CHAPTER 8
Trends That Affect Nursing Career Decisions
Healthcare agencies are constantly changing, with the goal of providing care to the community while
containing costs. Although there is sufficient evidence demonstrating a professional nursing shortage in
many areas across the United States, healthcare agencies are confronted with escalating costs, stringent
cost containment initiatives, streamlined reimbursement systems, and a plethora of state and federal
regulations that often constrain how well or poorly these agencies are able to deliver health care. In
response to these budgetary constraints, many hospitals have responded by moving traditional
inpatient care to outpatient settings, hiring fewer professional nurses, training more unlicensed assistive
nursing personnel, cutting nursing salaries, hiring more RNs to part-time positions to avoid providing
health and retirement benefits, and relying on fewer RNs to cover unfilled positions.
As you consider how to advance your nursing career, it is critical to examine projected trends in health
care, particularly as they apply to (1) where health care is delivered, (2) the type of practitioners needed,
and (3) the nursing educational preparation required to provide this care. The U.S. Department of Labor,
Bureau of Labor Statistics (2016) reported that 94% of RNs worked in the following areas:
61% hospitals; state, local, and private
18% ambulatory healthcare services
7% nursing and residential care facilities
5% government
3% educational services; state, local, and private
In forecasting the future needs of the U.S. healthcare delivery system, the Institute of Medicine (IOM,
2010) projects that by 2020, the profession of nursing will need to double the number of nurses with a
doctorate and increase the number of nurse practitioners in hospitals, home health, hospice, and
nursing homes. In addition, the American Association of Colleges of Nursing (AACN, 2015b) reports that
the nursing shortage may be easing in some parts of the country, but the demand for RNs prepared with
baccalaureate, master’s, and doctoral degrees continues to increase.
Investigate where the shortages are in the location where you will be practicing, what types of
practitioners are needed to meet these needs, and what type of advanced nursing education is required
for these positions. Remember, you are in charge of making choices that best fit your short- and long-
term career goals. You are your own best advocate in planning your nursing career!
Crafting the direction of your professional nursing career and executing the plan is transformational. The
IOM (2011) report, The Future of Nursing: Leading Change, Advancing Health, provides a blueprint for
how the entire profession must be transformed in order to advance the health of patients and
simultaneously direct needed changes in the healthcare delivery system. In setting the agenda for
nursing’s future, the IOM Committee on Nursing identified four key messages and eight related
recommendations that have potential for the greatest effect and for accomplishment within the next
decade. The four key messages are:
Nurses should practice to the full extent of their education and training.
Nurses should achieve higher levels of education and training through an improved education system
that promotes seamless academic progression.
Nurses should be full partners, with physicians and other healthcare professionals, in redesigning health
care in the United States.
Effective workforce planning and policy making require better data collection and an improved
information infrastructure (IOM, 2011, p. 4).
The eight specific recommendations include:
Remove scope of practice barriers
Expand opportunities for nurses to lead and diffuse collaborative improvement efforts
Implement nurse residency programs
Increase the proportion of nurses with a baccalaureate degree to 80% by 2020
Double the number of nurses with a doctorate by 2020
Ensure that nurses engage in lifelong learning
Prepare and enable nurses to lead change to advance health
Build an infrastructure for the collection and analysis of interprofessional healthcare workforce data
(IOM, 2011, pp. 9–14)
The IOM report on the future of nursing is a great starting point for setting your professional nursing
career goals and planning your career trajectory. Careful deliberation on these initiatives and
recommendations provides insight into the questions that you might ask in setting your own
professional nursing career goals. See Box 6-1 for a list of questions to ask yourself as you plan your
career goals.
