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The nursing role is rapidly evolving as nurses are tasked with an even wider range of health care responsibilities. Caring for the sick has certainly gotten more complicated. Hospitals are understaffed. Budgets are tight.

The graying of our society -- plus growing rates of diabetes, obesity, and other conditions -- means the health care system is dealing with an increasing number of complex illnesses. And with political elections looming, it's unclear what the regulatory landscape might look like in the future.

In hospitals, clinics, and care centers around the US, nurses are rising to meet these challenges. And advanced nursing education is empowering nurses to lead the way.

Today's nurses aren't just caring for the sick; they're changing our very notion of modern medicine and health care delivery. Nurses are giving TED talks, publishing scientific research, developing mobile medical applications, and actively addressing health care policy. They're collaborating with their colleagues, from social workers and oncologists to hospital administrators and public safety personnel. The field is growing, and so are opportunities for nurse practitioners, DNP and PhD nurses, nurse educators, nurse-anesthetists, and nurse researchers.

New health care technology is also creating opportunities for nurses. More and more aspects of the profession are electronic: Test results, X-rays, blood work, and ordering medication. An array of new technologies -- mobile devices, electronic medical records, cloud computing, and teleconferencing -- invite nurses to be digitally ambitious.

It's not just that nursing is becoming a broader field; it's becoming deeper, too. The opportunity to pursue medical specializations -- diabetes, obesity, pharmacology, and more -- is blooming, but the real opportunity is in mastering complex, multifaceted issues that impact our health care system and our nation. It's more than knowing how to perform tasks and procedures; It's about being a more effective member of the health care team and navigating clinical systems.

Soon, nurses won't just consider the symptoms of patients in front of them; they'll look at the health of their communities and beyond. Health information databases -- like the Joint United Nations Program on HIV/AIDS, which uses cloud computing to understand how HIV spreads -- will help nurses see how illnesses fit into national disease trends.

Even basic medical instruments are getting smarter: For example, new bandages for heart patients have built-in sensors to measure vital signs. It will be the nurse's role to track and synthesize multiple sources of comprehensive patient information. In the emerging field of nursing informatics, nurses will connect with technology developers to make these systems more user-friendly.

Nurses will also confront the growing costs of health care in America. For example, a major challenge is how to curb the large expenditures for chronic disease patients in hospitals. One proven way is to treat patients before they need a hospital visit. New at-home monitoring programs, where nurses see patients on live webcasts, will soon play a larger role in patient care. Because these emerging tools are at the forefront of more cost-efficient care delivery, nurses who can adapt and implement technology will become sought-after leaders.

Patient behaviors are also evolving in a digitalized world. Patients are using online resources to research and treat their symptoms. Health and wellness are consistently among the most searched-for topics on Google. Nurses will need to double as health technology librarians, directing patients to trustworthy websites and useful applications.

New technology won't preclude traditional care, but it will open up more creative options to teach patients about their health. Nurses will no longer be limited to one-size-fits-all safety pamphlets. Patient education can become more personalized, with hundreds of new medical apps, from glucose monitors to basal body temperature trackers.

Nurses will still need to be culturally wise too. Hospitals are increasingly diverse, cultural melting-pots where nurses work on the front lines of race, religion, and gender. Doctor time is limited, but nurses deliver hour-to-hour care and interact with the families of patients. It requires the ability to listen and understand people from all walks of life.

Nursing has become more complex in ways that couldn't have been imagined a generation ago. Now there's an imperative to be not just a great caregiver but a great innovator too. The demands of health care are calling for a new generation of thinkers who want to be agents of care innovation. It's a profession for the intellectually curious, lifelong learner.

However, as nursing continues to evolve with new hospital structures, fancier gadgets, and political challenges, the heart of the profession stays the same. Whatever the tools and technologies, the job of the nurse will remain caregiver and advocate for the most sick and vulnerable members of our communities.

Great nurses take what they've learned in their formal education -- the key concepts, the research, the policy and societal considerations -- and apply it to make surprising, difficult, life-or-death decisions every day. And that's why nursing education has such a crucial role to play. Getting an advanced nursing degree means preparing yourself for a changing world of possibility. With the right skills and knowledge, the next generation of nurses can make a bigger difference for patients, communities, and our national health care environment.

