In 2010, the Institute of Medicine (now called the National Academy of Medicine) published its seminal work on the “Future of Nursing,” projecting a huge number of retirements in the coming years and calling for 80 percent of nurses in the nation to have a Bachelor of Science degree by the year 2020. The report, the biggest seller in the institute’s history, helped elevate the profession to new heights and underscored the growing demand for qualified nurses to meet the needs of an aging population and a complex, evolving healthcare system.
On a local level, there are 123,000 registered nurses (RNs) in New Jersey, and a 2016 study by the NJ Collaborating Center for Nursing projected a 13.2 percent increase in RNs between 2016 and 2026. The study also showed the greatest nursing shortages to be in areas such as management, critical care, and operating room, followed by labor/delivery and emergency room services. The aging population is also increasing the need for nurses in long-term care and assisted living facilities as well as home care and hospice.
“Nurses’ roles are evolving a lot to move from the walls of hospitals to providing more care – acute, chronic and preventive care – in the community and in the homes of their patients,” says Aline M. Holmes, DNP, RN, and senior vice president, clinical affairs for the New Jersey Hospital Association (NJHA). “During the recession a few years back, experienced nurses either went back to work if their family needed money, or increased their work hours from part-time to full-time. Now that the economy is improving, those nurses are beginning to retire and/or cut back on their hours, leading to shortages in the specialty areas.”
Nursing Now Requires More Education
The rise of the nursing profession has led to long waiting lists for Associate Degree nursing programs at New Jersey’s community colleges, and Rutgers University, for one, has been receiving more than eight applications for every one student accepted into its School of Nursing. “The demand for nursing education has never been greater, and there are shortages pretty much everywhere,” says William L. Holzemer, RN, PhD, FAAN, dean and distinguished professor at Rutgers. “In New Jersey, there are opportunities to work not only in patient care but in pharma, insurance, behavioral health, detox, in-home and other areas. A lot of nurses go on to graduate school to become a nurse practitioner (NP), prescribing medications and working side-by-side with physicians.”
According to Prisca Anuforo, DNP, CTN_A, RN, and lecturer at Kean University’s School of Nursing in Union, a major reason young people are pursuing nursing is because unemployment in the field is very low and the majority find a job within six months of graduation. She also points to the diversity of places nurses can work as well as flexible hours – shifts can be during the day or at night and vary from eight hours five days a week to 12 hours three days a week. “Young mothers who are nurses are still able to join the profession and select a shift that works for their families,” Anuforo says. “Those who do not like hospitals can work in long-term care, outpatient facilities, doctors’ offices and industries. In nursing, you have choices as to where you work and when you work.”
Seton Hall University College of Nursing in South Orange, which offered the first baccalaureate nursing program in New Jersey in 1937, this year became part of an Interprofessional Health Sciences (IHS) campus in Nutley that also includes the School of Health and Medical Sciences and Hackensack Meridian School of Medicine at Seton Hall University. The College of Nursing has a close clinical affiliation with Hackensack Meridian Health, whereby the university sends groups of undergraduate RN and NP students to Hackensack Meridian locations – including the hospital, clinics, and long-term care facilities – to complete clinical work. Seton Hall’s philosophy is that nursing students need to be life-long learners, continually updating themselves on the best ways to care for patients and work with the latest technology.
“Our focus is on inter-professional education, teaching students to work on teams, collaborate and communicate,” says Marie Foley, Ph.D., RN, CNL, dean and professor at the College of Nursing. “When people graduate and are in the real world, they will be on teams. They need to understand different roles – nursing, medicine, physical therapy, occupational therapy, pharmacy and social work – all working together to provide the best and most holistic care for patients.”
Claudia Douglas, DNP, RN, APN-C, administrative director, Institute for Evidence-Based Practice and Nursing Research at Hackensack Meridian, agrees that nurses are now taking the lead and becoming more savvy with informatics, predictive analytics, use data, and the application of best evidence of practice. “I have been practicing for 40 years. We were always well educated, but our ability to run a practice with licensure is much greater now,” she says. “The delivery of care is changing, and the role of the nurse is becoming more prominent as she or he takes on more responsibility and becomes the coordinator within the interdisciplinary team.”
