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Educating the Future of Nursing: Adapting to the Changing Healthcare EnvironmentJessica L. McCluskyFerris State UniversityAbstractThere have been dramatic changes in the healthcare environment in recent years, with the majority focused on the quality of provided care. The development of quality and safety initiatives, as well as knowledge of patient population changes, role in system decision making, advances in information technology, and new policies and regulations affecting hospitals is vital to success in the nursing profession. Nurse educators can support and guide students toward this success through use of progressively complex simulation use focusing on QSEN competencies and skills. A mentoring program for students with a nurse leader in the community will help students understand their role in advocacy for the profession and develop a comfort level with letting their ideas be heard.Educating the Future of Nursing: Adapting to the Changing Healthcare EnvironmentIt is no secret that to be a successful member of the nursing profession, a nurse must commit to a lifetime of learning. Recent years have seen dramatic changes in the healthcare arena, and nurses must work to evolve their teaching and practices to satisfy new requirements and consumer demands. The development of quality and safety initiatives, as well as awareness of the changing environment of the nurse will help the profession to evolve seamlessly. The purpose of this paper is to give an overview of the Quality and Safety Education for Nurses (QSEN) initiative, to discuss the impact of the changing healthcare environment on nursing education, and to describe methods of incorporating these in to nursing school course design.Quality and Safety Education for NursesIn 2003, the Institute of Medicine (IOM) requested that nursing education included a focus on interdisciplinary teamwork and various quality measures (Cronenwett, 2012). From this, the QSEN initiative was born. Funded through the Robert Wood Johnson Foundation, QSEN focuses on increasing nursing care quality and safety through the use various competencies in the areas of patient-centered care, teamwork and collaboration, evidence based practice, quality improvement, safety, and informatics. While the initial focus in 2005 was on undergraduate students, the initiative was expanded with the addition of graduate level competencies in 2007 (QSEN, n.d.). QSEN focuses on the improvement of safety at both the level of individual performance and also system effectiveness (Barnsteiner, 2011). The competencies are designed to provide nurses with the education needed to improve the quality of the systems where they work (Warren, 2011). To aid with this, each competency in broken down in to the knowledge, skills, and attitudes (KSAs) necessary to be effective (QSEN, n.d.). QSEN has been developed over the span of three phases. Phase I defined the six competencies as listed above. Five were provided from the IOM, with safety being added by QSEN faculty (Warren, 2011). In 2007, Phase II funded 15 pilot schools to begin including the competencies in their nursing curriculum. Finally, Phase III, beginning in 2008, focuses on development of faculty and resources to sustain the continued expansion and success of incorporating the KSAs into pre-licensure and graduate curricula (Warren, 2011). The effectiveness of this initiative will depend on how well nurse educators are able to instill the six competencies and their KSAs into nursing students in the current healthcare environment.Changing Healthcare EnvironmentChanges in the healthcare environment in recent years can cause many challenges for the field of nursing. First, the patient population is changing and expanding rapidly. Advances in technology and medications have allowed for a longer life expectancy, increasing the prevalence of chronic diseases and associated morbidities (Hegarty, Walsh, Condon, & Sweeney, 2009). Additionally, the demographics of the United States are becoming more diverse, requiring the nursing profession to be well versed in culturally competent care (Heller, Oros, & Durney-Crowley, 2000). Healthcare is also becoming a consumer-driven environment with patients who are informed and demand the highest level of care. To adapt to this, the nurse must understand that the patient is becoming more involved in his or her own care and decision making (Hegarty et al., 2009). Patient education and exploration of options are vital to keeping the consumers feeling involved (Heller et al., 2000). In addition to the patient population becoming more diverse, the nursing profession is seeing a wider range of demographics as well, both in age and race. Commonly, a nursing student is seeking nursing as a second degree, and is raising a family and working a full time job during the duration of school. These students have higher expectations for their education, and also require and expect flexibility to allow for their family and job (Heller et al., 2000). Once in the workforce, there has been a rise in the amount of involvement the bedside nurse has in decision making. In order to be effective with this new responsibility, the nurse must have leadership skills and knowledge about effective advocating for themselves, their coworkers, and their unit (Tomajan, 2012). As the largest professional group within healthcare, it is imperative that nurses develop these skills to effectively influence patient care (Tomajan, 2012). Information technology (IT) has been rapidly advancing and is increasingly present in the patient care world, whether it is through electronic medial records, computer provider order entry, or even the ability to quickly and efficiently find information on diagnoses, drugs, or treatments. Especially with the mentioned growing diversity in the nursing profession, it is important that all nurses are taught and continue IT competency (Hegarty et al., 2009). Finally, another large change is the effect of healthcare policy and regulation on the hospitals. Reimbursement programs are becoming dependent on quality care and standards, making nurses the front lines to determining the amount of reimbursement a hospital will be given (Heller, 2000). For example, the Centers for Medicare and Medicaid Services (CMS) provides incentive payment based on the “meaningful use” of the electronic health record as it relates to various core measures. The responsibility falls on the nurses to fulfill this requirement fully and accurately to receive the payment (CMS, 2013).Impact on Nursing EducationWhile it is clear that the healthcare realm is experiencing change, it is the job of the nurse educator to adapt to those changes to allow new nurses to have the highest chance for success in both their own positions but also for the nursing profession as a whole. With the emerging viewpoint of patient as informed consumer, nurse educators need to modify their teaching approach. According to Barnsteiner (2011), traditional nursing care has focused solely on the patient individually, while having a lack of delivery system focus. Today, it is important that patient care is seen through the lens of this whole system in order to provide a truly