As nurses with a combined 75 years of experience, we have seen it all: from societal changes and technology advancements to a global pandemic. As we look toward the future, the nursing field is at a critical juncture. Care delivery continues to move out of the hospital, rapidly changing nurses’ responsibilities. Amid this industry disruption, the nursing workforce is shrinking, with more than 25% of the U.S.’s 4.7 million nurses planning to retire or leave the field within the next five years. This shift is creating an urgent need for highly skilled nurses who can adapt to new advancements while upholding the standard of quality care for patients.
While the nursing field continues to transform, it’s more important than ever for nurses to get valuable advice from those of us who have seen so much change over the years. In fact, key lessons from the past can set the foundation for a future where nurses are supported throughout their careers.
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In 1968, during the height of the Civil Rights movement, I [Elleton McCullough] walked into Forsyth Hospital as one of the first Black nurses in the institution’s history. During this time, some doctors, colleagues, and patients refused to speak with me due to the color of my skin. In the decades since, I’ve seen firsthand how diversity, equity, and inclusion (DEI) practices have impacted healthcare, from increasing diversity in the field to giving providers a framework to administer more culturally sensitive care. Despite the progress we have made, there’s still more that must be done to attract and retain minority nurses.
Across the country, our communities are becoming more diverse and are comprised of various races and ethnicities. However, the current nursing workforce is comprised of 80% white nurses and does not fully reflect the diversity of our communities. Although nurses of all backgrounds are trained to deliver equitable care, many patients of color seek provider relationships where they feel they are being heard and understood. Research has found that patients have a better overall experience when they receive care from a provider who shares their race, ethnicity, or native language. When cultural gaps are bridged between patients and providers, it can improve communication, support empathy, and increase trust, leading to better health outcomes.
As a longtime nursing educator, I [Elleton McCullough] know that a critical first step in supporting and developing a diverse nursing workforce begins in the classroom. We are seeing an increase in nursing program scholarships to attract diverse students, but we must ensure these students remain in their programs. Nursing schools should instill the importance of DEI in all facets of their programs to foster an environment of inclusion and acceptance for all students throughout their education. In the field, networking associations and other affinity groups can support nurses and connect them with mentors who have shared experiences. Throughout my career, I have mentored thousands of nurses and nursing students. I’ve seen how something as small as a message of encouragement can significantly impact nurses of all levels, particularly those struggling as they enter the field.
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While we are taught clinical judgment and critical thinking skills in nursing school, the most impactful lessons are often learned on the job. Nursing students today are entering the field at a time when there is an increase in the prevalence and complexity of patient conditions. These challenges, coupled with fast-paced healthcare environments, mean that nurses must maintain and evolve these skills to make correct care decisions quickly. As seasoned nurses prepare to retire, we will lose the ability to draw upon their expertise to train novice nurses and retain top talent. Health systems must adopt comprehensive, ongoing training programs to avoid widening the skills gap and support nurses’ career development.
We are seeing nursing schools leverage more advanced training programs that use emerging forms of technology, such as virtual reality (VR) and simulated scenarios. These help nurses prepare for real-life situations, evolve critical thinking skills, and practice communication with a wide demographic of patients. These tools also offer a safe, standardized way for students to learn and retain information as they prepare for the National Council Licensure Examination (NCLEX) and start their careers.
Once in the field, nursing staff must continue developing their hard and soft skills. Hard skills have expanded beyond providing care and now include competencies involving technology. Digital literacy has become one of the most influential hard skills for nurses to develop and maintain, with 37% of nurses desiring better training on new technologies. Health systems need to ensure nurses have access to trainings and resources so they can learn how to use these solutions correctly and not become overwhelmed.
As healthcare continues to move outside the hospital, nurses will continue to act as the main point of contact for those receiving at-home care. Like hard skills, maintaining soft skills like communication and compassion are equally crucial. All nurses must continue to be trained on cultural sensitivities and practice empathy so they can provide the best possible care to all patients. When trained on listening and communicating effectively, nurses can ensure every patient receives the best possible care, regardless of where they are.
