By Melissa Hagstrom, contributor
March 22, 2013 - As health care delivery is transforming before our eyes, nursing schools throughout the country are working to prepare nurses for the future--in a health care environment that focuses on technology, care coordination and patient-centered models. Although the fundamentals of good nursing care will undoubtedly withstand the test of time, experts point to new “must-have” characteristics and skills that will help student nurses meet tomorrow's nursing challenges.
1. A "big picture" understanding of the health care system
Knowledge is king in today’s comprehensive care model, and new nurses must have the ability to expand their scope of knowledge beyond their specialty and practice area. “It is no longer good enough to just essentially go and punch a time clock,” said Philip Greiner, DNSc, RN, director and professor at San Diego State University’s School of Nursing, adding, “You can’t just check in, check out, do your work and be done with it. You need to be able to have a more global awareness of what is happening within health care and how that affects your organization.”
“Our students have to understand the health care delivery system. Ideally, I would love to have a student who is taking an adult med-surg course be able to follow a patient from the point of transition to the next step,” he said. “We need to have flexible clinical placements where students can see a broad variety of practices.”
An understanding of the environment in which the nurse is working--including knowledge of the unit and the operational logistics of the facility--is key to success, Greiner explained. “New nurses need to have an understanding of the internal workings of their unit, and more importantly, they need to understand the larger organization and where their unit fits into the organization,” he said.
2. Personal initiative
Mariah Mellinger, RN, MSN, ACNP, clinical professor of nursing fundamentals at SDSU, said that personal initiative is an important quality for new nurses to focus on and develop. “They need the ability to take action and make changes, rather than depending on people to do that for them,” she said. The job marketplace is also very competitive for new nurses, which will require them to be proactive. “The students who are actively looking for the internships or tech-type of positions are the ones who seem to be getting jobs when they graduate.”
“We need to change the climate of nursing right now and be proactive instead of reactive,” she said. “We have a current standard and environment where a nurse doesn't react to a problem until it becomes a problem…The way that I am changing that is that I am having my students look up lab values, assessment findings, etc., from days prior, so that they can see what the trend is. I have them paying attention to trends rather than the problem. Because, by the time you get to the problem, it’s too late.”
3. Organizational skills, with flexibility to manage change
“The thing that I hear most often from chief nursing officers is that they are looking for nurses who are organized and detail-oriented,” Greiner said. Strong organizational skills and an eye for the specifics are two qualities that will continue to be essential for new nurses, regardless of their type of job or specialty area.
Being organized doesn’t mean that everything will go according to plan, however. In fact, nurses will often need to be creative and adapt to changing situations. “I think we need to create more innovation on the RN level,” Mellinger said. “And the other piece is flexibility. The nurses who seem to do really well are the ones who can move with the fast, rapidly-changing health care environment.”
4. Technical abilities
Many of today’s student nurses grew up with technology and already have an inherent understanding of the digital arena--giving them “a leg up” when entering into the professional nursing world, Mellinger said. Technology’s role in health care will continue to grow, and the nurses who are the most comfortable and proficient with the latest advances will find more opportunity in terms of job scope and specialty areas.
“I think we are going to have a new role for nurses, using telecommunications such as Skype to communicate with patients and better understand their environments,” Greiner said. “With an iPad or a smartphone, you can do that. We need nurses who are not distracted by technology, but instead think creatively in how to use existing technology to enhance care.”
5. A holistic approach to patient care
Patient-centered care is nothing new to the nursing world, but with an increased focus on care coordination due to the proliferation of co-existing conditions, nursing students need to be especially aware of the “whole picture” for each and every patient. They need to understand that every aspect of a patient’s care is important--whether it’s analyzing the patient’s current medications and supplements, tailoring instructions to his or her level of health literacy, or making follow-up calls to ensure the patient is transitioning smoothly and has the support to follow the care plan.
“You can’t make an appropriate referral if you don’t understand the patient, where they live and how they live. That is key to a smooth discharge or transition of care, whether it is to long-term care, home health or an assisted living facility. It’s no longer just okay to know your unit and have that be sufficient,” Greiner said.
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