Nursing

California Grads Having Trouble Finding Jobs

Posted in Hiring Nurses, Hospitals, Nursing, Nursing Jobs, Nursing News, Nursing School, Nursing Shortage

Image of California oranges courtesy of Randy Son of Robert via Flickr

Perhaps more California nurses should consider moving to Alaska?

While Alaska is seeing a shortage of nurses (at least in specialized fields), many recent California nursing school graduates are having a hard time finding a job. A survey of newly licensed (within the previous 18 months) RNs conducted by the California Institute for Nursing & Health Care (CINHC) has found that 43% of them were still looking for their first job.

A press release from CINHC states that the study was conducted in fall 2011 in collaboration with the California Board of Registered Nursing (BRN), California Student Nurses Association (CSNA), Association of California Nurse Leaders (ACNL), and the UCLA School of Nursing.

“Newly graduated RNs finding employment remains a pressing issue. After years of investment in building the workforce and increasing educational capacity, the economy continues to impact hiring and undermine the progress that has been made,” said Deloras Jones, executive director of CINHC. “An aging nursing workforce, along with health reform initiatives, will escalate the demand for nursing care in the future and California may again face a major nursing shortage.”

The survey was sent to 7,890 nurses out of 15,780 that been licensed in California between April 2010 and August 2011. Among the 1,492 nurses completing the survey (19% response rate), 57% were under the age of 30; 87% were female; 49% were White, non-Hispanic; 16% Filipino; 13% Hispanic; and 4% Black/African American.

Lack of experience was the main reason cited by nurses for not getting a job (92%), 54% said that no positions were available, 42% said a BSN degree was preferred by the employer, and 6% said they were told that they had been out of school too long. Other findings included:

- Among those working as RNs, 31% percent reported that it had taken six months or more to find a job; 40% found a job in under three months

- 77% of newly licensed nurses employed were working full-time

- Among new grads without RN jobs, 25% were either volunteering in a health care service or working as a non-RN in a health care setting

- 80% of nurses without RN jobs were interested in participating in a non-paying internship for reasons that included: increasing skills, exposure to potential employers, improving their resume, obtaining college credit applicable to a BSN or MSN degree, and deferring student loans while enrolled in an academic course.

“This survey was a snapshot of the hiring dilemma new RN graduates face in California. Its findings present a compelling case for nurse leaders to seek creative ways to employ new grads,” said Jones.

Survey results may not fully represent all new nurses in the state. Nurses who have not found employment may have been more likely to answer the survey, and if so, the actual employment rate may be higher than reported. Complete survey results are available at http://www.cinhc.org/2012/02/new-rn-graduate-hiring-survey-2010

Combatting Night Shift Health Risks

Posted in Hospitals, Nurse Safety, Nursing, Nursing News, Nursing Specialties

It’s not all bad on the night shift. Night shift nurses don’t have to deal with visitors, doctors or supervisors, and have fewer interruptions. The night hours may work best for a nurse’s family situation as well. But could working at night, when 80 percent of the world sleeps, actually be hazardous to a nurse’s health?

The International Agency for Research on Cancer has determined that the disruption of the natural circadian rhythms that happens with night shift work is “probably carcinogenic.” Circadian rhythms involve regulation of body temperature, blood pressure, sleep/wake cycles, mental clarity, and hormonal secretions. The rhythm is cued by exposure to light and darkness. Over time, disruption to circadian rhythms can put a nurse in a constant stage of sleep deprivation.

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Numerous studies have shown that night shift workers are at greater risk for type 2 diabetes, developing breast and colorectal cancer, irregular menstrual cycles and other fertility problems, strokes, higher blood pressure, cardiovascular disease, type 2 diabetes, and increased risks of anxiety and depression.

Nurses operating with a pervading sense of fatigue that night shift work causes may have slower reaction times, less attention to detail, decreased problem solving skills and impaired psychomotor skills. They may become irritable, forgetful, and complain of chills, nausea and eye-strain. The more consecutive night shift a nurse works, the worse it all gets and the higher the likelihood of making an error.

So what can be done to combat the increased health risks to both the nurse and subsequently, the patient?

