1. Mancino, Diane EdD, RN, CAE, FAAN

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We are challenged to develop a nursing education and health care system that is nimble and can adjust to hasty changes in delivery of nursing services. The Affordable Care Act (ACA), Medicare and Medicaid laws, and regulations are driving a major shift in the US health care system. Nurses are practicing in contemporary settings that are relocating health care services into the community. Note the trend of urgent care settings and retail clinics opening in the neighborhoods that you frequent.

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Approximately 50% of registered nurses (RNs) remain in acute care settings, where patient care is highly complex around the clock. RNs in these settings have experience and expertise in critical care. Many new graduates flock to high-tech monitoring settings and want to be "where the action is." On-the-job training consumes resources needed to ensure safe practice and to orient new graduates to the care of high-need patients.


The health care landscape is shifting beneath our feet. As health care becomes more collaborative and interprofessional, nursing has an opportunity to pay close attention to what is happening in other professions. As has been widely covered in the press, physicians are abandoning traditional primary care, and some of those who remain in practice are not accepting Medicare, Medicaid, or any third-party payments. Many take cash payments only and have even established concierge services with annual membership fees to cater to those who can "join the club."


How can our education systems and undergraduate and graduate curricula be modified to avoid being engulfed by the emerging health care landscape? Educators who are skilled in curriculum development, student assessment, pedagogy, and clinical knowledge are valuable assets to prelicensure nursing programs and to the profession. Current and future shortages of well-prepared nurse faculty are a serious issue with no real solution currently in sight. Additionally, clinical nurse specialists and in-service educators are critical to the ongoing education needs of staff nurses.


New graduates with degrees in other fields bring many experiences and skills to nursing. Creative ways of integrating knowledge from other fields enriches the nursing profession. Is it really necessary for students who already have bachelor's degrees in other fields prior to entering an associate's degree nursing program to earn another bachelor's degree in nursing? Would there be pipeline advantages to admitting students with previous degrees into graduate study with an associate's degree in nursing and a bachelor's degree in another field? Based on the rapidly growing shortage of primary care physicians and the explosion of retail and urgent care (as well as day surgeries, continuing care, community clinics, and acute care settings), advanced practice nurses are in high demand. Now is a good time to rethink our nursing education system beyond entry-into-practice issues.


Flipping the coin, we see a growing market in prevention and fitness. Patients with chronic illness are learning how to adjust and cope with limitations. This is an area ripe for nursing research and innovation. In the near future, the quality of life will be affected by a number of trends: increased life expectancy; development of new devices for everyday living; increasing use of robotics for personal care; creation of more synthetic body parts with 3D printing; manufacture of more population-based pharmaceuticals; advances in gene therapy; and maintenance of a healthy body. Personal monitoring using smart devices is also accelerating at an amazing pace.


The practice of infusion nursing is also growing more complex, with patients not only in acute settings, but in outpatient settings as well. From patients at home to those in chemotherapy settings, to complex patients with rolling veins, skill and clinical expertise are essential to the evolution of infusion therapy. As the demand for nurses in this specialty grows along with the need for established infusion therapists, the value that the Infusion Nurses Society brings to the specialty is significant. The role that nursing organizations play in today's health care landscape is vital to the advancement of the nursing profession.


No one can predict the future, but we can keep our eyes and ears open to detect trends and new challenges emerging in health care reform. Health care reimbursement is the key to understanding where the services will reside. New ways to deliver care by using technology and communication systems open the door to innovation. RNs must work side-by-side with other disciplines to keep the momentum of creativity moving in the right direction. Our obligation to society as professional nurses challenges us to be there to deliver the best possible nursing care to all in need. As a lover of nursing history and history in general, I look forward to reading what historians will write and say about the effects of the changes we are now experiencing.


These are truly exciting times for those of us who embrace change and who are willing to take on new challenges. After all, life without challenge is death.