Today and Beyond

Introduction

Nurses, a varied and essential profession, lead the delivery of healthcare. Today’s nurses, however, face a wide range of difficulties in the ethical, legal, economic, and social realms. This post will examine the three main problems nurses encounter when providing care and offer solutions. In addition, we will look at one of the key messages from the Institute of Medicine’s (IOM) 2010 Future of Nursing study and explain why it’s so essential for the nursing field. The IOM’s five core competencies for nursing will be scrutinized, along with any associated challenges and well-thought-out solutions. Nurses are crucial in the healthcare ecosystem as the protectors of patients’ well-being. Their commitment to high-quality treatment is admirable, but they face numerous obstacles that require a thorough analysis and creative solutions. By addressing these issues and adhering to the IOM’s Future of Nursing report recommendations, nurses can improve the standard of care even more, promote professional development, and make considerable progress toward assuring the highest possible standard of medical care.

Challenges in Nursing Care Delivery

Nursing Shortages

The need for qualified nursing staff is one of the biggest problems facing the delivery of nursing care today. The shortage of nurses significantly affects patient safety and the standard of care. The aging nursing workforce, rising patient demand brought on by an aging population, and a shortage of training resources for educating new nurses are some causes of this shortage.

Overcoming the Challenge

Healthcare groups and policymakers must work together to put forth meaningful solutions to the nursing shortage problem.

• Increasing Educational– According to Edwards et al. (2022), new nurses can be recruited more easily by expanding nursing education programs and opening nursing schools. Scholarships and financial incentives may help persuade more people to pursue careers in nursing.
• Telehealth and Remote Monitoring- By using telehealth technologies and remote patient monitoring, nurses can treat more patients while requiring less on-site staffing (Haleem et al., 2021). Using wearable technology, nurses can remotely monitor patients’ vital signs, medication compliance, and general health. This real-time information decreases the need for in-person visits and enables prompt interventions. Nurses can help patients determine the severity of their medical concerns and guide them to the best treatment facilities. The usage of healthcare resources is optimized as a result.
• Enhancing Workforce Retention- Health-care organizations should develop methods to keep experienced nurses on staff. Competitive pay, better working conditions, and chances for career advancement can all help with this.
• Policy Reforms-To allow advanced practice nurses to assume greater responsibility in patient care, policymakers should reevaluate rules that limit their area of practice (Woo et al., 2019). In addition to supporting the expansion of educational capacity, increased public funding for nursing education programs can help lower the financial barriers to entry into the nursing profession.

• International Recruitment-While domestic solutions are being implemented, looking into international recruitment opportunities can help fill temporary staffing shortfalls. To guarantee seamless integration into the healthcare system and the local community, healthcare institutions should spend money on cultural competency training and assistance for overseas hires. International recruitment may offer temporary respite, but it should differ from investments in domestic nursing education and retention methods for a long-lasting, sustainable solution.

Ethical Dilemmas

Nursing professionals frequently face moral problems in their daily work. Complex decisions regarding end-of-life care, informed consent, and distributing scarce resources may be involved in these problems. Emotionally draining ethical dilemmas may make it more difficult for nurses to offer patient-centered care.

Overcoming the Challenge

Nurses should be able to negotiate moral conundrums skillfully.

• Continuous Education: The ability to negotiate complex ethical situations can be acquired by nurses through ongoing training in ethics and critical thinking.
• Ethics committees: Ethics committees should be established by healthcare organizations so that nurses can consult them for advice and have ethical debates with professionals and other nurses.
• Ethics Rounds and Case Discussions: To encourage group ethical decision-making, healthcare organizations can regularly hold ethics rounds and case talks with interdisciplinary teams (Ferrell et al., 2021). This strategy encourages a cooperative approach to resolving moral problems. A systematic methodology called moral case deliberation enables medical practitioners to consider and evaluate ethical concerns collectively. It promotes candid communication and group decision-making.
• Technology Integration

Nurses now face opportunities and problems due to the healthcare industry’s rapid technological improvement. Although other technologies, such as electronic health records (EHRs), can potentially enhance patient care, they can also cause problems, including information overload and a decline in face-to-face patient connection.

Overcoming the Challenge

Using technology effectively in nursing practice requires.

• Training and assistance- To efficiently use EHRs, nurses should receive thorough instruction on technological systems and ongoing service.
• Balancing Technology Use According to Wang et al. (2018), healthcare institutions should stress the significance of maintaining a balance between technology use and face-to-face interactions with patients. Some problems can be solved by encouraging nurses to interact with patients meaningfully while using technology.

