1. Section Editor(s): Sharts-Hopko, Nancy PhD, RN, FAAN

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Change in American healthcare delivery is inevitable. Among the numerous reasons, we are on the cusp of a longevity revolution and aging baby boomers will be expensive to maintain; current fees for service financing mechanisms are unsustainable; advances in biotechnology are undermining traditional profit centers in acute care institutions such as cardiac surgery programs; and a marked shortage of physicians, particularly in primary care specialties, looms. The Institute of Medicine (2011) report, The Future of Nursing, provides direction. But those of us in the business of educating nurses for the present and future struggle to determine how best to prepare them for the world in which they will practice 20 years into the future and beyond.


Two issues have been on my mind that ultimately led to this special issue. The first is that for many decades, sociologists, ethicists, and others have struggled over the issue of the quality of people's interactions with one another in relation to the extent that they share social networks. To sociologists and ethicists this is a discussion on the importance of social capital. In lay terms, we tend to exhibit a greater sense of care and accountability toward others whom we personally know-or whom our friends and relatives personally know-than toward total strangers. This may mean that we are likely to provide better healthcare in our own communities than in more anonymous institutions. This will be a factor to examine in assessments of the results of this major health policy change.


The second issue has to do with preparing the nursing students and nurses of today for practice in the system of tomorrow. We need to grapple within the rapidly evolving context of healthcare delivery with the question of what is to be gained by continuing to teach within an outmoded healthcare delivery paradigm, using a teaching strategy, the clinical case method, that was articulated in the 1930s to transition nursing education from an apprenticeship model to a theory-infused practicum learning experience. Many students still spend the bulk of their childbearing and childrearing clinical rotations in acute care settings, whereas few of the nation's children ever spend a night in the hospital, and when the vast majority of pregnant and newly delivered mothers experience all but less than 24 to 72 hours of the childbearing transition in their communities.


We need to expand our efforts to generate evidence about educational outcomes related to innovations in clinical education. Nursing faculties need to engage in creative thought about how and where more conceptually focused curricula can be implemented. We need to collectively engage in discourse about preparing safe practitioners for a rapidly evolving practice arena that will not be centered in acute care settings.


These issues bring with them tall orders for collective strategizing. But our commitment to quality practice to promote the nation's health in a changing practice environment demands nothing less of us. What are we waiting for?




Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press.