Nursing: The Past, Present, and Future – A Limitless Profession
Five distinguished Columbia University School of Nursing alumni provided perspectives on the past, present, and future of nursing at a panel during reunion week 2021 organized by Professor Emerita and Special Lecturer Elaine Larson, PhD.
Larson assigned each panelist a focus area, and in breakout sessions the panelists met with conference attendees to develop goals for the future of nursing relating to this focus. Major themes included the need for full practice authority for nurses, and how the pandemic has given nurses an unprecedented platform for leadership in policy and research. Larson also asked the panelists to reflect on the changes COVID-19 has wrought, positive and negative.
“It’s unlikely that any of us are going to go back to exactly the way it used to be,” she said. “There’s going to be some new normals in the way we work, have our families, how we raise our children. How can we sustain some of the good things that came out of the pandemic?”
Read on for more details on the panelists’ presentations and recommendations from the breakout sessions.
While advanced practice nursing was originally developed to expand access to care given the dearth of primary care physicians, “the advanced practice role has gone far beyond fulfilling primary care roles,” noted panelist Edwidge Thomas, DNP ’05, vice president of clinical solutions at Northwell Health. Nevertheless, she added, “we still have barriers to practice.” Washington, DC, 23 states, and two US territories, give nurses full practice authority, according to the American Academy of Nurse Practitioners. In the remaining states nurse practitioners must be affiliated with a doctor in order to practice independently. “There’s still opportunities for us to go way beyond where we are today,” Thomas said.
Breakout session goals:
- Full practice authority for advanced practice nurses.
- Nurses learning to advocate for themselves and for their profession, for example to physicians who feel they’re being displaced by NPs. “Advanced practice nurses need to be at the ready to have these discussions,” Thomas said.
- Patients need nurses as patient navigators.
Nursing education has changed dramatically, from diploma training to doctoral preparation, noted Jeannie Cimiotti PhD ’04, an associate professor at Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta. “Now we have nurses that are at the highest level of educational attainment possible and still providing excellent care.”
While the demand for nurses used to follow a boom-and-bust cycle, those days are over, she said. “I think we are going to see chronic shortages, especially in acute care.”
In terms of the future of nursing education, the role of simulation will continue to increase, according to Cimiotti.
One positive thing she expects in the wake of the pandemic is a more close-knit, supportive nursing workforce. “The old saying that nurses eat their young—I think that’s going to be a thing of the past,” she said. “When the new nurses come in, the senior nurses are going to embrace them.”
Breakout session goal:
Create diverse pathways to prepare and retain nurse educators.
Research is evolving and building in the discipline of nursing, but still in its early stages, said Catherine Cohen, PhD ’16, a policy researcher at Rand Corporation in Santa Monica, California. “We’ve had lots of breakthrough superstars who are able to influence their field and get a lot of respect in the policy arena,” she added, but launching a research career in nursing is a slower process.
During the pandemic, “a lot of the voices of nurses are being elevated through social media in ways that they never have before, and I think that we could be capitalizing on this as a profession,” Cohen said. “It’s hard to translate research that way, but I think getting nurses’ voices out there and stories is really helpful and can draw some attention to the evidence and the work that’s been done at the policy level.”
Breakout session goals:
- Nurses need to recognize that they can push for better care, advocate for change, and conduct research at their own institutions and beyond.
- Nurses should be introduced to the concept of doing research during their undergraduate education.
Nurses have always been innovators, said Philip Gyura, DNP ’16, chief medical officer at YourPath in Minneapolis, a start-up that aims to improve access to substance abuse care. But while nurses have also stepped in as entrepreneurs, reimbursement and other factors are still holding them back from doing everything they’re qualified to do. “Nurse practitioners by themselves are still not getting 100% for certain services, there are still certain services we can’t order,” he said. “There’s still just a lot of disjointedness with it, but there’s a lot of innovation and there are a lot of people trying.”
The pandemic underscored the importance of flexibility in medicine, Gyura noted. “Nurses are just keyed up for this type of work. This is what we were built for, this is how we were designed, this is how we were educated. This is what we do.”
Gyura and other panelists mentioned the importance of moving toward value-based, rather than volume-based, care.
Breakout session goal:
Creating resources for nurses to help them advocate for their own profession and for the value of the care they provide. This could involve a mini-MBA, for example, and other resources to help build entrepreneurship.
Olivia Velez, PhD ’11, is health informatics lead for ICS. She is co-chair of the Global Digital Health Network, which has 3,900 digital health practitioners representing 117 countries; she is the first nurse to hold that position.
Ever since Florence Nightingale, Velez noted, nurses have been taking on high-level leadership roles. “We have a voice at senior policy tables,” she said. “Nurses really have the opportunity to highlight where weaknesses are in the health care system that we need to strengthen in order to achieve global equity and universal health care and all those things that we really want to achieve.”
She noted that while the U.S. may be turning the corner on COVID, “globally the picture really is not very good.” Lower- and middle-income countries are overwhelmed by the pandemic, she added, and information on conditions on the ground is often scarce or non-existent. While every epidemic and pandemic brings calls to improve the global public health system, but little action, she added, maybe this pandemic will be different. “COVID doesn’t care about your border and neither do a lot of other diseases,” Velez said. “What I’m hoping is that we see more nurses taking these policy positions and taking these leadership roles and really impacting global health and how we work together across nations to improve the health of all people.”
Breakout session goals:
- High-income countries should learn from lower income countries that achieve better health outcomes with fewer resources.
- Name a nurse as secretary general of the World Health Organization.