Key Message “Remove scope-of-practice barriers”

The IOM’s Future of Nursing study emphasized the necessity to “Remove scope-of-practice barriers” (IOM, 2010). This important message advocates for the elimination of needless legal and regulatory restrictions that limit nurses’ ability to exercise their training, education, and competence to the maximum. The significance of this message is multidimensional and affects patient care, nursing practice, and healthcare systems significantly.

Significance of the Nursing Profession

It is impossible to stress the importance of reducing restrictions related to the scope of practice in nursing. This message is important because it recognizes that significantly advanced practice nurses (APNs), like nurse practitioners, clinical nurse specialists and professional nurse midwives have the expertise to provide a range of healthcare services due to their knowledge, abilities, and experience. For numerous reasons, it is crucial to remove these obstacles.

• Enhanced Access to Care- The removal of limitations on the scope of practice, according to McWilliams et al. (2022), enables nurses to provide a wider range of services, such as primary care, preventative care, and chronic illness management. This expanded function is especially important in impoverished and rural areas where healthcare access is constrained.
• Meeting the Growing Healthcare Demand- As the population ages and healthcare requirements rise, there is a rising demand for primary care physicians. APNs can close this gap by providing high-quality, affordable healthcare.
• Enhancing Healthcare Quality- Several studies have shown that APNs deliver quality care that is on par with physicians (Eriksson et al., 2018). Patients’ healthcare results may be improved by broadening their area of practicians who can deliver care at a lesser cost than physicians, which lowers the cost of healthcare for both patients and healthcare systems.
• Fostering Interprofessional Collaboration-Removing barriers related to the scope of practice promotes interprofessional collaboration, in which nurses give treatment alongside doctors and other healthcare professionals on an equal footing. This cooperative strategy fosters a team-based healthcare model and improves patient-centered treatment.

Importance to Patient Care

• Improved Access-Patients have better access to healthcare services, preventive care, and chronic illness management, especially those who live in underserved and rural areas.
• Improved Continuity of treatment-APNs may offer patients ongoing, thorough treatment, establishing stronger patient-provider bonds and better care coordination.
• Patient-Centered Care-Removing obstacles are consistent with the concepts of patient-centered care, which gives patients more freedom and control in choosing their primary care physicians.
• Timely Care-Care that is delivered on time results in quicker diagnosis and treatment because patients have shorter wait times for appointments and get prompt interventions.

Overcoming challenges

• Resistance from Physician Groups-Physician groups have occasionally objected to extending nurses’ practice areas, citing concerns about patient safety and treatment quality. To overcome this opposition, healthcare stakeholders must communicate openly and work together.
• Regulatory Obstacles-State regulations differ, and negotiating the legal system to eliminate impediments to the scope of practice can be challenging. Policymakers must advocate for and implement changes.
• Education and Training- As the range of practice increases, APNs must continue their education and training to ensure they can deliver high-quality care in their new jobs.

IOM’s Five Core Competencies and Obstacles

The Institute of Medicine (IOM) established five fundamental skills as a guide for nursing practice and education in its 2010 Future of Nursing study. Nursing professionals must possess these competencies to deliver high-quality, patient-centered care in the rapidly changing healthcare environment. Each of the five essential competencies will be thoroughly examined in this part, along with any roadblocks to its application in nursing practice.

Patient-Centered Care

Core Competency

According to Olson et al. (2021), patient-centered care entails understanding individual patients’ and families’ unique preferences, values, and requirements and adjusting treatment accordingly.

Obstacles and Solutions

Time Constraints

Nurses frequently experience time restrictions due to their excessive workloads, which can limit their capacity to provide complete patient-centered care. One way to enable fruitful patient interactions is to streamline operations and increase the workforce.

Communication Barriers

Language hurdles, cultural differences, and problems with health literacy can all obstruct clear communication with patients. Nurses should undergo training in cultural sensitivity and communication techniques to overcome these challenges.

Interdisciplinary Teams

Core Competency

Interdisciplinary healthcare teams must effectively collaborate to deliver complete and well-coordinated patient care.

Obstacles and Solutions

Healthcare Hierarchy

Open communication and teamwork among team members might need to be improved by conventional healthcare hierarchies. This challenge can be overcome by fostering a culture of respect for one another and group decision-making (Terkamo‐Moisio et al., 2021).