Mentoring
The IOM report on The Future of Nursing (2011) recommends mentoring to assist in increasing the
readiness and retention of nurses to improve patient outcomes (Figure 6-2). Mentoring is a relationship
between two nurses in which the more experienced nurse provides leadership and guidance to the
nurse with less experience, often referred to as the “mentee” (Minority Nurse, 2013). Preceptors and
mentors play different roles. A mentor provides counsel regarding career management, and the
mentoring relationship may take place in the beginning of a nursing career, when changing positions, or
when a nurse is furthering his or her education. The mentor–mentee relationship may be a long-term
relationship. In contrast, a preceptor provides direct short-term coaching to a new graduate nurse, a
newly hired nurse, or a nurse who transfers to another unit and orients the nurse to roles and
responsibilities on the unit and within the organization. A mentor may also serve as a preceptor;
however, a preceptor is not a mentor. It is not uncommon for mentees to become mentors, guiding
others in their pursuit of professional growth and development.
Being a mentor takes time and requires patience. The mentor must be reasonable, competent,
committed to assisting the mentee in being successful in his or her career, adept at providing feedback,
and open to sharing knowledge. Professional growth should be the outcome for both mentor and
mentee. It is the responsibility of the person seeking career mentorship to find a mentor. The mentor
may be a nursing faculty member, an experienced nurse within a healthcare organization or nursing
school, or a nurse from a professional nursing organization. This relationship has benefits for both. The
mentor receives confirmation from witnessing the career development and advancement of the mentee
in professional nursing. The benefits of being mentored are many and include:
Burnout and compassion fatigue may be the end result of stress not being managed. Burnout is
progressive and involves disengagement and withdrawal. Compassion fatigue is acute and may present
itself as overinvolvement in patient care (Lombardo & Eyre, 2011). The two concepts may occur
simultaneously. In caring for patients, the nurse may be depleted physically, emotionally, and spiritually.
These indicators involve compassion fatigue. Burnout causes physical symptoms that lead to feelings of
being constantly tired. Some observed signs are avoiding certain patients; not feeling compassion for
your patients and their families; experiencing headaches, digestive problems, fatigue, mood swings,
anxiety, and/or poor concentration; and/or feeling underappreciated and overworked. In response,
nurses may not want to go to work and/or just go through the motions when at work.
The healthcare workplace is demanding, requiring many caregiving responsibilities from various
members of the interdisciplinary team that must be accomplished and communicated within an
abbreviated time. Sustained workplace stress can dramatically influence how we interact with
colleagues, how professionally satisfied we are with current career choices, and employee retention
rates.
Stress at work can be managed in a civil environment. Civility builds community and allows for efficient
functioning units. Civility is defined as respect for others (Clark, 2010). A code of conduct establishes
ways of behaving for interacting with people. The ANA (2015a) developed a Code of Ethics for Nurses
with Interpretive Statements that requires nurses to communicate with respect when interacting with
colleagues, patients, and students. Civil behavior is not always easy to accomplish; it requires courage
and genuine concern for others. We have the choice to be colleagues who habitually respect and assist
one another and who are instrumental in creating a milieu of civility and safety or to be colleagues who
are engaged either overtly or subtly in lateral and vertical workplace violence exhibited by bullying,
harassing, speaking ill of one another, demeaning one another, and excluding colleagues.
Class 3375
Module 1: Discussion - Coach Johnson Group 9
From
1 1 unread reply. 1 1 reply.
Module 1: Discussion
PROMPT
Click on this link: https://www.nursingworld.org/practice-policy/advocacy/federal/ (Links
to an external site.)
Scroll down to, "Select a topic to learn more about Federal Issues." Choose 2 of the topics
and read the information provided. Then, post a 3-4 sentence summary for both of the
topics you chose in the discussion board. Remember to cite the website (using APA
format).
GUIDELINES
Post your summaries of the 2 topics to the Discussion Board by 23:59, Wednesday of Module 1 (
please scroll to the module you want to post for---click on the link for that module and your
coach discussion group).
Then respond to two or more of your colleagues' summaries by asking each colleague at least
two probing questions. The probing questions may address the summaries, or, you may ask one
question for each paragraph in the summary. The questions you ask may solicit the writer’s
stance and reasons behind that stance or may serve to clarify the content in the summary or the
paragraph. Responses are due by Saturday at 2359 of Module 1.