patient-centered care experience. This is where a program like QSEN can be used to help guide faculty to broaden to a system focus (Barnsteiner, 2011). The changing demographics of the nursing student also present a challenge for nursing faculty. Faculty must be prepared to deal with a more mature student with multiple job and family obligations. This requires educators to provide a more flexible schedule to accommodate these needs. Additionally, second-degree students have high expectations for their education, and will demand the most up-to-date teaching styles available (Heller et al., 2000). This challenges faculty to provide successful simulations and effective clinical experiences on a routine basis.As discussed, when the nurses enter the workforce, they will begin to be asked to be involved in decision making on a more frequent basis. To be successful with system leadership, the nurses must have baseline leadership and advocacy skills. This can start to be introduced in the university setting, however this is an area of opportunity for the clinical nurse educators. According to Tomajan (2012), one of the best ways to learn leadership skills is through mentoring. The clinical educators’ responsibilities now go beyond teaching new skills and updating staff on policies. Mentoring nurses to become successful advocates and leaders is now vital to the advancement of the nursing discipline. The IT advancements of the recent years will pose a challenge to both educators at the university level as well as in clinical areas. Proficiency with technology is now a vital skill to function efficiently and properly in the hospital today. Additionally, technology provides much faster care, whether it is through test results or consultations. Patients will expect this same pace from the nursing staff, who will need to learn the benefits of using technology to their advantage (Hegarty et al., 2009). Additionally, the IT advancements cause a new level of expertise needed for clinical educators. Nurses nearing the ends of their career may not be as familiar or comfortable with computers or technology as a whole. It is imperative that those in the clinical arena not only learn about developing technology, but also need the ability to teach it to those who do not have a baseline familiarity (Hegarty et al., 2009). Finally, changes in healthcare policy and reform provide yet another emerging area of importance for future nurses. With current healthcare reform, an understanding of political arenas and ways to involve themselves is necessary. This is a relatively newer topic in nursing schools, however, the importance of it cannot be dismissed. Educators would benefit from becoming involved personally in political reform, as new mandates will directly affect nursing care (Heller et al., 2000). Additionally, as reimbursement programs become more prevalent, this will need to be added in to undergraduate curricula, as it will largely affect the way they provide care. This just adds yet another area of expertise for the nurse educator to stay up-to-date on.Incorporation of Changes into EducationIt is clear that the field of nursing education needs to be fluid and adapt to the changing healthcare environment, which places a large amount of responsibility on the educators to be aware of new or developing trends. The next challenge comes with bringing these new developments to the classroom. Incorporating QSEN and nursing advocacy should be supported with assignments and experiences throughout an undergraduate program. To ensure each of the six QSEN competencies are fully understood and developed, it would be beneficial to focus on one competency with each class or clinical rotation within the program. A program goal for QSEN could be that the student is able to discuss the QSEN initiative competencies, and is able to effectively demonstrate these in the clinical arena. The use of simulation would be most successful, as simulation has been shown to be an efficient tool when used to teach quality and safety competencies (Shrapnack, Goliat, Baker, Rogers, & Shockey, 2013). Simulations could build on to each other throughout the program, with the final courses combining all of the competencies together in to increasing complex scenarios. For example, for information technology, training domains of popular electronic health records could be utilized for students to be come familiarized with in early courses. In later semesters, this train domain could be used to get a history of a patient with a simulated interdisciplinary team, and then the team could move to treating a high fidelity manikin using the most current accepted practices.As stated by Tomajan (2012), the best way for students to learn leadership skills and to advocate is through mentorship from current nurse leaders. In an undergraduate program, a mentorship relationship could be created upon admission. The student would be able to attend meetings or workgroups with this mentor in order to see a nurse leader functioning in his or her daily routine. Before graduation, the nursing student could begin taking part in these meetings and workgroups, learning to be comfortable with advocating for the profession early on.ConclusionIn conclusion, the healthcare environment is evolving rapidly in important and exciting ways. The nursing profession will continue to play more of a role in the total care of a patient through the health system than ever before. Because of this, it is vital that quality initiatives such as QSEN, and recent advances in healthcare are completely incorporated in to nursing school curricula to provide nurses with the education necessary to succeed and advance the profession.ReferencesBarnsteiner, J. (2011). What students need to know about a culture of safety. The Online Journal of Issues in Nursing, 16(3). Retrieved from 758853_3Centers for Medicare and Medicaid Services. (2013). Meaningful use. Retrieved from Meaningful_Use.htmlCronenwett, L. R. (2012). A national initiative: Quality and safety education for nurses (QSEN). In G. Sherwood & J. Barnsteiner, Quality and safety in nursing: A competency approach to improving outcomes (pp. 49-64). West Sussex: Wiley-Blackwell.Hegarty, J., Walsh, E., Condon, C., & Sweeney, J. (2009). The undergraduate education of nurses: looking to the future. International Journal Of Nursing Education Scholarship, 6(1), 1-11. doi:10.2202/1548-923X.1684Heller, B., Oros, M., & Durney-Crowley, J. (2000). The future of nursing education: 10 trends to watch. Nursing & Health Care Perspectives, 21(1), 9-13.Quality and Safety Education for Nurses. (n.d.). Competencies. Retrieved from competenciesSharpnack, P. A., Goliat, L., Baker, J. R., Rogers, K., & Shockey, P. (2013). Thinking like a nurse: Using video simulation to rehearse for professional practice. Clinical Simulation In Nursing, 9(12), e571-7. doi:10.1016/j.ecns.2013.05.004Tomajan, K. (2012). Advocating for nurses and nursing. The Online Journal of Issues in Nursing, 17(1). doi:10.3912/OJIN.Vol17No01Man04Warren, J. J. (2011). History and impact of quality and safety education for nurses [PowerPoint slides]. Retrieved from kumc.edu/documents/seeds/092811-Warren.pdf? ................
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