Lack of Standardization

Misunderstandings can arise from differences in healthcare providers’ workflows, vocabularies, and procedures. The use of uniform communication tools and strategies can promote cross-disciplinary cooperation.

Evidence-based Practice

Core Competency

To make decisions that improve patient outcomes, nurses must be adept at incorporating the best available research into clinical practice.

Obstacles and Solutions

Limited Access to Research

It could be difficult for nurses to find current research and supporting data. Healthcare companies should spend money on training and resources to make it easier for people to get scientifically sound information.

Resistant to Change

Nursing professionals may be reluctant to adopt new evidence-based procedures. Overcoming resistance can be facilitated by providing continual education and showcasing the beneficial effects of evidence-based therapy.

Quality Assurance

The ability to spot areas for patient care improvement and to take an active part in quality improvement programs should be a core competency for nurses.

Obstacles and Solutions

Resource Constraints

More resources can be needed to thwart efforts to improve quality. Healthcare organizations should plan their resource allocation and include nurses in decisions that affect quality.

Resistance to Change

The execution of programs for quality improvement can be hampered by resistance to change within healthcare organizations. You will need strong leadership support and efficient change management techniques to overcome this challenge.

Safety

Core Competency

Ensuring patient safety is of utmost importance, and nurses must be watchful in spotting and reducing hazards to patients’ health.

Obstacles and Solutions

Fatigue at work- It can jeopardize patient safety when healthcare professionals are fatigued. This problem can be solved by implementing sufficient staffing, scheduling guidelines, and tiredness risk management programs.

Hierarchy and Retaliation Fear- Hierarchical cultures and retaliation fear may prevent nurses from reporting mistakes and safety issues. To overcome this challenge, it is essential to create a safety culture that strongly emphasizes reporting and learning from mistakes.

Conclusion

Nursing care delivery faces several difficulties, including nursing personnel shortages, moral conundrums, and technology integration problems. Education, support, cooperation, and changes in policy are among the strategies used to address these problems. The Future of Nursing report by the IOM emphasizes the importance of removing scope-of-practice restrictions, with substantial implications for the nursing profession and patient access. The IOM’s core competencies highlight critical abilities for medical professionals, including a list of challenges and solutions to improve nursing practice. Improving patient care and continuous progress of the nursing profession will be facilitated by overcoming these difficulties and adopting the core competencies.

References

Edwards, L., Corley, A. G., & Lucea, M. B. (2022). An assessment of the Libyan baccalaureate nursing education during political turmoil. Public Health Nursing, 39(4), 831–838. https://doi.org/10.1111/phn.13047

Ferrell, O. C., Fraedrich, J., & Ferrell. (2021). Business Ethics: Ethical Decision Making and Cases. In Google Books. Cengage Learning. https://books.google.com/books?hl=en&lr=&id=o38xEAAAQBAJ&oi=fnd&pg=PP1&dq=To+encourage+group+ethical+decision-making

Haleem, A., Javaid, M., Singh, R. P., & Suman, R. (2021). Telemedicine for healthcare: Capabilities, features, barriers, and applications. Sensors International, 2(2). https://doi.org/10.1016/j.sintl.2021.100117

McWilliams, L., Paisi, M., Middleton, S., Shawe, J., Thornton, A., Larkin, M., Taylor, J., & Currie, J. (2022). Scoping review: Scope of practice of nurse‐led services and access to care for people experiencing homelessness. Journal of Advanced Nursing, 78(11). https://doi.org/10.1111/jan.15387

Olson, A. W., Vaidyanathan, R., Stratton, T. P., Isetts, B. J., Hillman, L., & Schommer, J. C. (2021). Patient-Centered Care preferences & expectations in outpatient pharmacist practice: A three archetype heuristic. Research in Social & Administrative Pharmacy, 17(10), 1820–1830. https://doi.org/10.1016/j.sapharm.2021.02.005

Wang, Y., Kung, L., & Byrd, T. A. (2018). Big data analytics: Understanding its capabilities and potential benefits for healthcare organizations. Technological Forecasting and Social Change, 126(1), 3–13. https://doi.org/10.1016/j.techfore.2015.12.019

Woo, B. F. Y., Zhou, W., Lim, T. W., & Tam, W. W. S. (2019). Practice patterns and role perception of advanced practice nurses: A nationwide cross-sectional study. Journal of Nursing Management, 27(5), 992–1004. https://doi.org/10.1111/jonm.12759