NUR 513 Identify recommendations for nursing education you believe will be most effective or radical in creating change within the industry

NUR 513 Identify recommendations for nursing education you believe will be most effective or radical in creating change within the industry

According to the consensus report of the National Academies of Sciences, Engineering, and Medicine, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity, “The authoring committee produced a set of recommendations for the field of nursing and it provided a blueprint for improving nurse education; ensuring that nurses can practice to the full extent of their education and training; providing opportunities for nurses to assume leadership positions; and improving data collection for policymaking and workforce planning.” Out of the nine key recommendations the consensus report has addressed, the two main ones that I consider to be on the top level of importance within my community and organizations involve the nurse’s health and wellbeing and the inequities surrounding public health emergencies.

Recommendation 3: By 2021, nursing education programs, employers, nursing leaders, licensing boards, and nursing organizations should initiate the implementation of structures, systems, and evidence-based interventions to promote nurses’ health and well-being, especially as they take on new roles to advance health equity.

Recommendation 8: To enable nurses to address inequities within communities, federal agencies and other key stakeholders within and outside the nursing profession should strengthen and protect the nursing workforce during the response to such public health emergencies as the COVID-19 pandemic and natural disasters, including those related to climate change.

Recommendation 8 hits close to home on so many levels. I have been a nurse for 3 years, and the pandemic took me by surprise. I had been working as a nurse for about a year when Covid started. The amount of stress and distrust myself and my coworkers felt navigating around the everchanging policies and procedures associated with the pandemics CDC instruction was unnecessary. Unfortunately, I experienced the blatant disregard our organization had for our health and wellbeing by withholding and rationing vitally needed supplies when they were readily available for us to use. It was infuriating at the time, because this was a whole new ballgame for even the most seasoned nurses, and it caused a significant number of employees to resign. Management never came on the unit anymore like they used too and we felt abandoned. Bringing up the concerns with our director and management at staff meetings was futile and our concerns would be triumphed over with CDC recommendations and the organizations rationales based on fear and lack of knowledge. The COVID pandemic was an eyeopener to the world in terms of high-level planning and preparation for patient and provider safety.

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I agree with how the report describes the evolution of the advanced practice registered nurse role. The solution the report proposes states, “The committee recommends that all relevant state, federal and private organizations enable nurses to practice to the full extent of their education and training by removing practice barriers that prevent them from more fully addressing social needs and social determinants of health and improve health care access, quality, and value.” Advanced practice nurses can help curb disparities and positively influence communities’ health and wellbeing by letting the ever evolving career of nursing take the front seat with the physicians and other specialty roles. As nurses we are in the frontlines and are the eyes and ears for our physicians. We may not be as educated in medicine as the physicians are but we are strong in our assessment, implementation and evaluation skills. We are a golden asset to the care team and as APNs, we can have a deeper impact within our patients lives and communities with the right education and support.

National Academies of Sciences, Engineering, and Medicine. 2021. The future of nursing 2020–2030: Charting a path to achieve health equity. Washington, DC: The National Academies Press. https://doi.org/10.17226/25982

One phrase that stood out to me while reading The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report was “cultural humility” (National Academies of Sciences, Engineering, and Medicine, 2021).  This phrase was new and intriguing to me. What exactly is cultural humility and how do we include the concept into nursing education since, according to the authors of the report, it is “essential” to accomplishing the goal of delivering person centered care and education to diverse populations (National Academies of Sciences, Engineering, and Medicine, 2021, p. 206)? The report states that the concept of cultural humility is so important that it should be included in nursing education “as a thread throughout the curriculum.” (National Academies of Sciences, Engineering, and Medicine, 2021, p. 206) 

Shamaila Khan, PhD states that the phrase “cultural humility” is a “dynamic and lifelong process focusing on self-reflection and personal critique, acknowledging one’s own biases” (Khan, 2021). This phrase struck me as radical, when I read it for the first time in the report. Although I do view the concept of cultural humility as a drastic shift from the previous and current approaches to addressing culture in healthcare, it is a very appropriate change in the right direction. Khan makes a profound statement that part of being culturally humble is to realize “that even in sameness there is difference” (Khan, 2021). This concept speaks to the foundation of providing the “person-centered care” that the report has deemed necessary to achieve the goal of healthcare equality (National Academies of Sciences, Engineering, and Medicine, 2021, p. 206) 

I have personally witnessed situations where individuals within the healthcare system treat certain patients differently, based on their race, culture, or socioeconomic status. In each of these experiences, I was amazed at how oblivious the person was to the inappropriateness of their actions. While I agree that nursing education should include courses on cultural humility and biases, if we are going to see the change in the industry that is needed, every discipline within the healthcare system needs to be educated on cultural humility training, not just nurses. 

