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Authors

  1. Morgan, Deb MSN, WOCN, RN
  2. Somera, Patricia MSN, ARNP

Abstract

Nursing remains at the top of the job growth market and has the potential to positively or negatively impact changes in the delivery of health care today. Professional nurses play a crucial role in the prevention of medication errors, decreasing infection rates, and facilitating a patient's safe transition from acute care into the home environment. Nurses must make critical life-saving decisions associated with caring for the more acutely ill patient. Doctoral prepared nurses have the unique position to assist the direct care nurse because of their advanced education. The doctor in nursing practice concentrates on direct care, specifically research utilization for improved delivery of care, patient outcomes, and clinical systems management There is a future shortage of doctoral prepared nurses, and a resolution is needed. Doctoral prepared nurses with advanced degrees play an important role in mentoring the bedside nurse to promote an interdisciplinary collaborative relationship. The doctor in nursing practice has the ability to effect change in health care systems, organizations, and policy through focusing on the essence of nursing-the care.

 

Article Content

INTRODUCTION TO THE ISSUE

According to the Bureau of Labor Statistics, employment projections for 2010-2020 (released in February 2012) announces that professional nursing is the top occupation in terms of job growth through 2020. For the occupation in which a master's degree is needed for entry, employment is expected to grow by 21.7% more than any other category. Health care is projected to gain about 5.6 million jobs, which is one of the fastest growing occupations. Occupations that need postsecondary education for entry are projected to grow the fastest during the 2010-2020 decade. Master's degree practitioners are projected to grow by 21.7%, followed by doctoral degree professionals at 19.9%.1 Because of the expected increases in demand of practitioners as the population ages, more health care practitioners will be needed.

 

Because nursing remains at the top of the job growth market, the profession has the potential to positively or negatively impact changes in the delivery of health care today. Advanced practice nurses play a crucial role in the prevention of medication errors, decreasing infection rates, and facilitating a patient's safe transition from acute care into the home environment. They must make critical life-saving decisions associated with caring for the more acutely ill patient in primary care to provide health promotion and disease prevention. The nursing profession brings a steadfast commitment to safe, quality patient care delivery, which is linked to organizational stability and growth. Nurses' professional job dissatisfaction remains correlated to many organizational issues. Doctoral prepared nurses have the unique position to assist the direct care nurse because of their advanced education. There is a future shortage of doctoral prepared nurses, and a resolution is needed. Doctoral prepared nurses with advanced degrees play an important role in mentoring the bedside nurse to promote an interdisciplinary collaborative caring relationship.

 

The future projections in terms of primary care providers are worrisome because of the severe shortage of primary care physicians, which are in great demand. A shortage of 40 000 primary care providers is predicted by 2020. Advanced practice nurses have already demonstrated their ability to provide quality health care in a primary care setting. They receive additional education in the areas of leadership, practice management, and health care policy. This makes doctors of nursing practice (DNPs) essential to become leaders in providing primary care to reduce disease prevention and health promotion.2

 

The "DNP...Why Now"3 discusses a report from the Institute of Medicine that documented issues related to patient safety and the delivery of health care. This report suggested a need for insightful leaders with education credentials necessary to be in a high level of health care management to make policy decisions. The predicted shortage of nurses will be linked to a shortage of nurses with terminal degrees. Today's challenges in our health care system and practice environment will require dynamic changes in nursing practice.

 

The rapid transformation in health care requires the leadership of the DNP to support all direct health care workers in adapting to rapid technological changes and process improvement initiatives. The DNP is a leader who is able to reconceptualize the current infrastructure and framework and lead innovative changes to improve the quality of care delivered while meeting the bottom line. When leading innovative changes, the nurse with a terminal degree is able to link these changes not only to the goals of the organization but also to the community as a whole.

 

REVIEW OF THE CURRENT LITERATURE

A review of the current literature found many studies focusing on the nursing shortage, but there remains a gap in the literature addressing the future shortage of doctoral prepared nurses and recommendations for resolution. An article4 discusses the importance of nurses with advanced degree and their role in mentoring the bedside nurse and promoting an interdisciplinary collaborative relationship between all health care disciplines. These intraprofessional relationships supports the bedside nurse in the promotion of safe, quality patient care delivery in all health care environments.5

 

The nursing shortage of the future involves new driving forces such as global economic issues and health care reform.6 This shortage is now challenging the values and beliefs of the professional nurse. Another article7 discusses how nurses are questioning their ability to fulfill their ethical responsibilities to patients when there is a shortage at the bedside, technology malfunctions, and ineffective systems and processes. These situations raise ethical issues not only for nurses and patients but also for the society.8 Bedside nurses are now voicing a lack of regard for their opinions and input when patient care decisions are being made.

 

The DNP has the knowledge necessary to construct a framework for the future of nursing practice and place value back on bedside nurses, enabling them to be moral agents within a restructured and supportive work environment.9 In addition, the DNP can create a future for nursing that is aligned with our professions' caring practices so that we can continue improving practice and improving the health and well-being of our diverse populations.10

 

Our current health care environment has a negative impact on the caring practices of the bedside nurse.11 The DNP understands this reality and possesses the academic and emotional intelligence to create a practice environment that fosters the optimal nurse-patient relationship-the care. A shift toward human caring values is necessary as organizational systems must value life purposes, inner meaning, and a process for nurses and patients alike, not just economics alone.12

 

The DNP understands the value of the caring nurse-patient relationships. We hear and see the positive comments from patients, which are indicators of a quality practice environment. This type of feedback solidifies the economic value of the nurse-patient relationship in terms of patient satisfaction and quality organizational outcomes.13 Promoting a caring practice environment through the DNP validates the humanistic component of the nurse-patient relationship as a key indicator when defining quality of care.14

 

IMPACT OF THE ISSUE ON NURSING

Some authors15 have reported that nurses express levels of job dissatisfaction, which are among the highest in the United States. The fundamental issues causing nurses to leave the profession, adding to the shortage, is the work environment and design. These concerns contribute to job strain and emotional exhaustion, which interfere with the essence of nursing.

