic, 2016).
3.3. Academic/practice partnerships
The creation of partnerships with a wide range of community organizations and providers can instill shared interests and offer broader learning chances for nursing students. While faculty may consider that an optimal clinical training experience is one where students are adjoined with instructors in a one-to-one ratio with patients inflowing at preset appointment times, establishing partnerships with hospitals and care providers in various clinical settings and environments might be valuable. The establishment of community relationships with a service-learning framework can offer creative chances for students to interact and take part in in health awareness, physical and mental health evaluations and intervention with people with no access healthcare services in a given setting. Thus, cooperation between educational institutions of nursing and hospitals or clinical practice settings is a method of resolving complex conflicts confronting educators and clinicians. They believe that academic practice interchange can be an efficient technique for decreasing workforce deficits and those policymakers should promote such partnerships (Koy, 2016).
One method with ability to help in the nursing faculty deficit and to create more clinical resources accessible for nursing education includes internal actions by academic institutions to establish and reinforce cooperative partnerships. Academic institutions function coherently as well as with hospitals and healthcare institutions to establish creative and enabling methods for making nurses and nurse educators ready and to promote the extension of nursing academic programs. These programs are liable to be expensive, but if the advantages can be well identified, educational organizations, hospitals and healthcare institutions may be ready to venture upon their success (Robert Wood Johnson Foundation, 2010). Partnerships tackle complicated healthcare concerns such as the deficit of nurses and nurse educators, the necessity to develop employee skills by strengthening the values and resources provided by the partners and endeavors employed towards accomplishing shared advantageous aims and mutual responsibility. Advantages of partnerships involve shared space, clinical resources and an enhanced research existence in the hospital (Horns et al., 2007).
Academic-practice partnerships offer the required leadership, mentorship and reinforcement in a cooperative mechanism to execute and integrate the best new evidence into practice and promote an elevated level of professional interaction by nurses. Academic-practice partnerships can be an efficient method to tackle workforce deficit as it prepares nurses directly to be employed in institutions that are involved in mentioned partnerships thus it should be supported by policymakers (Gimbel, Kohler, Mitchell, & Emami, 2017).
The transition from student to nurse is a strenuous one. Novice graduates are confronted by various obstacles when adjusting to the workforce. These involve an increasing number of patients with complicated cases and various comorbidities, unavailability of expert instructors and coaches, age variations within the workforce, performance anxiety and bullying. To aggravate the conflict, these problems often occur collectively. Novice nurses start out with immense pressure and with the lack of the proper reinforcement, the pressure of this adaptation can sum up to an elevated turnover rate for new nurses within their first 2 years of recruitment (Hofler and Thomas, 2016). Since it has been indicated a novice nurse needs a minimum of 1 year to conquer the transfer into actual practice (Tradewell, 1996), many novice nurses leave their prime employers before they have had an opportunity to become adapted to their unfamiliar environment.
Internship programs enhance novice nurses’ intentions to stay and increase retention rates. For novice alumni to attain mastery, self-confidence and autonomy, institutions need a disciplined and well-planned method to developing mentors. The aptitude of novice nurses is enhanced after the execution of such a mentorship program (Daniel, Ramnarine, & Kathiravan, 2017).
The employment of nurse practicum programs helps nursing students in adaptation for practice in the working setting before their graduation from nursing programs. The aim of the program were to transform novice professional nurses to skillful PNs, enhance the competency of novice nurses in fields such as efficient decision-making associate with critical thinking and functioning, innovate reinforcing work setting, offer clinical leadership at the point of patient care, reduce mistakes in caring for patients, reinforce the individual’s dedication to nursing as a career choice, create an individual evolvement plan associated with the nurse’s modern clinical role, integrate research-based evidence into practice and reduce nursing staff turnover rate. Such programs facilitate the adaptation of professional nurses to professional registered nurses, help them in offering competent and safe care and enhance job satisfaction and retention. Program elements include designed clinical experience with a mentor, orientation for novice nurses practicing in specialty areas and internships in academic health centers.
3.5. Develop and test innovative program Models/technology models
Information technology can promote the conveyance of course materials, streamline course management, enhance availability by students and faculty, diminish expenses and enhance educational results (Huston, 2013). Information technologies have a broad spectrum of implementations in nursing programs, involving e-learning, simulations, blogs and online scholarly and research journals. Technologies such as clinical simulation and e-learning can aid organizations invest in assets and thereby broaden teaching abilities.