- Whether working the night shift or off for a few days, try to stick as closely as possible to the same sleep schedule.
- Use blackout shades to keep the room as dark as possible.
- Use sunglasses to block out blue light when driving home from work.
- Keep the lights bright; this prevents the body from wanting to lower its temperature during the 0400-0600 hours.
- Avoid caffeine and nicotine before sleeping.
- Avoid large meals before sleeping.
- Sleep at least four hours.
- Expose your body to bright light upon waking.
- Most importantly, try to nap when you can.

The National Sleep Foundation recommends night shift napping for every person working at night in order to combat fatigue and increase mental clarity. In a study done with critical care nurses, 10 out of 13 nurses reported they’d felt more alert and had better moods when they napped on the job. Many healthcare facilities have adapted rooms to accommodate napping nurses by providing couches, recliners, blankets and pillows. These facilities not only tolerate but expect nurses to take nap breaks as part of their night shift routine. In order for nurses to care for their patients, they must first tend to their own needs. And that includes the need for sleep.

Nursing Shortages in Alaska

Posted in Hiring Nurses, Hospitals, Nurse Employers, Nursing, Nursing News, Nursing School, Nursing Shortage, Nursing Specialties, Travel Nursing

Image of Alaskan mountains by arthur chapman via Flickr

Alaska has added more than 11,000 health care jobs in the last decade. But they’re still seeing a shortage of nurses, especially in specialized areas like operating room nursing, according to this story on the KTVA website.

There are an abundance of Alaskans who are qualified to take entry-level positions in nursing. The director of the University of Alaska – Anchorage’s School of Nursing, Barbara Berner, says that her school alone graduates about 200 new nurses per year, while the estimated need for nurses in the state is 130 nurses per year.

So there is both a shortage (for some of the most specialized areas) and a surplus (for entry-level positions), at the same time. Berner says that she’s also hearing that many institutions are not requiring as many traveling nurses from out of state to do basic nursing care, as they had in the past.

Across the state, including at Alaska Regional Hospital, experienced specialty nurses are in short supply, and it’s necessary to draw people up from the Lower 48, which doesn’t always work out.

“I would say for every 10 nurses we recruit from out of state we are able to keep one,” Kaminski said.

Students who are finishing specialized graduate programs are getting picked up much more quickly.

“People with particular specialties often have jobs before they even leave the graduate program because there is such a need in the state,” said Berner.
And to help ease the shortage of operating room nurses, a cross-training program is being piloted in Anchorage.

“We take nurses who have a couple years of nursing experience, who are eager to go into perioperative nursing settings and we pair them up with a preceptor one on one to go through the program; in the end they are trained to be perioperative nursing nurses,” said Kaminski.

It’s hoped innovative training like this will mean hospitals and other facilities can retain the qualified nurses they have and continue to hire from in the state.

Certification Signals Expertise

Posted in Hospitals, Nursing, Nursing Jobs, Nursing News, Nursing Specialties

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Is specialty nursing certification necessary? What are the benefits? Must an RN be certified to compete for jobs?

These are some of the questions addressed in this article on Nurse.com. There is no question that specialty nursing certification has become increasingly popular. The American Nurses Credentialing Center reports that more than 250,000 nurses and more than 80,000 advanced practice nurses have received certification from them since 1990.

While specialty nursing certification is voluntary, studies have indicated that it has potential benefits that include increased job satisfaction. The article quotes a nurse as saying that after she received certification, “Physicians seemed more respectful of my opinions.”

It is not yet clear whether certified nurses earn more. One study found that registered nurses who hold certification in a specialty area earn $7,300 more a year, on average, than uncertified RNs. But then another recent study found that there wasn’t a high correlation between salary and certification.

One nurse manager interviewed for the article said, “Certification is definitely a plus when I am reviewing nursing applications for my unit and the candidates are otherwise equal.” She said that almost half of the nurses on her unit have certification in critical care or progressive care nursing. She says that certification also seems to make families feel more confident about a nurse’s ability to care for their loved one.

Indeed, certification may lead to improved patient outcomes. A study in the June 2011 issue of the Journal of Nursing Scholarship shows a link between nursing specialty certification and better clinical outcomes, including lower inpatient mortality. Other studies have found that certification is associated with fewer medical errors, according to ANCC.

“Certification indicates your commitment to patient care. It’s something nurses are very proud of,” ANCC’s Swartwout said.

An ongoing study should shed more light on whether certification affects clinical outcomes. The American Board of Nursing Specialties is sponsoring a study of trends in specialty certification of RNs in acute care hospitals and the connection between certification and specific patient outcomes. According to the ABNS, the research project uses the National Database of Nursing Quality Indicators.

