Posted: March 28th, 2019
As the largest group within the healthcare profession, nurses operate as the primary link between the healthcare system and the patients and communities they serve. From traditional RNs to advanced practice registered nurses, the role of nurses has expanded due to an aging population and an evolving healthcare system, both in the United States and abroad. They are involved in every aspect of patient care as they work to preserve and promote health across all patient populations.
On Tuesday, April 2, the School of Public Health will hold the Dean’s Symposium, “Nursing and the Health of Populations,” to examine the current state of nursing science and practice, and explore how nurses can continue to impact global population health. The event will feature a keynote speech by Barbara Stillwell, executive director of Nursing Now and a veteran leader in international health workforce issues and health worker migration. Stillwell is heralded for introducing the nurse practitioner role in general practice in the UK.
The symposium will also feature a panel of nursing experts in clinical, administrative, academic, and policy roles, including Jacqueline Fawcett (SON’64), professor of nursing at the College of Nursing and Health Science at University of Massachusetts Boston; Karen Daley (SPH’88), former president of the American Nurses Association; Kelley Brittain, associate professor at Michigan State University College of Nursing; Kate Lorig (SON’64), professor emerita of immunology and rheumatology at Stanford University; and Deborah Washington, director of diversity for patient care services at Massachusetts General Hospital. The panel discussion will be moderated by Maureen Bisognano, president emerita and senior fellow of the Institute for Healthcare Improvement.
Ahead of the event, Stilwell and Bisognano spoke about the expanding role of nurses and the impact of their work on global population health.
In which way has the role of nurses in the healthcare system changed most significantly in the past 10 years, and what are the best skills to have as a nurse?
BISOGNANO: I’ve met a nurse in Sweden who partnered with a young man to teach him self-care in doing hemodialysis and together, they developed a new way of co-producing care that results in better health for chronic dialysis patients across the county of Jonkoping. This nurse has joined with the patient to spread this model across Sweden, and now around the world. Seeing them teaching a nephrologist in Texas this new way really demonstrates the shift in hierarchy and bureaucracy when nurses take the lead in design.
The skills of nurses are so well recognized. Nurses demonstrate the three skills I consider most critical to our mission today. I value IQ and nursing research is adding to our clinical knowledge every day. Nursing education is adapting to include all new methods of building clinical and scientific skills for students and continuing learners. And nurses show EQ—emotional quotient—and empathy. Every day, I meet patients and family members who tell me that nurses’ empathy meant so much at a critical time in their lives. And nurses are always champions of CQ—curiosity quotient. Nurses have taken a challenge I gave several years ago, and have spread a campaign to ask patients not only “what’s the matter?” but also, “what matters to you?” The campaign has spread to over 35 countries and impacts thousands of organizations, patients, and families, and interestingly, has a positive impact on joy within the nursing workforce.
STILWELL: Many ofour Nursing Now groups, now in over 80 countries, are keen to try developing Advanced Nursing Practice in a number of care settings. I think this reflects the way that healthcare is changing overall, with a much greater use of technology and sophisticated medicines shifting the pattern of caregiving so that nurses take on more responsibility for leading and coordinating the overall care of a patient.
While we all appreciate the great strides in medicine that keep us alive longer and cure our ills, we still need to understand what is happening to us, and nurses can provide that bridge—not separately from other providers, but as the advocate and interpreter for the patient. Nurses and midwives are with you at every step of life: midwives see you into the world and nurses care for you as you leave it.
Nursing care is cost-effective—so investing in nursing is smart. A nursing workforce has great clinical skills, as well as the ability to practice the art of nursing—bringing it all together with the patient at the center. This is where the IQ, EQ and CQs all come in so powerfully. They create the influential leaders who listen to the team, digest the information, feedback what they hear and plan a pathway of care with the patient.
How has information and communication technology transformed nursing practices and improved patient outcomes?
BISOGNANO: Nurses in Sao Paulo, Brazil have worked with technical experts to design new artificial intelligence and machine learning systems to improve patient flow and to reduce complications. The impact of new technologies, designed with nurses, is making a huge difference in care and caring.
STILWELL: The potential to use technology to get just-in-time advice is huge. It is possible to take X-rays and get them read, take pictures of injuries and skin conditions and send them for specialist opinion, or ask for help. This can transform care with nurses taking the lead backed up by a team at a distance.
And we now have the possibility of collecting and using big data to show the patterns of nursing care. Nursing Now is working with the University of Edinburgh on innovative ways that we can support nurses to collect data and use it in dialogue with policy makers to improve decision-making.
There is currently a global shortage of nurses. How can the industry retain and attract more people to this profession?
BISOGNANO: This is the first time in history we have had five distinct generations in the nursing workforce. We need more nurses entering the workforce and need new ways to engage nurses to stay. I believe we need new ways to lead that recognize the assets and drivers of each generation, including ways to demonstrate regularly the meaning and impact of this work to the nurses providing the care. Young nurses need a mentor who will work with them to build a plan to develop new skills, every year. They have a strong expectation that each year will bring opportunities for new ways to work. I think each nurse needs several “stay interviews” each year rather than an “exit interview” as they seek new opportunities.
STILWELL: Nursing remains a gendered profession—predominantly women, with men often not viewing it as a profession for them. In many countries, this gender effect lowers the status of nurses and nursing. Nursing Now carried out a global survey recently with questions about women nurses and leadership. Survey respondents were asked to rank the top five out of twelve items they felt would interest them in staying in the profession in a higher-level nursing job. The following items were ranked most often in the top five requests: having equipment and resources to perform the job (47%), leadership training (45.3%), good and fair salary (45%), having clear decision-making guidelines (38%), and decision-making support from senior management (35%). These are great signposts for us as we try to recruit and retain nurses—they are not rocket science, but surprisingly often overlooked.
What can be done to increase diversity and inclusion in nursing?
BISOGNANO: Recruiting a more diverse nursing workforce will require us to expand the public image of who is a nurse. We can use many ways to send this message, including sharing stories on social media and including examples in films and books. We’ll need to focus recruitment in the field, where these people live today. I visited recently the Frontier Nursing University in Kentucky, and was amazed at how effective this university is in recruiting nursing and midwifery students from very rural parts of the country, and in using electronic education to keep these students connected to their home sites. We can have a diverse group of young nurses visiting schools, as they are doing in England, to change the face of nursing for the young. It’s a vital need for us to expand the diversity of our teams.
STILWELL: In some places, we need to be careful to recruit nurses from the populations that are under-represented, by going into schools and colleges and having nursing schools in places that are easy for students to access. As we get better with distance education, it will be possible to create more innovative ways of education delivery that will open opportunities for those who might not be able to otherwise access education.
Link to BUSPH Post: https://www.bu.edu/sph/2019/03/28/nurses-are-with-you-at-every-step-of-life/