While the starting salary of an RN is an impressive $60,000 or more, the national mean average salary in 2016 was $83,289 – leading to criticism that potential growth is not as strong as in other fields. Thus, many nurses are pursuing more advanced degrees and certifications. Dr. Neddie Serra, chair of the Division of Nursing at Bloomfield College, says her department encourages students to pursue skills that are not generally taught in nursing schools, such as IV certification, that would make them more marketable in initial hiring situations right after graduation.
“There are so many opportunities and many students are moving on to be a nurse practitioner, or working toward a DNP (Doctor of Nursing Practice), which allows you to go into higher paying roles in hospitals or private practice, such as a CVS clinic, medical clinics, or doctor’s offices,” she says.
As Holzemer explains, agencies have created clinical ladders for nurses to move up based on additional education: If you get a masters degree, you move up the ladder; if you complete certification in pain management, you move up the ladder; and so on.
Hospitals Calling for Nurses With Advanced Degrees
When the Institute of Medicine made its recommendations to raise the nursing education standard in 2010, CentraState Medical Center in Freehold made a decision to require a Bachelor of Science in Nursing (BSN) degree for new hires. CentraState has for several years offered “externships” to nursing students entering their senior year in college where they shadow a staff RN, learning clinical skills and getting a more in-depth picture of the role. “When they graduate, they begin an RN residency program for six months, perfect their skills, grow in the role, and improve in critical thinking,” says Fiesta Clanton, RN, MSN, ACNS-BC, CentraState’s director, professional development and education.
“It’s a seamless way to transition from student to a professional nurse role. Offering programs like the Extern Program and the RN Residency Program have assisted us in our recruitment efforts.”
Both CentraState and Valley Health System in Ridgewood have earned Magnet status (the gold standard in nursing) from the American Nurses Credentialing Center (ANCC), largely because they are employing increasing numbers of BSN nurses to meet the ANCC’s stringent standards. “Research shows that patient outcomes are improved when there are large numbers of BSN nurses caring for the patients,” says Ann Marie Leichman, Valley’s senior vice president of patient care services and chief nursing officer. Leichman also points to the expanding role of the NP, who is becoming a greater presence in healthcare today, especially in primary care, adding, “I foresee this role eventually providing most primary care to the citizens of our nation.”
How the Nursing Profession has Changed
There is no doubt that becoming a nurse today is more challenging than it once was. While the profession continues to be recognized as one of compassion and caring – nursing once again topped the 2017 Gallup poll of trusted professions – it’s now also recognized as intellectually demanding, requiring students to maintain at least a B+ average in subjects like nutrition, anatomy and physiology, microbiology, statistics, epidemiology and pharmacology.
CentraState’s Clanton points out that nursing has risen to more of a clinical leadership position that requires problem-solving skills. “We are encouraging nurses to speak up more. They’re able to do that because of education and tools to address issues with patient care and to question physicians when the nurses need clarity,” she says. “They’re becoming proactive, more patient advocates. As technology has improved, so has the ability for nurses to have a broader reach.”
In addition, with the advent of managed care, the average length of a hospital stay has decreased considerably. Therefore, nurses who work in hospitals, long-term care, and home care are taking care of patients with higher acuity levels. Skills such as IV therapy, central line management and wound care are now done at home and at sub-acute facilities. “It requires the nurse to acquire these skills needed to take care of the patients at their various locations,” Clanton adds. “Nurses in long-term care and home care often have IV certifications, which was not the case 25 years ago. Advanced practice nursing and doctor of nursing practice are new areas of nursing that did not exist previously.”
Doing bed baths for hospital patients – once a major part of a hospital nurse’s duties – is barely in his or her purview now. Hospital patients are much sicker than they used to be, and many are on medications, so nurses have to know how to prioritize patient loads, using a lot more technology and documentation, interpreting orders, and assessing clients.
“Nurses today are taking on the role of managing populations with chronic illnesses, providing care to patients having same day surgery, following up with clients in their homes, and providing complex treatments to them in a non-hospital setting,” Valley’s Leichman says.
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