 
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09:55 PM on 04/02/2012
After 2 years in nursing I have already asked myself "what was I thinking"?. Im in my 40s and decided on this 2nd career. My first job was at a nursing home/rehab facility. I was shocked at the poor level of care, poor staffing, neglect, etc. I left every day feeling horrible that I couldnt provide the level of care I was taught and ethically obligated to give. (and this was one of the "better facilities"). I started at a major hospital in the Austin area 1 yr ago. It had no training program/internship. I got horrible training, no support and my preceptor did NOT know how to teach. Basically I went thru 4 mo's of hell but managed to hang in there. I have witnessed bullying, pettiness, and outright rudeness- I attribute that to stress and understaffing. We can have 4 patients and no CNA- so I am doing the job of 2 people on a floor where pts are high acuity. Once again- I feel unsafe and unable to provide the level of care I was taught. Its downright SHAMEFUL that hospitals care more about PROFIT than pt quality pt care. We get the "our HCPAP scores are falling" lecture on a constant basis. (well then- get more staff!). Highly trained and excellent nurses are leaving b/c of these issues. The pay here is low here also. This profession has done nothing but show me how flawed the delivery of care can be.
05:15 PM on 03/30/2012
thanks for a great article. Please be advised that nursing is a distinct and separate profession from medicine. Nurses are not licensed to practice medicine, just as physicians are not licensed to practice nursing. Therefore, it is not accurate to say that nurses pursue medical specializations. Physicians pursue medical specializations, nurses pursue nursing specialization. There are many professionals that provide health care (the more inclusive and accurate term)--physicians, nurses, pharmacists, physical therapists, medical lab technicians, etc. These professionals do NOT provide medical care, only physicians can do that. These other professionals provide health care services.
07:46 PM on 03/29/2012
To start each shift with a combination of dread and anxiety is an unfortunate reality in the world of acute care nursing. Daily staffing shortages, unrealistic staffing grids, high-acuity patients and "regulatory readiness" are just some of the stressing situations that nurses face on any given day. Bedside nursing offers the opportunity to have a meaningful connection with a multitude of patients, to make a positive influence in the health and well-being of another person; yet bogged-down, time constrained, overworked nurses have not the chance or support to function at the potential that each possesses, which is most likely the potential that got the nurse into nursing in the first place.
02:52 PM on 03/30/2012
Well said. Regulatory requirements that do not improve outcomes have strangled nursing care. I choose the path of peaceful resistance and of speaking out when the opportunity arises. I hope other nurses will do the same.
03:54 PM on 03/29/2012
I just have to say that, after reading all of the comments thus far, the push for professionalism, committee membership, research all exist within my job as an RN, but to say that nurses' aides, CNAs and the like are performing most of the bedside duties is just not true, in my experience. I work as an RN in a New York City university hospital, and not only am I expected to take on more leadership responsibilities, but still perform optimum bedside care. I am still chamging dressings, colostomy bags, starting IVs, educating pts., comforting family members, giving medications, and am expected to know all about my arrythmias, shared governance, evidence-based research---and the list goes on. The profession has become elevated from what it once was as health care has become more complicated, but the bedside nurses are still here, doing what we do. And the stresses of inpatient care, with a shortage of nurses' aides, is what may also keep nurses from working at the bedside throughout their entire careers. I've been doing it for 10 years, but I won't be for another 10! Even though it can be rewarding---
02:57 PM on 03/30/2012
I agree. In the Level 1 Trauma ICU where I practice, we have not had CNAs to empty linen hampers, help turn patients, hold a limb for a dressing change, disinfect used equipment and so on for many years.