How to search for a certification program

Nurse experts recommend the following steps in beginning the journey toward certification:

• Ask advice from a board-certified colleague or supervisor.
• Search your specialty nursing organization’s website. It may have a certification link.
• Search among the member organizations of credentialing bodies. Those for nursing certifications include the American Board of Nursing Specialties and the Institute for Credentialing Excellence.
• Search certification review materials. At PearlsReview, a subscription-based collection of nursing specialty certification reviews from Gannett Education (PearlsReview.com/courses.aspx), each specialty review page contains links to the certifying organizations for that specialty’s exams.

What’s standing in the way

Despite the benefits, most U.S. nurses are not certified. Among the barriers to pursuing nursing certification is the cost of the exams, an ABNS survey found in 2006. Initial certification exams in 2011 typically cost several hundred dollars or more, although discounts are available for members of the board’s affiliated nursing organizations, such as the American Nurses Association for ANCC exams.

Nurses also must meet eligibility requirements, which vary by certification. Generally, licensed RNs must have a certain amount of nursing experience and clinical and continuing education hours to be eligible for ANCC specialty nursing certification. For instance, ANCC criteria for certification in med/surg nursing requires candidates to have worked two years as full-time RNs and have 2,000 clinical hours and 30 continuing education hours in the field in the past three years. Other organizations may have no continuing education requirement. Eligibility criteria to sit for the CCRN certification exam from the American Association of Critical-Care Nurses Certification Corp. include 1,750 hours in bedside care of acutely or critically ill patients during the prior two years, with no requirement for continuing education. Advanced practice certifications have educational requirements as well.

Study guides

For some nurses, the concern is how to find the time and discipline to study for the exam while juggling work and family responsibilities. Nurses can make their study goals more attainable by studying over a longer period, Saxton recommended. The ANCC suggests about six months of study before taking the certification exam.

However, ONCB’s Lasley said how long to study is an individual matter and that some orthopedic nurses have found six weeks is enough time to prepare for the ONC exam.

Saxton suggested a peer study group to prepare for a board exam. “Having a support system helps nurses achieve their goal. It gives them accountability,” she said.

Finding a mentor also is recommended. Some certifying programs and specialty nursing associations have volunteers who help peers through the certification process, such as the ONCB’s certification mentors called Ambassadors.

Review seminars are available at hospitals and nursing schools across the country as well as online sites including NurseCredentialing.org for some ANCC specialty certification exams. The credentialing center gives applicants a 90-day window to take the exam after deeming them eligible.

ANCC nursing certifications are valid for five years before requiring renewal. Swartwout said most nurses renew their certification through professional development rather than testing.

Reducing Paperwork Confusion

Posted in Hospitals, Nursing, Nursing News, Technology

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A proposed rule would save healthcare providers and health plans up to $4.6 billion over the next 10 years, according to estimates from the U.S. Department of Health and Human Services. At the center of it is a unique identifier for each health plan. It would simplify administrative processes for hospitals, health insurance plans and physicians’ offices.

Kathleen Sebelius, secretary of HHS, is quoted in this article from Nurse.com as saying that the simplifications will allow clinicians to “spend less time filling out forms and more time seeing patients.”

Right now, a wide range of codes are assigned to health plans and other entities like third-party administrators. These codes aren’t standardized at all — they come in a variety of lengths and formats. They’re tough to keep track of and can cause time-consuming problems like transactions being rejected because of insurance identification errors. Meanwhile, the increasing use of Electronic Health Records means that standardization can also be helped along by computer prompts or forms.

The rule simplifies the administrative process for providers by proposing that health plans have a unique identifier of a standard length and format to facilitate routine use in computer systems. This change will allow provider offices to automate and simplify their processes, especially when processing bills and other transactions.

ICD-10 compliance

The proposed rule also delays the requirement for compliance with new codes used to classify diseases and health problems. The compliance deadline is now Oct. 1, 2014, instead of Oct. 1, 2013.

These codes, known as the International Classification of Diseases, 10th Edition diagnosis and procedure codes, or ICD-10, will include new procedures and diagnoses and improve the quality of information available for quality improvement and payment purposes.

Many provider groups have expressed concerns about their ability to meet the 2013 compliance date. The proposed change would give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition to the new code sets.