Please respond to each of the questions you are asked by your colleagues during the online
discussion.
You will be evaluated on the quality of your summaries, questions, and responses to colleagues’
questions. Replies must be made by Saturday 2359 of Module 1.
Module 1: Readings
The Professional Nurse's Responsibility for
Health Policy Development
Do you feel that you have a professional responsibility to try to influence health policy
development?
Staffing is a major issue in nursing. How can nurses get involved in setting policy and
helping to pass legislation to affect this issue?
Reading #1
Role Development in Professional Nursing Practice
Citation: Masters, K. (2020). Role development (5th ed.). Burlington, MA: Jones & Bartlett.
Chapter 14-Foundations of Ethical Practice
Chapter 15-Law & the Professional Nurse
Website #1
Policy and Advocacy-The American Nurses Association (Links to an external site.)
From this main site for Policy and Advocacy, click on the option for State Legislative Issues & Trends, then
click on Nurse Staffing Plans & Ratios and read about the legislative efforts in your state and/or others.
Website #2
Influencing Health Policy in the Legislative Arena (Links to an external site.)
Citation: Retrieved January 6, 2014 from the ANA website
Website #3
FAQs - Multistate Recognition - Nurse Licensure Compact ― Texas Board of Nursing (Links
to an external site.)
Citation: Texas Board of Nursing - Licensure FAQ. (n.d.). Retrieved from https://www.bon.texas.gov/faq_licensure.asp#t5
Texas Board of Nursing. FAQs – Multistate Recognition – Nurse Licensure Compact.
ANA President Responds to Executive
Actions to Regulate Gun Sales
Jan 5th 2016
FOR IMMEDIATE RELEASE
January 5, 2016
CONTACT:
Jemarion Jones
301-628-5198
jemarion.jones@ana.org
Statement:
ANA President Responds to Executive Actions to Regulate Gun Sales
SILVER SPRING, MD – Today, President Obama announced new executive actions to
reduce gun violence. The following statement is attributable to American Nurses
Association (ANA) President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, in
response to today’s announcement:
“Mass shootings and other tragedies have unfortunately become all too common in this
country and steps must be taken to stop the carnage. We commend President Obama
for taking necessary actions today to reduce gun violence and make our communities
safer.
The president’s actions will make an immediate impact. Commonsense reforms aimed
at keeping guns out of the wrong hands through background checks and increasing
research into the development of gun safety technology will help protect our
communities from the endless series of preventable violence that steals innocent lives,
taxes our health care system, and leaves communities and families broken.
We are especially heartened by the president’s emphasis on increasing access to
mental health care. While people with mental illness are more likely to be the victims of
gun violence rather than the perpetrators, recent events have repeatedly shown the link
between easy access to guns and inadequate access to mental health care services.
ANA applauds President Obama’s investment of $500 million dedicated to supporting
the engagement of individuals in their care and improving service capacity within the
mental health care system. These actions are needed to fix a system that is clearly
broken.
As the largest single group of health care professionals, nurses regularly witness the
trauma that gun violence inflicts on victims, families and communities. As the premier
organization representing the nation’s 3.4 million registered nurses, the American
Nurses Association has and will continue to be engaged in efforts to prevent and reduce
gun violence. In the aftermath of the Sandy Hook tragedy, ANA issued a call to action to
Congress and policymakers to take swift action to curb gun violence.
Today’s actions are a start, but we will continue to call on lawmakers to enact additional
meaningful reforms to protect society and stop the constant cycle of gun violence and
death that plagues our communities.”
###
The American Nurses Association (ANA) is the premier organization representing the
interests of the nation's 4 million registered nurses. ANA advances the nursing
profession by fostering high standards of nursing practice, promoting a safe and ethical
work environment, bolstering the health and wellness of nurses, and advocating on
health care issues that affect nurses and the public. ANA is at the forefront of improving
the quality of health care for all. For more information, visit www.nursingworld.org.
For high-resolution images of the ANA logo or photos of ANA leadership, please click
here.