A long time ago (I've been a nurse for 30 years), a fellow RN told me that nurses would be all-powerful if we collectively stopped doing housekeeping and other non-nursing tasks. This suggestion predated the IOM recommendation that nurses "practice at the top of [our] licenses" by over 2 decades. I do hope her idea will now come to fruition.
10:10 PM on 03/28/2012
I'm a Registered Respiratory Therapist. I have a B.S. in Respiratory. I've noticed an increase in bullying and harassment in the hospital environment over the last few years. I've taken to documenting events as they happen. We are responsible for the ICU, Nursery, ER, Recovery Room, floors, etc. We are always short-staffed. We are poorly paid. We are the ones who are called for every code, trauma, bronch and high-risk delivery. We never receive any recognition. I suspect our lobby is not as powerful as the nursing lobby. Our profession is growing and will continue to grow. Hopefully working conditions will improve along with the salary.
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medicontheedge
big loud broad
04:53 PM on 03/28/2012
How wonderful it is that nurse driven standards, policies, practices, etc. are changing healthcare! No longer are nurses relegated to handmaiden status. And right along side, those very nurses are educating and pricing themselves out of direct, hands-on patient care. RNs are graduating with BSNs in "nursing" with little actual practical experience; hospitals have to run "internships" for these new nurses to teach them how to perform duties in the various areas they are used. Then these same nurse start the treadmill on which they are expected to continue their education, join committee after committee, etc etc.
Most direct, hands-on patient care in hospitals is performed by various "allied healthcare " staff, like CNAs, patient care techs, whatever they are called in a particular facility. Still, powerful nursing organizations fight every move by these same people who are actually doing most of the work from seeking their own professional status and acquiring other duties that RNs with loads of degrees and big paychecks no longer care to do.
And don't believe the whole Nurse shortage myth.
I await the rebuttals by offended nurses.
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MiamiMama
04:31 PM on 03/28/2012
My son has a BSN in nursing and wants to advance his degree. He has been checking out a Masters in Nursing and Infomatics to get into the technology side of nursing. I was wondering if anyone knew about the opportunities in this area.
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Sanity Inspector
He who laughs, lasts.
05:41 PM on 03/28/2012
See if this entry from the Bureau of Labor's Occupational Outlook Handbook is useful: http://www.bls.gov/oco/ocos083.htm
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JimbolandJots
Storyteller, humorist, musician, thinker, scholar,
03:54 PM on 03/28/2012
Sadly, the advanced degrees - MSN, DNP, PhD - require enormous indebtedness and only a small portion of the population can afford to acquire these credentials.
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Donnaruth
Stand up all you lovers in the world
12:41 PM on 03/28/2012
The nursing profession is just that: a profession. The entry level for RN should be a bachelors degree just like it is for any other "profession". This does not mean that other levels diploma, LVN, or associate degree are less knowledgeable or less caring than anyone else. The image of nursing in the past has been inaccurate and the general public is often confused by what a "nurse" is. The medical assistant that weighs you at a clinic is always called a "nurse" but they aren't. Caregivers can be caregivers no matter what their education level is. But for RNs, if you want to looked at as a profession we must act like one. Nurse have always been leaders in education, prevention and treating patients holistically. Medicine is now starting see this. There is nothing wrong with a bedside nurse. I work with many bedside nurses with masters or DNP degrees. Some of them teach on the side or publish research. There is nothing wrong with this very powerful and trusted profession advancing themselves as experts in care, research and education. It strengthens the profession and it is where nursing is going. Part of what is wrong with health care is the out of control profits from insurance and big pharma. Nurses are not a profit driven profession and they will lead the way in health care.
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ddubya1978
Travel is fatal to prejudice, bigotry, and narrow
04:45 PM on 03/28/2012
Everyone should take insult to you implying that for a job to be considered a profession one must have earned a BS degree. Do the bricklayers, the house builders, the plumber or any other trade you can name, many of whom are very profitable, not work honest and respectable professions? Bill gates dropped out of college to start a little company. Does he have a profession? In closing, I think your overall point was that nurses need to act like professionals and expect to be treated as professionals. On this we both agree.
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Donnaruth
Stand up all you lovers in the world
12:32 PM on 04/01/2012
Well, hopefully anyone in various "trades" such as bricklayers, plumbers etc. would not be insulted because that isn't what I'm talking about. I'm talking about the profession of nursing and it isn't a trade. I'm not talking about income or prestige, I'm talking about setting standards for entry level education. Other professions(engineering/scientists,etc) have it as well and I don't think there is anything wrong with setting standards for yourself and your profession. I'm speaking of the profession I have spent the past 23 years working in and have a tremendous amount of knowledge and experience in (pediatric oncology and intensive care). Yes, I have a BS and yes, I am in a masters program. There are also health and safety regulator agencies for standards of care so a free lance Bill Gates entrepreneur RN isn't working with patients inventing new treatment plans. Nothing wrong with entrepreneurs either. I think more nurses should start up their own business and get away from the corporate takeovers of hospitals. The post was not meant to insult anyone. I specifically spoke of nursing and what are standards of education should be.
08:09 PM on 03/28/2012
I agree with you mostly, except there are vast differences between the curriculums of LVN, diplomas, ADNs and BSNs. Therefore, the outcomes of care are expected to reflect differing levels of knowledge and education.
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Moder8tion
12:16 PM on 03/28/2012
Nursing is probably one of the best paying jobs a person can get with a 2-year degree. If you are smart and disciplined you can be making $90,000 within 10 years. I have a lot of respect for them.
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ddubya1978
Travel is fatal to prejudice, bigotry, and narrow
04:56 PM on 03/28/2012
Where do you know that nurses are making 90,000 per year as bedside nurses? The only places I know of are places where the cost of living is so hight that the extra pay is pretty much canceled out. Now I know that traveling nurses and agency nurses can make this much money because I have. Im asking where do you know that a RN working 48 hours per week can make 90 grand with a full-time job with benefits? I had to for 50- 60 hours per week to do it even when agency nursing. I made 86,000 my second year out of school. I was in a flex pool at one hospital and a per diem at another and working 48-60 hours per week to do it though. This idea that a nurse can work a normal work week and make this kind of money is just not what I have seen. Most nurses I know who are working staff positions make under 40 bucks per hr. That doesn't add up to 90,000 per year. I will say though. Yo can make a decent living as a nurse with a two yer degree. I just think sometimes people are led to believe the the grass is greener that it actually is.
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Moder8tion
11:06 PM on 03/28/2012
My ex GF in Northern VA has worked her way into Neonatal, Labor & Delivery stuff that is very intense. She does have to work 1 weekend a month and teaches 1 birthing class per month also... She gets a pay raise every year and also when she completes certifications.
03:07 PM on 03/30/2012
I actually do know some RNs who make that much at the bedside. They are MS-prepared nurses, and they work weekends, nights, overtime and holidays. Not to mention shouldering a risk of musculoskeletal injury, exposure to violent patients/family as well as hazardous materials (carcinogenic chemicals and body fluids.)
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ShahinaLakhani
Founder ThroughLifeAndDeath. comTeaches and adv
11:14 AM on 03/28/2012
"Whatever the tools and technologies, the job of the nurse will remain caregiver and advocate for the most sick and vulnerable members..." Charles, this right here says it all. I agree that nurses are naturally placed to lead the way in our changing world of healthcare. And, that is the reason, nurses need to unite and stand up for their patients and themselves. In a lot of ways, clinical/bedside nursing is still in the dark ages. This is a big disservice to patients and the profession of nursing alike. That is pretty much 100% of the population as each one of us, at some point, will need healthcare.
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Hugatreetoday
Do or do not, there is no try.
07:55 AM on 03/28/2012
Nursing is absolutely not what it used to be. There are very few places that "accept" non BSN educated RNs anymore. Hospitals want BSN as a minimum and they push RNs to get their MSN and MBAs. Everything is customer service driven now as per Medicare and JCAHO regulations. Add in Magnet status and you are talking VERY high standards. Nurses have very little time at the bedside anymore. They are constantly documenting everything from soup to nuts on medical software programs (about their patients). They are also pushed to join self-governance committees and councils, thus taking them away from bedside care even more. While I am not saying that the aforementioned is necessarily a bad thing, it most certainly has changed the scope of what one thinks of when they think of nursing in conventional terms. Becoming a nurse can be quite lucrative now and rightly so. However, one should not enter the profession if they are not fully prepared to keep climbing the ladder into management. There should be a distinct career path CHOICE for new nurse graduates: a) they want to care for patients and not be pushed to go into management or b) they are career driven and welcome taking on leadership roles. I can tell you this much...I've known many RNs who have left direct patient care in favor of higher paying Rx sales rep positions. They leave because they have become disheartened with the pressures within the health care system.
05:23 AM on 03/28/2012
The nursing profession is becoming very broad in scope. Nurses with low technical skill and high caring skills are caring nurses. Then there are many other specialized forms of nursing.

