Almost 20 years ago, when I was president of the New York Organization for Nursing Leadership, I met with Maureen Swick, who was then president of the Organization of Nurse Leaders of New Jersey. As presidents from neighboring states, we were interviewed for the periodical Nursing Spectrum about our thoughts on the state of nursing. Reading it again after foraging through boxes of archived journals, I was struck by the congruence with today's issues. Maybe you're not surprised?
What did Dr. Swick and I talk about in 2005? Workforce capacity, new nurse education, practice environments, policy, workplace safety, quality, developing leaders, generational differences, having a voice, building a better future...you get the idea... it was totally aligned with our current situation.
However, there are significant differences. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey hadn't been implemented yet. We weren't talking about diversity or racial reckoning, although an adjacent advertisement to the article proudly announced: "culturally diverse health services." At that time, appreciating cultural diversity was as far as it went. We didn't talk about technology either. The impact of technology on practice and care delivery wasn't projected widely at that time, although the Veterans Administration had already implemented bar-coded medication administration in 1999, forging the way for the rest of us. The Health Information Technology for Economic and Clinical Health (HITECH) Act wasn't passed until 2009, setting the path for electronic health record implementation nationwide. Most of us were documenting on lots of paper, making mistakes in transcription and omission.
And we hadn't yet practiced through a pandemic that took millions of lives across the globe and left the surviving nursing workforce in tatters, crawling its way back to thriving. That alone puts the 2005 issues in a simpler world. One might say it was the good old days even though we were in a significant shortage, blind to structural and internalized racism, and had many more inadequate systems and processes that contributed to error.
We've come a long way. Addressing well-being and moral stress is now expected in our workplaces for both clinical staff and leaders. In fact, there's a feature article in this issue about thriving in the workplace (see p.18), which wouldn't have been a topic covered in a nursing journal back in 2005. We now recognize the importance of public health, long-term care, and destigmatizing mental illness, including substance use disorders. We have gene therapy, continuous glucose monitoring, and information at our fingertips. Nursing research flourishes. Relational leadership is valued. There are multiple ways to be recognized for nursing excellence, as individuals and as organizations, providing pathways to extraordinary practice. The role of ever-expanding technology is huge. These are all significant improvements, and there are many more.
In some ways we're seemingly going backward. Team nursing with new roles (including virtual), and some old ones, is back due to necessity. Having a just culture, originally characterized in 2001 for healthcare, made baby steps for many years and is still not embedded. Healthcare financing didn't make sense then and doesn't now, with many misaligned incentives on all sides of the equation.
The eternal optimist in my character, combined with this reflection on then and now, leads me to conclude that there's plenty of hope for the future, even though fundamental issues may persist, and we're on an excruciatingly slow pandemic recovery headlined by workplace stressors, turnover, and shortages. What will 20 years from now look like? We're all counting on leaders such as yourself to get us back to thriving.
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