Nursing is a dynamic profession that keeps changing with the times. While the core, which is that of caring for patients, remains the same, the needs of patients and the demands made on the nurse are the underpinnings of a crucible for perpetual change.
Moving into the 21st century Nursing
In the days of Florence Nightingale, most of nursing revolved around caring for the critically ill and severely wounded patients. Health care was a matter of life and death and the nurse was the physician’s “right hand man” in saving lives that were on the verge of death. The patient was fully dependent on the nurse for their existence and the nurse in return derived meaning from being the “patient’s savior.”
As healthcare advanced, the nurse’s role shifted to that of being the patient’s caregiver even in a stable state of existence.
Nursing roles have again shifted from the simplistic tasks of bathing, feeding, changing, drugging and discharging to more advanced tasks such as creating nursing diagnoses and crafting intervention measures for patient care. The mental model and skill set for the 21st century nurse are entirely different, as much as empathy remains at the core of nursing practice. This calls for a paradigm shift and creation of new models of training to lay better foundations for the 21st century nursing practice.
Technology has transformed health care as we know it, this has made a great impact on the length and quality of life of patients. Patients are more educated and informed about their conditions and are no longer solely dependent on the nurse for their care. Health care has taken a more engaging outlook as the patient, physicians and nursing teams are open to deliberating on the appropriate treatment course for the patient. Technology has made it possible to anticipate the patients’ needs and address them as a potentiality and not an emergency. Genomics may enable us in the future to completely stop diseases even before they occur, time will tell. But advances made in the last few decades have created urgency for drastic shifts in nursing practice that calls for adaptability as outlined below:
Health care is now a highly decentralized technologically advanced service that is internet moderated. Most health care procedures including note taking are now fully dependent on the internet. When the nurse checks into their work station, they immediately begin to engage with machines and software to get them updated with the state of affairs in the wards. Every task including checking for vital signs and recording patient information is technologically controlled.
Nurses are constantly compelled to adapt to newer medical technologies and equipments so that they can offer the best care to their patients.
Some of the prior nursing roles have been completely taken over by technological gadgets. This has allowed the nurse to offer more advanced and specialized services, moving away from menial tasks that previously defined nursing. Patients are also able to access medical information from the internet and engage the nurse in planning their care process.
The 21st century nurse cannot dispute the role of technology in dispensing quality patient care and it is the prerogative of the nurse to keep abreast of technological advances in the space, if they are to remain relevant as modern nurse practitioners.
Nurses are among the most sought after professionals around the globe. Thousands of nurses leave their countries every year to work in other countries as international migrants. With increasing permeable borders for professionals, it is easy for nurses to migrate and work in different countries where conditions may be better than in their domicile countries. Nurse mobility is fuelled by the need for better pay, better work environment, better professional development, personal safety and mere novelty of the experience.
Developed nations are greatly dependent on foreign nurses for the delivery of health care services due to scarcity of labor in their countries. A WHO 2006 report estimated that about 30,000 nurses and midwives trained in sub-Saharan Africa are working in developed nations. Ireland was exporting nurses for many years, but tides have turned and they are currently importing nurses from the Philippines, Africa and the US.
The 21st century nurse is a global nurse, equipped with skills to serve a global population. The nurse can no longer be confined in their thinking to restrict their practice to geographical boundaries, but they are compelled to contextually expand their knowledge and skills to suit the needs of a global audience.
Emerging nursing specialties
Technological advancements have afforded nurses the opportunity to specialize and sub specialize their training and allow them to be experts in their field of choice. Nurse specialization allows nurses to practice as private practitioners, much in a similar way that physicians do. Nurse practitioners are able to conduct full body examinations, make diagnosis, and create treatment plans for common acute and chronic conditions such as the flu and hypertension.
Nurse practitioners are able to offer comprehensive and affordable health care to the general population. In some countries nurse practitioners can prescribe medication without the approval of a physician.
Initially, nurses were trained on the job through observation. But as nursing has advanced, nurses have to spend more and more time in school in order to be fully equipped to execute specialist roles. The world over, nurses are now training to degree level as the most basic form of nursing qualification. Nurses can then proceed to obtain a masters degree, doctorate and even post doctorate training.
The emergence of the nurse practitioner role has compelled the 21st century nurse to spend more years in training. The modern nurse has greater responsibility and risk attached to their role. They are able to question the doctors’ teams and offer recommendations on a planned course of care for the benefit of their patients.
The 21st century nurse has an open outlook to patient care. They may be conducting a research, training students, working in a lab setting, dispensing drugs, working with machines etc with all these activities being geared towards providing better services to the patient. The nurse working at the bedside and the nurse independently seeing patients all have one goal in common, to offer the best possible care to patients in need of their services.
The future of nursing
The coming years may witness a greater demand for advanced practice nurses offering primary care, at affordable costs to patients. Physician teams also stand to benefit from working with nurses with a global view and who have been trained to specialist levels as they can be able to delegate with confidence and free up their time for other duties. Nurses have been proactive in strengthening the collaborative effort between physicians and nursing teams. These transformative changes in nursing care will result in better patient experiences and patient outcomes in the coming years.
- NCBI (2011): Florence Nightingale and the Crimean war.
- NCBI (2002): Empathy and Quality of Care.
- NHGRI: What is Genomic Medicine?
- OJIN (2008): Nurses on the Move: Historical Perspective and Current Issues.