B Y J U L I E K E I T H P H O T O S B Y M I L L E R M O B L E Y
Their field is changing rapidly, but nurses still play a vital role in patient care. Follow Princeton Baptist Cardiac Intensive Care Unit nurse Nathan Bowden, R.N., on one of his shifts, and read what local nursing administrators and educators have to say about the future of nursing.
“The staff nurse is the most important caregiver in the hospital.”
These are strong words from Princeton BMC Chief Nurse Executive Regina Yarbrough, and they’re not spoken lightly. This 38-year veteran knows what she’s talking about. After almost four decades of working as a nurse at Princeton (the hospital where she was born), Yarbrough has moved up from staff nurse to charge nurse to now the highest executive nursing position at the West End institution. In her current role she oversees all nursing staff and policy and reports directly to the CEO.
Yarbrough knew in high school that she’d be a nurse. “Nursing was always the goal I wanted to get to,” she says, and admits that for her, as for many countless nurses before and after her, “nursing chose me, I didn’t choose nursing.” Cindy Williams, who has been chief nurse executive at St. Vincent’s Hospital in Birmingham for eight years, agrees with Yarbrough. “This is a calling.” she says. “So much of [a nurse’s job] involves action and skill, but sometimes their voice is not in their words, it’s how they demonstrate their care and compassion. People still need human touch. It’s what patients and families react to.”
Williams also agrees with Yarbrough that the nurse fi lls the most important caregiver role in the hospital.
“The nurse is the center of the wheel,” she explains. “Nursing is often the pivotal role in the collaboration among disciplines.”
Dr. Doreen Harper, dean of the UAB School of Nursing, uses a different metaphor, but one that still illustrates the signifi cance of the nurse’s role. “The nurse is at the frontline of medical care,” she says fi rmly.
“Whether that’s in the hospital, in an offi ce, in a home, in the community, in a school or in a nursing home. The nurse is the one with the patient.”
TEAM BUILDING
When Yarbrough, Williams and Harper were beginning their careers, nursing was primarily a women’s profession. Teaching, nursing, secretarial work—in the 1960s and 1970s those fi elds offered most of the options for working women. And back then a hierarchy was fi rmly in place at most hospitals. Doctors made the big decisions, and nurses were the assistants who ensured that those decisions were carried out. But times have changed. “Nursing is recognized differently than in the past. A nurse is more of a colleague with other team members,” Williams says.
Yarbrough agrees. “We have a much more collaborative team approach now. Doctors know that the nurse is the one with the patient for 24 hours. They need that information. Nurses come out of schools, quality schools, and they are ready immediately. They come to the workforce clinically ready. They work on a team to build the patient’s whole plan of care.”
Harper says that improving the development and functionality of highperformance clinical care teams has been the focus of her career. “No one practices on an island anymore,” she says. “Not nurses, not doctors. We couldn’t do what patients need if we didn’t work together. We are here for one reason, and that is improving the health of the patient.”
The demographics of the team have changed, too. No longer a women’s-only fi eld, nursing today is comprised of men and women from all backgrounds. And men, in particular, make great nurses, Yarbrough says. “As nursing has evolved, I see older men coming to nursing as a second career. Men see that nurses have a tremendous impact on patient outcomes, and that appeals to them.
Many of them are mission-minded and are drawn to a servant role later in life. That’s a great change for nursing, men wanting to give back.”
A NEW WORLD
After the dissolution of the old top-down hierarchy of doctornurse- staff, perhaps the second greatest change that has transformed nursing is technology. Gone are the days of nurses relying only on the symptoms reported by the patient. With a mountain of data at their fi ngertips, nurses can quickly and accurately assess a patient and engage the team to begin treatment. “When nursing began, it was based on anecdotal evidence; there was no science or data behind it,” Williams says. “But now the technology, the devices, the pharmaceuticals, the infrared—it has enabled the nursing professional to adapt quickly.”
Yarbrough seconds that. “Technology is providing us with critical data to better manage the patient,” she says. “It’s exciting, having that at your fi ngertips. Nurses now have the ability to critically think, to look at best practices, to look at evidence-based data and make decisions based on that.”
Nurses with information are major players on the clinical fi eld. As many of the nursing professionals and educators whom I interviewed pointed out, an informed nurse is often the catalyst for policy change at the hospital where they work. Yarbrough talked about staff nurses coming to their superiors with data that showed how time was being wasted when a cardiac patient arrived in the ER. It was nurses who led the greater cardiac team in identifying ways they could eliminate precious minutes before the patient was moved to the catheterization lab.
“Data is powerful,” Yarbrough says.
A COMPLEX FUTURE
From more and better technologies that deliver data instantaneously— even from a hospital bed that instantly downloads data to a nurse’s computer, more a device than a bed—to the challenges of aging patient and nursing populations, the future of nursing is alternately exciting or worrisome, depending on how you look at it. After all, what good is data if you don’t have enough nurses to analyze it and you have a “tsunami” of an aging patient base, as Harper describes it? “Between 2016 and 2020, the needs of our population are going to be extraordinary,” she says. “We’ve never faced anything like this. And when our average age for our most experienced nurses is 48 to 49 and they’ll be retiring—you can see how diffi cult this will be.”
What that means is a tremendous push to not only graduate more nurses—from much-needed “generalists,” as Yarbrough says, to specialists in geriatrics and other fi elds—but the push to also graduate those who will do the “mentoring, leading, educating, and science to support the nurses themselves,” as Harper explains. “You can’t educate nurses if you don’t have the faculty to teach them,” Harper says. “People have to come from all stages of the nursing pipeline.”
The future of nursing also means playing a bigger role in prevention— working closely with families and communities to teach lifestyle changes that will keep patients from ever coming through the hospital doors—and playing a bigger role in sending patients home with the tools they need to stay home and not come back. “75 percent of every dollar spent in healthcare is spent on chronic illness,” Harper explains. “One in every fi ve patients is readmitted [to the hospital] within 30 days. We’ve got to do a better job in helping patients and families transition into their communities, otherwise they’ll end up back in the hospital. We have to prevent people from using the most expensive healthcare.”
Williams explains that people come to the hospital for two reasons: “One, they need advanced surgical or medical intervention. Or two, they need continuous observation, and that is nursing. Nursing is about frequent assessments, continuous monitoring, managing complex lists of patient data, handling multiple physician orders from several specialists, and educating patients and families. At the end of a hospital stay, nurses have to make sure that patients can answer this most important question, ‘What do I need to know and do when I leave?’
SOME THINGS NEVER CHANGE
Despite the almost revolutionary advances that have changed the fi eld of nursing in the past 40 years, there are some things that have remained the same, says Yarbrough. “What hasn’t changed, what is consistent, is the heart of nursing. [Nurses] want to give of themselves. They want to take on the burdens of the patient. It is their ministry. The effective nurses know it is their life’s work—their mission, if you will. It is a privilege to do what we do.”
