A physician possessed a unique body of knowledge and skills and put them to use in the care of patients. As such, the doctor-patient interaction was paramount and served as the foundation of a personal, caring relationship that has stood the test of time. But the forces that are changing 21st century medicine are on track to disrupt millennia of tradition.
Transforming the health care system to provide safe, quality, patient-centered, accessible, and affordable care will require a comprehensive rethinking of the roles of many health care professionals, nurses chief among them. To realize this vision, nursing education must be fundamentally improved both before and after nurses receive their licenses.
As part of its report, The Future of Nursing: Leading Change, Advancing Health, the committee considered many challenges that face the nursing education system and some of the solutions that will be required to advance the system.
It determined that nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. The Need for Highly-Educated Nurses In the 21st century, the health challenges facing the nation have shifted dramatically.
The American population is older—Americans 65 and older will be nearly 20 percent of the population by —as well as more diverse with respect not only to race and ethnicity but also other cultural and socioeconomic factors.
While chronic conditions account for most of the care needed today, the U. The ways in which nurses were educated during the 20th century are no longer adequate for dealing with the realities of health care in the 21st century. As patient needs and care environments have become more complex, nurses need to attain requisite competencies to deliver high-quality care.
These competencies include leadership, health policy, system improvement, research and evidence-based practice, and teamwork and collaboration, as well as competency in specific content areas such as community and public health and geriatrics. Nurses also are being called upon to fill expanding roles and to master technological tools and information management systems while collaborating and coordinating care across teams of health professionals.
To respond to these increasing demands, the IOM committee calls for nurses to achieve higher levels of education and suggests that they be educated in new ways that better prepare them to meet the needs of the population.
An Improved Education System Much of nursing education revolves around acute care rather than community settings that include aspects of primary care, public health, and long-term care.
Nursing education frequently does not incorporate the intricacies of care coordination and transitions. Many nursing schools have dealt with the rapid growth of health research and knowledge by compressing available information into the curriculum and adding layers of content that require more instruction.
New approaches and educational models must be developed to respond to burgeoning information in the field. For example, fundamental concepts that can be applied across all settings and in different situations need to be taught, rather than requiring rote memorization.
Competencies also must move from task-based proficiencies to higher-level competencies that provide a foundation for care management knowledge and decision-making skills under a variety of clinical situations and care settings. Entering the Profession Nursing is unique among the health care professions in the United States in that it has multiple educational pathways leading to an entry-level license to practice.
Nursing students are able to pursue three different educational pathways to become registered nurses RNs: These various pathways provide numerous opportunities for women and men of modest means and diverse backgrounds to access careers in an economically stable field.
The qualifications and level of education required for entry into the nursing profession have been widely debated by nurses, nursing organizations, academics, and a host of other stakeholders for more than 40 years.
Although a BSN education is not a panacea for all that is expected of nurses in the future, it does, relative to other educational pathways, introduce students to a wider range of competencies in such arenas as health policy and health care financing, community and public health, leadership, quality improvement, and systems thinking.
Care within the hospital continues to grow more complex, with nurses having to make critical decisions associated with care for sicker, frailer patients and having to use more sophisticated, life-saving technology coupled with information management systems that require skills in analysis and synthesis.
Care outside the hospital is becoming more complex as well. Nurses are being called on to coordinate care among a variety of clinicians and community agencies; to help patients manage chronic illnesses, thereby preventing acute care episodes and disease progression; and to use a variety of technological tools to improve the quality and effectiveness of care.
A more educated nursing workforce would be better equipped to meet the demands of an evolving health care system, and this need could be met by increasing the percentage of nurses with a BSN. The committee recommends that the proportion of nurses with baccalaureate degrees be increased to 80 percent by While it anticipates that it will take a few years to build the educational capacity needed to achieve this goal, the committee maintains that it is bold, achievable, and necessary to move the nursing workforce to an expanded set of competencies, especially in the domains of community and public health, leadership, systems improvement and change, research, and health policy.
Improving the education system and achieving a more educated workforce—specifically increasing the number of nurses with baccalaureate degrees—can be accomplished through a number of different programs and educational models, including: In addition to increased numbers of BSN-educated nurses, schools of nursing must build their capacities to prepare more students at the graduate level who can assume roles in advanced practice, leadership, teaching, and research.
While 13 percent of nurses hold a graduate degree, fewer than one percent have a doctoral degree. Nurses with doctorates are needed to teach future generations of nurses and to conduct research that becomes the basis for improvements in nursing science and practice.
The committee recommends doubling the number of nurses with a doctorate by To improve health in the next century, we will have to do a better job of applying the knowledge we already have. In addition, we will have to be able to take advantage of new knowledge, and be as well prepared as possible for threats we can’t even define at this point.
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Download PDF The Role of the Physician in 21st Century Healthcare Steven A. Wartman, MD, PhD, MACP // President/CEO Introduction. For thousands of years, the practice of medicine has followed the long-standing traditions typical of a profession.
Adapted Jan. from "The Meaning of the 21st Century: A Vital Blueprint for Ensuring Our Future" by James Martin, author of Pulitzer Prize-nominated "The Wired Society," and founder of the 21 st Century Institute and the Institute for Science and Civilization, both at Oxford University.
A 21st-century health care system requires electronic health records. To empower wired consumers with information, choices, and control, the immense power of information technology must be harnessed. The briefing underscored that critical role of partnerships amongst the federal government, academic medicine community, and industry in preparing for the health care workforce of the 21st century.