Embracing change: Moving bedside care to your fingertips
We have seen a remarkable transformation in the way nurses care for patients. Previously, nurses relied on written patient charts and were required to visit a patient’s bedside every time they needed to take vitals and evaluate next steps. Even as patient monitors were introduced, nurses still had to spend time sorting through siloed data to understand a patient’s condition, a time-consuming task that nurses still face. In fact, a 2022 JAMA study found that for each patient visit, care teams spend nearly 16 minutes on electronic health records, with 33% of that time being spent on reviewing charts.
As a trained nurse specializing in medical technology and healthcare informatics, I [Tammy Beaulieu] have seen the impact that innovation can have on improving workflows and giving time back to nurses. For example, patient monitor displays have evolved to feature easy-to-read interfaces that can be accessed anywhere in the hospital. Importantly, the introduction of medical device integration and the capturing of live-streaming data from various devices or patient monitors gives nurses an unprecedented, complete view of a patient’s condition. In addition to saving time, this holistic patient view empowers nurses with the clinical confidence to make clinical decisions to deliver personalized patient care.
Shifting how nurses can deliver care will also help us tackle the current nursing shortage. Virtual nurses, skilled professionals who collaborate with on-site interdisciplinary care teams from their homes or call centers, can perform non-bedside tasks, such as paperwork, patient admissions, discharge, and medication management. By lightening the administrative workload for nurses on the floor, the bedside teams can better focus on the in-person needs of patients. Virtual nursing also extends the careers of those approaching retirement age who may experience physical limitations, such as lifting patients out of bed, while maximizing the impact and knowledge-sharing they can deliver to the next generation of nurses.
For patients receiving remote care, nurses also play an important role in monitoring their health and treatment progress while keeping an open line of communication. Nurses today need to be comfortable using telehealth platforms and online portals to help them maintain personal relationships with remote patients and keep them motivated to stay on track with their treatment. Remote monitoring technologies, such as wearables, also help provide nurses with a clearer picture of the patient’s health and adherence to care plans.
Ultimately, while new technology and a massive influx of data can be overwhelming, staying up-to-date with trainings and embracing new tools will enhance the care nurses can deliver and expand their role.
Healthcare’s duty to the nurses of the future
Throughout recent changes and tribulations impacting healthcare, nurses have been at the frontlines of it all and remained resilient. We are often the first faces a patient sees when seeking care, and the trusted clinical partners to physicians, so why shouldn’t the industry do everything it can to empower the next generation of nurses?
The healthcare field must come together to support all of us – experienced, new, and soon-to-become – nurses, as we navigate the shifting care landscape. As we’ve seen over our many years in the field, new training programs and technology will be introduced and evolve, and better minority representation in nursing is attainable as long as we make it a priority. The one constant that remained true throughout our time and will continue now and into the future is that nurses are the heart of the healthcare system – the ones who transform ordinary clinical care into a comfortable and compassionate experience for patients and their families.
Photo: Fly View Productions, Getty Images
Elleton “Mickey” McCullough is an experienced nursing leader and educator with over 56 years in the field. She spent nearly 38 years at Forsyth Medical Center (part of Novant Health), where she was the organization’s first Black nursing supervisor and served as the first RN manager in its radiology unit before retiring from clinical practice. In addition to serving as long-time assistant professor at Winston-Salem State University, Elleton has authored research publications, and served as the nursing program’s retention coordinator, ensuring countless students made it to graduation and entered the nursing workforce.
Tammy Beaulieu is a clinical product manager at Philips with more than 15 years of bedside nursing experience, and 26 years total in the healthcare field. In her day-to-day work, Tammy applies her clinical background and expertise to her role in health tech, looking through the lens of nursing, clinical services, and product management to truly understand customer insights.
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