Pennsylvania nurses and their allies in organized labor and the General Assembly rally on the steps of the state Capitol on Tuesday, May 2, 2023 (Capital-Star photo).
By Antonia M. Villarruel and Kevin B. Mahoney
The month of May is designated National Nurses Month. It’s a time to thank, celebrate and recognize nurses who make a difference, whether in health care settings or beyond.
Yet, this month should be more than flowers, candy, signs, and discounts. It is also a time to make changes to ensure the safety and well-being of those who serve in this noble, caring, and invaluable profession.
It is said that nurses are the oxygen of the health system. They are often the closest to patients, their families and their communities and play a vital role in keeping people healthy in hospitals, schools, workplace settings and communities. Nurses amplify issues or concerns.
They also provide solutions to address processes of care that affect patient outcomes, using training that instills a holistic perspective, leadership skills, and a sense of ingenuity.
The COVID-19 pandemic magnified long-standing issues nurses face, including burnout from stressful working environments and workforce shortages.
The importance of nursing to the entire health care system has never been more apparent, and the need to address present and emerging issues is urgent. Policymakers, leadership of health care systems, nursing schools and other health-related organizations, and the public all have roles to play.
So, where to begin?
First, health care organizations need to balance messages about the stress nurses face with reminders of the joy inherent to this profession. Employers need to emphasize the impact and contributions nurses make daily.
This is critical not only for the recruitment and retention of nurses, but also for reinforcing a positive message to the public.
Nursing needs to be viewed as more than a job, but rather as a profession for leaders and health advocates. Similarly, the field needs to highlight the innovations and new models of care that create flexible, safe, and supportive environments in health care systems and beyond.
These improvements support nurses’ full scope of practice and full range of skills and decision-making abilities across all levels of an organization.
Second, health care leaders need to ensure short-term fixes to address care shortages don’t jeopardize longer-term solutions.
Graduating more nurses, recruiting nurses from foreign countries, and focusing on resiliency training will not solely address nurse retention.
Workplace safety, schedule flexibility, competitive wages and professional growth opportunities must also be addressed. Health organizations need to move away from the “volume-as-volume” model and instead make decisions guided by a philosophy that keeps patients at the center of care.
Efforts to increase the number of nurses, without considering the type of nurses needed to ensure good health outcomes, must also be addressed.
A report from the National Academy of Medicine recommended that 80% of the registered nurse workforce should be prepared at the baccalaureate level by 2020, however, only 59% of this population achieved the goal.
In addition, there has been an escalation of associate degree and diploma programs across the country without a clear trajectory to reach a higher level of education. The level of education is important not only to the nurse but also this metric directly relates to improving patient care outcomes.
Third, schools of nursing, health systems, and other practice settings must work together to ensure that graduates are practice-ready and can transition safely to practice environments.
Within schools of nursing, competency in the use of electronic health records, telehealth, remote monitoring, evidence-based practice, social needs assessments at the point of care, and population health are important areas of concentration.
Similarly, there needs to be a focus on developing nurses as leaders and innovators to create and evaluate novel approaches that address patient and system issues. Schools of nursing, accrediting bodies, and state boards of nursing need to adopt evidence-based policies that include the use of simulation to address clinical competencies.
This would allow a shift from the use of arbitrary requirements of clinical hours and mandated ratios for educator and preceptor models. The failure to do so results in increased costs to students and added stress to educators and practitioners.
Finally, there are many policy initiatives that need to be employed to facilitate the impact of nurses to improve the health of individuals, families, and communities.
One of the most critical policy initiatives is allowing nurses, especially advanced practice nurses, to work at the full extent of their education and license.
Currently, 27 states and the District of Columbia provide such authority, which improves access to care for millions of people.
In addition to full practice authority, impending federal legislation, such as the Improving Care and Access to Nurses (ICAN) Act, removes barriers to providing certain services (for example, ordering of diabetic shoes, supervision of rehabilitation programs or certifying the need for inpatient hospital services) to Medicare and Medicaid recipients.
The best way to celebrate nurses and underscore the important contributions they make to health is to support their careers, which ultimately benefits us all.
Antonia M. Villarruel, PhD, RN is a professor and the Margaret Bond Simon Dean of the University of Pennsylvania School of Nursing. Kevin B. Mahoney is the CEO of the University of Pennsylvania Health System. They write from Philadelphia.
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