1. Nursing in the Ever- Evolving Health Care System

2. Historical Grounding of Nursing Practice Currently nursing is grounded in hospital-based management of sickness Most nursing practice during the past 75 years has been associated with hospital care Basic nursing education is predicated on the hospital-based role of the nurse Trends are developing that radically affect nurses’ ability to practice in traditional models

3. Historical Grounding of Nursing Practice Impact of technology Increasing use of minimally invasive medical applications and advanced pharmacological therapeutics Less invasive, more portable, shorter term, and faster health care Growth in non-institutional and outpatient based delivery of care Increasingly shorter lengths of stay with patients moving out of the acute care setting as quickly as possible

4. Historical Grounding of Nursing Practice A conflict between the old and the emerging Nurses (average age 47 years) are having difficulty coping with the changing health care system Rather than comparing current status to past nursing practice, nurses should assess their obligation for new models of nursing practice

5. Historical Grounding of Nursing Practice Characteristics of the 21 st century health care system Short-term stay Fast patient turnover High tech Flexible Early-engagement Mobile Family members as primary care giver

6. Shifting Requirements for Nursing Care Changing expectations for patients and nurses Expectation that patients should receive the full range of nursing services now is unrealistic Patient and nurse must be reoriented to a different reality for their service relationship and for care expectations

7. Shifting Requirements for Nursing Care Major factors causing shifts in the health care system Health care is moving into mobility-based approaches with less treatment and recovery time Emerging interventions requires very short stays Accelerated movement from inpatient service to outpatient service Care traditionally given by nurses in the hospital is now being provided in the patient’s own home by family caregivers

8. Shifting Requirements for Nursing Care Payment structures for health care services are challenged to respond to the newly advanced technologies Staff shortages challenge the appropriate distribution and use of professional services including nursing Behavioral demands of work are changing from institutional models to mobility models New technology applications arise faster than providers can accomodate

9. Shifting Requirements for Nursing Care New priorities for nursing practice Transitioning patients quickly and effectively through the system in a cost and service effective method Identifying (codifying) nursing skills that need to be transferred to emerging care givers and developing unique ways to transfer those skills Creating easy access for patients and family caregivers to important information and interactive communication with providers

10. Determinants of Health, Mobility, and the Changing Ground of Practice Shifting role of the nurse Fewer nurses will be used in hospital settings Increasing nursing resources will be required in settings outside the hospital Transformation calls for a re-conceptualization of nursing practice

11. Determinants of Health, Mobility, and the Changing Ground of Practice Managing the “journey” of health care Foundation of nursing practice since the time of Florence Nightingale Nursing educators and service leaders must join forces to reconfigure nursing practice Continual learning through a nurse’s lifespan Continuing education that will enhance clinical practice