There has been a trend to restrict entry into the profession to those qualified to become technician or specialized nurses thus excluding the less well-educated to become caring nurses.

Professionalization leads to the diminution of care.

Nursing leaders seeking higher status for their profession are in denial about this.
10:23 AM on 03/28/2012
As someone who leads a team of nurses this article is spot on. Technical nurses are in HIGH demand and we need tens of thousands more. Nurses with great technical skills are not precluded from being caring nurses as well. There are many roles for less technical nurses including the role of the LPN.

Your comment is not well thought out given the massive nursing shortage that exists today. We need more nursing schools and teachers to handle just the current demand for seats in classes.

Your comment about professionalism was intended to be a joke right? They do not need to strive for a higher status...they have it.
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ShahinaLakhani
Founder ThroughLifeAndDeath. comTeaches and adv
03:16 PM on 03/28/2012
Tom 84, I agree with most of what you are saying but one point. The shortage in nursing is more from attrition than anything else. The demanding conditions in nursing drive a lot of good hearted caring nurses away. The high patient ratios coupled with increasing acuity of patients that enter hospitals are making it impossible for nurses to function at their optimum. Often it becomes a choice between their passion for caring and their own health and sanity. To address nursing shortage we need to address work conditions nurses are subjected to everyday. Increasing the number of nursing graduates is only part of the equation.
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chatnuptime1
The Wolf's Den.
04:19 PM on 03/28/2012
You have a point there about the dimunitive effects of carreer nurses vs bedside nurses. I have always said that with the advent of technology we should learn to use it on a broader scope thus untying our hands of the mundane aspects of Pt care. I have been a technocrat most of my life and I like playing with my tech toys and I am well educated in the medical feild as well. While not a nurse for the obvious reason of being stone deaf I and I did put myself thru college to get a Nurses liscence to take that knowlege and help my praciticing nurse freinds merge tech and care and make their feild life easier to manage so they could spend more time with their pt's. Cloud computing is a great tool for that. I think that people educated in both feilds can come together and facilitate more personable care as a team. I took this path after being a CMA and for a few years and found that most CMA's could help their doctors out in ways they had time for. Like sitting in on reveiws at the end of the day with the doctors on his case load and offering observations about their pt visits. I have done more research and offered other tid bits related to their care and the Doctors loved the imput.
05:23 PM on 03/28/2012
Thanks for you interesting reply.