Tips for Travel Nurses on Going Green

Posted in Hiring Nurses, Hospitals, Nursing, Nursing Jobs, Nursing News, Nursing Specialties, Travel Nursing

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Travel nursing can be exciting, challenging, and rewarding, but it can also be a little rough on the environment. The San Francisco Chronicle’s website has a list of tips for reducing your carbon footprint.

These suggestions are geared towards travel nurses, travel therapists, and other mobile healthcare professionals who wish to be more green while on assignment.

On average, American commuters traveled 25-minutes to and from work each day in 2009 or 50 minutes per day, according to the American Community Survey of the U.S. Census. Densely populated areas may have trouble meeting federally recommended air quality standards due to the pollution vehicles create. Altering daily habits will aid in reducing carbon emissions in these areas as well as in other communities across the U.S., where Aureus Medical’s healthcare employees are assigned.

1. Purchase a fuel-efficient vehicle. The rising cost of gas makes buying a fuel-efficient car sensible for a commute and a sound future investment. Many newer used cars can offer exceptional mileage options that range from 24 to over 35 miles per gallon, which can greatly reduce the amount of fuel required and the emissions the vehicle produces.

2. Maintain the car by ensuring the correct air pressure in tires. Proper inflation alone can drastically improve gas mileage, which will save money over the course of the year and decrease pollution.

3. Consider public transportation, such as buses, subways and commuter trains. This helps make the footprint of the overall system greener due to the decrease in pollution per capita.

4. Bike to work. Not only will it save gas, but will also reduce car maintenance costs, parking fees and toll expenses. According to Time Magazine, an individual may be able to save $5,000 annually by biking to work.

5. Walk to work. Depending on the location of temporary housing and the hospital facility, a mobile, a travel nurse or travel therapist may be able to walk all or part of the way, and incorporate public transportation that follows the route required.

Empathy Decline in Nursing Students

Posted in Hospitals, Nursing, Nursing News, Nursing School

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A study reported in the January issue of the Journal of Professional Nursing shows a decline in an important nursing skill that is more about understanding a patient’s perspective and fears than about technical ability: empathy.

Empathy improves patient outcomes and patient satisfaction scores, but empathy isn’t an easy skill to learn. For example, a new young nurse who comes from an urban background might find it difficult to empathize with a middle-aged rural Amish woman with several young children who is facing a medically necessary hysterectomy. Students may also experience empathy challenges when they need to deal with areas of nursing that does not interest them. In this case, a student interested in being a pediatrics nurse could have a difficult time mustering empathy for geriatric patients.

Empathy requires nursing students to focus less on the practical aspects of nursing (the science) and more on the nurse-patient relationship (the art).

The study focused on 214 undergraduate nursing students at the same institution from three degree types: an associate’s, a bachelor’s and a post-degree (for second degree students). Eighty-four percent of the students were female. Surprisingly, the more clinically experienced students showed the greatest decline in empathy. In other words, the more exposure to patients and to a professional environment, the less empathy a nursing student demonstrated. Similar declines were also noted in students with previous clinical work experience. Younger nurses and the less clinically experienced students showed greater empathy with their patients.

The decline in empathy is not only limited to nursing students. Medical students demonstrated less and less empathy as they worked through their degree programs. Unfortunately, researchers could not isolate a single cause as the reason for the decline. Researchers could only speculate that lack of time for meaningful patient and caregiver interactions, anxiety, pressures of academia, and an increased need for technical expertise – for which the students felt unprepared – as possible contributing factors of empathy decline. The researchers also considered the role of technology-driven education systems, such as distance learning, which limit exposure to faculty members who can serve as role models. These role models not only provide examples of professional behaviors, but provide counseling to students who find themselves challenged in their empathy skills.

The researchers suggested five initiatives to slow the decline and improve nursing students’ confidence in the use of empathy with their patients:

- Selecting preceptors who demonstrate empathy.
- Clinical experience where a great deal of empathy is needed.
- Role playing.
- Study and recording of therapeutic communication between patient and nursing students.
- Recognition and reward for demonstrating empathetic skills.

The science of nursing is easier taught than the art of nursing, but the question remains as to the root cause of the decline and whether or not clinical experiences could be taught or experienced in a manner that would enhance the students’ levels of empathy rather than contributing to the decline of this important attribute.