 

Nurses' professional job dissatisfaction remains correlated to organizational issues such as inadequate staffing, increased use of overtime, inadequate support staff, and salary compression. There is a direct correlation between the number of registered nurses and the hours they spend with patients and whether these patients develop serious complications. Current research has related nurse staffing to a number of patient care quality indicators, such as patient mortality, length of stay, and multiple adverse events.16 In many studies, data on work environment factors other than staffing are not included because administrative databases do not capture them. Factors amenable to organizational change also contribute greatly to nurses ratings of quality work environments, such as cohesive nurse physician relations, nurse manager support, and workgroup cohesion.17

 

Direct care nurses remain discouraged by the lack of responsiveness to their concerns on the part of administrative leadership. Nurses believe that there is a lack of opportunity to participate in organizational policy decisions and their contributions to patient care is not being recognized by the senior team. Another great concern is the lack of opportunity for career advancement in their current practice setting. Many organizations are not Magnet accredited, nor do they have career ladders promoting and recognizing the professionalism in nursing. Nurses with terminal degrees are innovated leaders willing to undertake the risk of opening doors to change possibilities aligning with both professional and organizational expectations.

 

IMPLICATIONS FOR NURSING

The increased complexity and ever-changing nature of our health care environment has resulted in a dire need for nurses with terminal degrees in administrative leadership positions. There is a direct link between the characteristics of the clinical practice environment and nurse and patient outcomes. Direct care nurses believe that the greater the control they have in the practice setting, the higher the rates of patient and nurse satisfaction with the career and the care. With the increased patient acuity, DNPs possess the leadership qualities to lead change by working collaboratively with the bedside nurse and deliver the enhanced education and professional support necessary to improved clinical practice. The future of nursing is dependent on nurses with terminal degrees to construct an innovative framework able to support the mounting complexities of effective and accessible care with excellent outcomes while preserving organizational resources.

 

FUTURE CONSIDERATIONS

Today's competitive health care environment has heightened the importance of achieving positive patient outcomes and excellent customer satisfaction. In addition, today's consumer is more informed, and with the cost of health care rising, the consumer has greater expectations of the health care delivery system's ability to provide high-quality, compassionate, and professional health care. To remain competitive and fiscally responsible, health care organizations must adapt quickly to ever-changing regulatory requirements, quality improvement initiatives, and customer expectations.

 

C-Suites are responsible for strategic decisions that are operational in moving the organization toward successful outcomes. These leaders focus on the connections with key stakeholders and system networks.18 This responsibility translates into ensuring that the stakeholders, organizational processes, and resources are aligned for the success of the strategic plan. C-Suites are experts in operations, growth, and finance. They look to marketing and business development specialist to attract additional physicians into the facility to grow patient and procedure volume.

 

Although C-Suites are experts in operations, growth, and finance, they lack the knowledge and understanding of direct care at the bedside. It is not the marketing and business development plan that will sustain and grow business, but the hands-on care delivered at the bedside by the nurse. The chief nursing officer is responsible for nursing and patient outcomes but does not have equal decision-making power as the C-Suite.

 

This current health care environment has a negative impact on the caring practices of nurses. Our pronounced issues of nursing shortages, reimbursement changes, and rising patient expectations are the reality.11 Organizational values have been guided by economics, technology, and medical science instead of taking into consideration what it truly means to be human and in need of caring. Economics models that are devoid of caring produce only short-term solutions to patient care needs. These models focus on disease, advancing technology, and innovative product lines. They address nursing by focusing on incentives such as sign-on bonuses and relocation fees without understanding nurses' underlying dissatisfaction. The dissatisfaction from the nurse stems from the dominance of a medical-technical focus over direct patient care, person-centered human relationships, and caring-healing practices.12

 

The C-Suite must work within this reality to create a practice environment that fosters the optimal nurse-patient relationship-the care. Future consideration for the C-Suite would be to appoint a DNP in the chief operating officer role. Doctoral prepared nurses are the nursing profession's voice for the future.

 

The DNP concentrates on direct care, specifically research utilization for improved delivery of care, patient outcomes, as well as clinical systems management. The DNP has the ability to effect change in health care systems, organizations, and policy through focusing on the essence of nursing-the care.

 

REFERENCES

 

1. Bureau of Labor Statistics. Employment projections for 2010-2012 fact sheet. http://www.bls.gov/news.release/ecopro.t06.htm. Published 2012. Accessed January 3, 2013. [Context Link]

 

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9. American Association of Colleges of Nursing. DNP program schools. http://www.aacn.nche.edu/DNP/DNPProgramList.htm. Published 2011. Accessed January 5, 2013. [Context Link]

 

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18. Porter-O'Grady T, Malloch K, eds. Quantum Leadership: Advancing Innovation, Transforming Health Care. Sudbury, MA: Jones & Bartlett Learning; 2011. [Context Link]

 

expanded DNP role; health care; nursing shortage