I agree that the advanced practice registered nurse role has evolved to include more autonomy and prominence within the healthcare system since the growth and changes in healthcare delivery methods, such as retail clinics. I also agree that APRNs could have a greater positive impact on promoting equality of healthcare access if certain political barriers were removed. (National Academies of Sciences, Engineering, and Medicine, 2021) 

References:

Khan, S. (2021, March 09). Cultural humility vs. cultural competence- and why providers need both. Health City. https://healthcity.bmc.org/policy-and-industry/cultural-humility-vs-cultural-competence-providers-need-both 

National Academies of Sciences, Engineering, and Medicine. 2021. The future of nursing 2020–2030: Charting a path to achieve health equity. Washington, DC: The National Academies Press. https://doi.org/10.17226/25982

As health care continues to change with the ever-evolving patient population, nursing education needs to be strengthened to better prepare the nurses of the future. “Nursing schools will need to ensure that nurses are prepared to understand and identify the different social determinants of health, have expanding learning experiences and cultural values, and have the competencies to care for an aging and diverse population” (Wakefield, Williams, Menestrel, & Flaubert, 2021). The National Advisory Council on Nurse Education and Practice (NACNEP) recommends population health concepts be incorporated into the nursing curriculum. They also suggest nursing programs should partner with HRSA, the VA, and the Indian Health Services to increase a student’s exposure to different environments and experiences.

I completely agree with this recommendation. My experience in nursing school was secluded to Banner Health facilities. The patient population seen was very predictable, especially on the med-surg floor. As the student, I did many head-to-toe assessments, and then proceed to pass out medication multiple times throughout the day. The population consisted of patients recovering from surgeries, broken bones, an exacerbation of COPD, or, etc. These clinicals felt very redundant and they changed my perspective of nursing until I started as a new grad in the emergency department. With the ability to visit a VA hospital, a student could be introduced to many different disease processes. War veterans have a combination of problems including PTSD, war amputations, drug addiction, mental instability, alcoholism, or other issues complicating their health. These complications allow a student to be exposed and educated on various disease processes. If the nursing school partnered with the Indian Health Services, a student would be introduced to a whole community they are unaware of or unexposed to. During nursing school, there was one patient I took care of who was from the Indian reservation. Having access to different patient populations, a student will be more accustomed to cultures, different age populations, plus rural and urban communities, allowing them to be more rounded as they graduate and enter real-world practice.

With the evolution of incorporating advanced practical registered nurses (APRN) into practice, there are many regulations that control a nurse’s scope of practice. There are private and public health systems restraining an APRN from practicing their full scope, limiting their expertise. Approximately 62% of rural areas have health shortages and would benefit from increased access to APRNs. With limited autonomy in urban areas, APRN can help patients and practice at their licensed ability (Wakefield, Williams, Menestrel, & Flaubert, 2021). I do agree with the report on the evolution of APRN. From personal experience, I was looking into becoming a certified registered nurse anesthetist (CRNA). I was speaking to a CRNA about the education route, and what licenses are needed before applying to CRNA school. She informed me it is very political depending on the state where practiced. Arizona is one of the states where CRNAs are welcome but a state like Colorado, prefer a doctor, and will not hire a CRNA. It amazes me how far nurses have become but there is still a limitation to their ability based on politics.

References:

Wakefield, M., Williams, D., Menestrel, S., & Flaubert, J. (2021). Chapter 7. In Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity (pp. 189–201). essay, National Academies Press.

The recommendation that I believed would be most effective is creating a change in the nursing workforce. Per the report, It is important to build better communication with patients to further assist in specific needs that may arise with a new illness to the health care system (National Academies of Sciences, Engineering, and Medicine, 2021). I agree with the report because it is more efficient in providing patient safety care for our patients. As nurses, we must continue learning and educating ourselves about the new technology and ways to provide care for the patient based on evidence-based practice. By doing this, we are not only helping with health care, but we can also increase patient satisfaction and provide safe patient care to the community.

Furthermore, another reform is number 4 The role of nurse in improving Health care Access and quality. The reform stated, “health care equity focuses on ensuring that everyone has access to high-quality health care” (National Academies of Sciences, Engineering, and Medicine, 2021). As a nurse, we can provide assistance to provide health care equity to our patients by providing education about the health problems and the health changes that can be made to improve the condition. Another solution is advocating for the patient and communicating with the health care members to find resources to help the patient’s wellbeing. In the future, the increased number of older people will also change the kind of care that patients will need, which is important to continuing education (National Academies of Sciences, Engineering, and Medicine, 2021).

National Academies of Sciences, Engineering, and Medicine, (2021). The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity, Retrieved August 8, 2022, from https://www.nationalacademies.org/our-work/the-future-of-nursing-2020-2030