Nurse Executives Taking the Helm

Posted in Hospitals, Nurse Employers, Nursing, Nursing News, Nursing Specialties

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In the Atlantic, Christine Mackey-Ross writes about the importance of improving the quality of health care, not just driving down costs, and the new breed of health care leaders that have been attracted by this challenge: physician and nurse executives.

Many organizations are now forming Accountable Care Organizations (ACOs) with the goal of improving quality and reducing costs. ACOs, explained in this earlier post, are integrated networks of hospitals, clinics, physicians and other providers, who are all held accountable for the quality and cost of care for a specific population such as Medicare beneficiaries.

Mackey-Ross writes that the Centers for Medicare and Medicaid Services (CMS) estimate that ACOs could save Medicare up to $940 million in the first four years, based on participation levels and successful implementation. While this is encouraging, ACO-style health care remains untested.

As these new care models emerge, a new type of leader is needed, and that’s the physician and nurse executives.

There has been a major uptick in the number of requests for physicians and nurses who are prepared to lead health systems, academic medical centers, community hospitals, and managed care organizations. According to the executive search database at Witt/Kieffer, there are already 64 physician CEOs leading U.S. health care systems with thousands more in the talent pipeline. They are exchanging their lab coats for a seat in the C-suite, taking advantage of opportunities to lead during the post-reform era.

These new leaders are arriving with strong clinical backgrounds and nuanced perspectives on patient care as well as physician behaviors. They are charged with the enormous task of preparing health care organizations to thrive in this age of quality and cost accountability. Most importantly, based on their clinical credentials and patient care experience, they bring the voice of actual caregivers to the executive offices and board tables where strategic decisions are made.

Among physician executives new titles are emerging, such as chief quality officer and chief clinical integration officer, signifying a strategic move to remake the organization’s capacity for seamless delivery of care. Physician executives are tasked with bringing the medical staff and the executive team into full alignment. Physician executives understand how providers think and can encourage the consistent use of best practices throughout the medical staff. To be successful, health care organizations can no longer afford to use the “us” (practitioners) against “them” (administrators) paradigm. They need a combined talent approach that puts the best minds on the field, advancing quality, safety, and cost goals together.

According to Dr. John B. Chessare, president and CEO of the Greater Baltimore Medical Center: “Alignment of the physicians is the first step. Getting them to work together toward a unified goal of doing right by the patient — and doing well financially — will be the real trick. Our only hope in making this new world work is to keep calling out the problems in the present system that every patient — especially those with chronic diseases — must navigate every day.”

So where are these new executives coming from? Their career routes are varied, from private practice and medical affairs offices to nursing leaders who worked their way up the organizational chart. Many of them returned to school to earn MBAs and degrees in finance so they can bring sharpened business skills to their new positions. They speak both clinical and financial languages to help the organization achieve full accountability in quality and safety. In addition to their patient care credentials, today’s physician and nurse executives must be fluent in pro forma development, business plans, cost containment, staff productivity, and data mining.

The stakes are high. Beginning in 2013, hospitals’ reimbursement for care will be based on documented performance. Health care organizations not meeting national clinical and patient satisfaction benchmarks are likely to see huge declines in Medicare revenue under the new federal Value-based Purchasing Program. Reimbursements to high-performing hospitals will be larger than those to lower performers as CMS uses financial incentives to drive improvements in quality, patient satisfaction, and cost efficiency.

On a personal level, consumers are feeling the impact of these changes. For example, they are now invited to participate in “medical homes” where the physician, hospital, ambulatory services, and other professionals are connected to patients in a less fragmented and more results-focused way. The medical home delivers coordinated care backed by best practices, not test volumes. In turn, patients are expected to actively engage in their own care plans, making lifestyle changes and monitoring their wellness. Nurse navigators have emerged to help patients implement healthy behaviors and remain compliant with medications and therapies.

Distinct models may evolve over time, but these transformations are increasingly directed by physician and nurse executives for better outcomes at a lower cost. That’s the new face of health care.

Reduce Worthless Tests

Posted in Hospitals, Nursing, Technology

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Some tests are life-savers, but some are worthless. A campaign called Choosing Wisely has been launched by nine national medical groups, with the goal of getting U.S. doctors to tell the difference. Specifically, Choosing Wisely wants health care providers to back of on 45 diagnostic tests, procedures and treatments that range from harmful to merely useless.

