Partnerships of healthcare providers, educational institutions and workforce development councils are trying to increase the diversity of our nation's healthcare workforce as well as the number of students in schools of nursing. This critical work will produce even greater benefits if it is linked to efforts to redesign care-delivery systems and work environments and to identify and develop critical leadership skills for our future.
Although the total U.S. workforce grew at an annual rate of 1.6% from 1950 to 2000, the forecasted workforce growth rate for the next 50 years is a meager 0.6% annually. The future looks even more challenging in healthcare, where changing technologies and care settings and growth in the numbers of seniors, the frail elderly and people with chronic healthcare conditions may combine to overwhelm the number of potential workers.
In Crossing the Quality Chasm: A New Health System for the 21st Century, the Institute of Medicine issued an urgent call in 2001 for fundamental changes in healthcare delivery and a transition to a healthcare system that better meets patients' needs. This urgent call gives us an important road map in which to integrate our work on the workforce shortage and work environments. Furthermore, we simply will not have enough workers by the end of this decade to continue delivering health and wellness care to the citizens of this country using our current processes. As such, collaborative and creative partnerships among all healthcare disciplines are needed to realize the vision of a more patient-centered delivery system that fully utilizes the future healthcare workforce.
The American Organization of Nurse Executives began a strategy in 2003 that is focused on developing future care-delivery models. The AONE committed to using a systems perspective and adopted the belief that we need to simplify the work related to this very complex strategic problem. We began by studying what the work of the future would look like and then began identifying the roles needed to do the work, including the competencies and credentials of tomorrow's healthcare workers. From that work, we believe continuing conversations are needed to examine the education required for these roles.
The AONE has been looking at the central question: What are the principles that can guide us as we define future care-delivery models and the nurses who will be providing care to our patients and populations in the future? That work to date has resulted in the following set of guiding principles that will provide a framework for these continuing conversations:
* The core of the work of nursing in the future is gaining knowledge and caring.
* The care is to be directed by patients/clients and is respectful of the diversity of health belief models of all users.
* The knowledge base of the nurse will shift from knowing a specific body of information to "knowing how to access" the evolving knowledge base to support the needs of those for whom care is managed.
* The processing of accessed knowledge will shift the work of the nurse from critical thinking to "critical synthesis."
* Technology is changing the nature of the relationships between the nurse and the patient or population. In the future, even more than now, the caring relationship between the nurse and the patient or population may be transmitted either through a presence (at the bedside, so to speak) or in a "virtual" relationship.
* The work of the nurse in the future will be to manage the journey for the patient, client or population in accordance with the needs and desires of the patient and family and available resources.
With the AONE guiding principles in mind, nurse executives are in a critical position to collaborate with various stakeholders. Some of the questions that will stimulate these stakeholder conversations include:
* What are the care-delivery models that will support this work?
* How does this work help create a multidisciplinary model?
* What will be different in the work environments of the future to support this work?
* What are the restraining and driving forces within the regulatory environment with respect to these guiding principles?
* What are the new leadership competencies that will be needed?
* What technologies are driving or are needed to facilitate the transition to this future work of the nurse?
The issues that confront healthcare leaders today are many: health disparities, the uninsured, lack of capital, reimbursement, resource and workforce shortages, and the misaligned incentives of our healthcare financing system. Keeping a system perspective while addressing one leverage point at a time offers leaders the opportunity to begin this work for the future by identifying simple solutions, one step at a time, to a complex system issue.
These guiding principles that relate to the future work of the nurse are a framework for just such a leverage point.
Editors note: Karen Haase-Herrick is president of the American Organization of Nurse Executives and executive director of the Northwest Organization of Nurse Executives.