Simulation, the art and science of reinventing a clinical framework, has been an essential engaging approach in nursing edification because it has the capability to be employed for assessment of cognitive, psychomotor and efficient levels of learning (Regan and Onello, 2013, Ravert and Mcfooes, 2014). Simulation offers the student nurses a chance to exercise competencies until they master the skills and ability to provide secure patient care.
3.6. Simulation: The future of nursing education
Nowadays, simulation is prevailing more than ever, promoted by trends such as the deficit in nursing educators and patient secrecy issues at hospital-based practice settings. Simulation has also gone high-tech, enhancing its efficiency as a not only as a potent tool for novice nurses but for experience nurses as well who are interested in improving their advanced competencies.
Thus, simulation is a powerful educational strategy which can enhance patient outcomes and a culture of safety among nurses. Numerous studies have showed that nurses participating in simulation have displayed improvement in skills such as detecting a deteriorating patient condition, classifying emergency patients more meticulously, dealing with stroke patients, functioning cooperatively in obstetrics settings and more.
The future of nursing education might reside in what is known as high-fidelity simulation: the employment of computerized mannequins that can display a wide range of patient situations. These high-fidelity simulation laboratories demonstrate an efficient outlet for nurses to practice the competencies required to take care of complicated, highly critical cases; drill for emergency preparedness, or function collaboratively amongst a team of health care providers.
With more revolution in nursing education comes an upper level of competence and knowledge in nursing practice. Nowadays, there is an increasing demand for nursing educators who are able to induct transformational leadership into the profession through a conception of simulation and other educational strategies.
3.7. Inter-professional education (IPE)
Observers to nursing education systems around the world attain that nursing students are tutored by various health care professionals at clinical settings. Therefore, Koh and Baker (2016) maintained that nursing education in the 21 century needs to sustain inter-professional education to nursing students. There is an agreement that quality of care cannot be improved without integrating health care professionals efforts and have all health care professional acknowledge and recognize various roles of care professionals. IPE is an educational strategy that sets practitioners or students of various health care or social care associated disciplines in a single room to foster sharing competencies and information among disciplines (Lewitt, Cross, Sheward, & Beirne, 2015). Thus, IPE is expected to fill the void that prevails among healthcare providers as it’s associated with communication and enhancement of patient results. IPE has been identified by accreditation agencies and professional institutions as impartial to attaining secure, quality patient-oriented services. Furthermore, there is proof documenting that interdisciplinary and inter-professional healthcare training techniques could be efficient in enhancing patient outcomes and decreasing healthcare expenses as when various health care practitioners of different disciplines cooperate in managing a patient’s case, diagnosis can be more accurate thus leading to fewer misdiagnosed cases, fewer referrals and less visits to other health care facilities, and consequently more prompt and more accurate treatment. In order to promote cooperative performance and sturdy interdisciplinary health care teams, nursing education should incorporate IPE into contemporary programs.
Interdisciplinary education in healthcare and potential for nurses to practice among healthcare personnel from various professions provides students advantages from their mutual educational experiences; it also improves inter-professional engagement yielding in a clearer perception and cooperation in the work environment (Fealy, 2005). Fealy highlights the potent employment of human and material assets in mutual learning settings. Approaches of interdisciplinary education involves instructive experiences with mutual courses and modules, clinical training including learning experiences in interdisciplinary care delivery and project-based student experiences integrating these two factors (Fealy, 2005).
The International Nursing Association for Clinical Simulation Learning (INACSL) and The National League for Nursing (NLN), argued for simulation employment to train students for IP teamwork, complicated clinical judgment and competencies to be more accomplishable of the simulation approach. Simulation-IPE is described as the employment of health care simulation approaches with frameworks created to enhance comprehension about other disciplines for comprehensive model and transformative learning. Team members take part in distinct knowledge base and specific skills, establish open communication and include mutual decision making during simulation exercises (Palagnas, 2012, Sanford, 2010). Simulation-IPE enables individuals to function coherently as a team in a modulated setting that mimics the health care environment. It has displayed enhancements in the attainment of information, competencies, attitudes and behaviors of collaborative group work which is basis to foster secure, quality patient care (Decker, 2015). The objective of the simulation enhanced IPE is to improve quality and safety of services, perception and admiration for other professions, relationship, cooperation, transfer of information, cost effectiveness, problem-solving, future health system requirements and communication among health care personnel and to enhance the value of care in health environments. IPE is not a blending of or weakening of roles (Hermann, Head, Black, & Singleton, 2016).