CT scans, MRIs and X-rays comprise many of the 45. For example, they recommend that if a child comes into the emergency room with low belly pain and appendicitis, do an ultrasound before a CT scan. That will provide an answer 94% of the time, plus it’s cheaper, plus it doesn’t expose the child to radiation.

It’s not just actual tests that this covers, though — the groups also suggest that, for example, if a patient has heartburn, avoid high doses of acid-suppressing drugs since lower and shorter courses will do the job. The high dose might actually make symptoms worse once the patients try to stop the medicine.

This article on NPR.com goes into some other examples of when to keep the medical touch light:

An apparently healthy middle-aged guy with few cardiac risk factors comes in for a yearly exam and wants to know how his ticker is. Don’t give him a full cardiac workup, with a treadmill test and fancy imaging. This kind of patient accounts for almost half of unnecessary cardiac screening.

Postpone repeat colonoscopies for 10 years if the first one is negative, or if it found and removed one or two early-stage colon polyps, the guidelines state. And stop prescribing antibiotics for mild-to-moderate sinus infections.

And here’s one that raises some tricky questions: Most patients who are debilitated with advanced cancer shouldn’t get more chemotherapy.

“When somebody is literally bed-bound and unable to walk or take care of himself, it’s almost futile to use cancer-directed treatment and will probably have negative consequences,” says Dr. Lowell Schnipper, a Boston cancer specialist who helped develop the new guidelines.

Schnipper tells Shots many cancer patients are getting chemotherapy in the last weeks of their lives. He says that does no good, makes patients miserable and may shorten their life.

The Choosing Wisely project was launched last year by the foundation of the American Board of Internal Medicine. It recruited nine medical specialty societies representing more than 376,000 physicians to come up with five common tests or procedures “whose necessity … should be questioned and discussed.”

The groups represent family physicians, cardiologists, radiologists, gastroenterologists, oncologists, kidney specialists and specialists in allergy, asthma and immunology and nuclear cardiology.

Eight more specialty groups will join the campaign this fall, representing hospice doctors, head and neck specialists, arthritis doctors, geriatricians, pathologists, hospital practitioners, nuclear medicine specialist and those who perform a heart test called echocardiography.

Consumer groups are involved, too. Led by Consumer Reports, they include the AARP, National Business Coalition on Health, the Wikipedia community and eight others.

The effort represents a growing sense that there’s a lot of waste in U.S. health care, and that many tests and treatments are not only unnecessary but harmful.

Harvard economist David Cutler estimates that a third of what this country spends on health care could safely be dispensed with.

“That’s certainly the number we use,” Dr. Steven Weinberger, CEO of the American College of Physicians, tells Shots. “Most of us feel something like $750 billion or so could be eliminated from the system out of the $2.5 trillion or so that we spend on health care.”

Weinberger says unneeded diagnostic tests probably account for $250 billion.

“I talk about this a fair amount around the country, and invariably physicians come up to me and recount their own anecdotes about overuse and misuse of care,” he says.

Proponents of the campaign are aware they’re wading into dangerous waters. “There will be some … that may demonize this campaign and infer the R-word — rationing,” Daniel Wolfson of the ABIM Foundation wrote in December when the campaign was launched.

But rationing is the denial of care that patients need, Wolfson points out. The Choosing Wisely campaign aims to reduce care that has no value.

The Changing Role of Today’s Nurses

Posted in Affordable Care Act, Hospitals, Nursing, Nursing Specialties

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In the Huffington Post, Charles Tiffin writes about the many ways that nursing “has become more complex in ways that couldn’t have been imagined a generation ago.”

To begin with, the nurses are tasked with an ever-wider range of health care responsibilities. And they’re not just caring for the sick — they’re giving TED talks, publishing scientific research, addressing health care policy, and more.

New health care technology has a place in the changing role of nurses as well. Many things are moving to electronic versions — X-rays, blood work, ordering medications. Many new technological devices, such as the use of mobile devices and electronic medical records “invite nurses to be digitally ambitious,” as Tiffin puts it.

Technology is giving a boost to basic medical instruments too. Tiffin points to new bandages for heart patients that have built-in sensors that measure vital signs. Nurses will increasingly be responsible for tracking and synthesizing multiple sources of comprehensive patient information. The emerging field of nursing informatics involves connecting nurses with technology developers to make these systems efficient and 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.