There are various standards for efficient IPE experiences include responsibility, making use of time in pre-planning with all stakeholders, guaranteeing open communication, accountability, organization, collaboration, confidence, autonomy and shared trust and admiration. A prosperous IPE will assist the students in exhibiting, sharing and exercising these principles with each other. By participating in simulation enhanced IPE health care, students become more engaged in their own edification and more holistic comprehension of their status in the healthcare team (IPECEP 2011).
As nursing curriculums drift towards university environments, the opportunity for mutual education augments. Policymakers should foster interdisciplinary and inter-professional education. This could be accomplished by innovating interdisciplinary and inter-professional educational approaches and illustration projects that incorporate education of healthcare personnel to offer cooperative and client oriented services.
Nowadays, nursing education is facing various challenges locally and globally, as well as it is exhibiting multiple facets of reformation. From aligning nursing education with the practice settings to incorporating nursing as an integral part of the health workforce, to adequately preparing nursing educators and providing them with proper development opportunities, to dealing with technological, economical and ethnic challenges, nursing educators are entitled to recognize and deal with the obstacles that come with the 21st century, in order to maintain a high quality of nursing graduates, quality of care as well as safeguard patient safety and satisfaction.
Nursing education is an ever-changing field and upon the transition from conventional classroom to web-based clinical instruction, educators have become required to guide, motivate and coach students to acquire a more advanced technological experience within their field of study. However, the deficit in nurse educators which is worsened by the present task overload, deficient reinforcement and difficult access to academics when educators are cross-performing as clinical practitioners as well makes such transition a difficult one. Thus, some solutions that can be summarized in working on maintaining a high quality of bachelor education for nurses, implementing articulation programs, establishing strong partnerships between educational facilities and clinical settings and implementing internship programs, simulation and inter-professional approaches in nursing education, can be proposed that are ultimately beneficial for scholars, educators and the profession of nursing education. These proposed improvements revolve around valuing nursing practitioners, which in turn results in modifications in culture and attitude. Therefore, public health education regulations in Lebanon should be put in place to facilitate nurses’ efficient activities, such as the formalization of occupational educational facilities based on identifying nurses as the essence of improving the quality of health care services in Lebanon.
To tackle these demands, managers will require nursing practitioners who can provide health care services of high quality to clients of varying acuity in hospitals and community settings, as well as other health services such as case management, health promotion and disease prevention. In order to stay up to date with the vast variations in the health care settings, nursing educators should regularly assess and audit educational syllabuses, programs and strategies employed to prepare novice nurses. In addition, innovating and piloting new frameworks to ease the access and progress to a Bachelor degree in nursing, as well as strengthening and creating new relationships between educational facilities such as universities and colleges and clinical settings should be supported to establish articulation and bridging programs and tackle prospective labor market problems such as nursing deficits that might be avoided in such cases. Moreover, post-graduate educational programs in nursing should be well financed, in order to facilitate the functioning of nurses in faculty settings, as well as increasing the financial support to nursing residency programs in order to support the entry to practice and promote nursing retention and reduce burnout and attrition and promote maintainable tactics to support retention of racially diverse body of nursing in education and practice. Furthermore, developing a reliable feedback system between practitioner nurses and educational institutions is key to identify the deficits in nursing curricula and facilitate bridging the gap between theory and practice thus providing higher quality of care as well as satisfying the diverse needs of the patients with enhanced safety measures. To add, inter-professional educational models should be embraced and promoted and well incorporated into the educational process of nursing students, as such models prepare prospective nurses with the major skills and knowledge that are required in the 21st century health care system, enhance the use of technology and training of prospective healthcare providers on the use of medical technologies potently, foster cooperation and collaboration among various disciplines of the complex health care system which is patient centered, as well as help nursing practitioners in safe-guarding quality of care, patient safety and satisfaction in both hospital and community based settings.