1. Carroll, V. Susan Editor

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Healthcare in the United States continues to morph, not quickly to be sure, but the need and impetus to change underpin much of what we do. We look at trends and transform our practices and the places in which we practice. We're global but population based, and the populations for whom we care have more complex needs. Lots of buzz words to understand and data to examine, but what does it all really tell us? Where are we headed? Why should we change? What is on the horizon?

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Despite recent changes in federal healthcare policy (read Affordable Care Act/"Obamacare") and changes in reimbursement linked to outcome, the U.S. healthcare system continues to struggle against persistent problems: safety, unequal access to care, payment incentives that don't routinely reward good outcomes, no significant link between costs and quality, and fragmented, variable processes that hinder productivity and efficiency. Nurse and physician education has also come under fire: not enough diversity, too expensive, not comprehensive enough, and not enough of the "right" practitioners where they are most needed.


The nursing workforce has grown substantially in the past decade and continues to outpace growth in the U.S. population. The percentage of nurses holding at least a bachelor's degree has increased from 50% to 55%. Nurses are gradually becoming more diverse, with the number of non-White nurses increasing from 20% to 25%; the proportion of men in the workforce has increased to 12%, an increase of ~3.5%. However, the current nursing shortage is deep, likely long term, and probably more resistant to "quick fixes" than in the past.


A call to reform nursing education has been highly publicized and discussed in many forums. To date, it remains largely single-discipline focused, with only baby steps taken in planning and implementing interdisciplinary learning. Team-based approaches to learning among disciplines can improve clinical outcomes and reduce cost. But, for the most part, we haven't transformed the ways in which we educate nurses or other healthcare professionals.


Nursing science and the research that underpins it need to address healthcare issues globally (think Ebola, measles, polio, maternal deaths) as people are mobile and borders are often porous. Nursing research is essential in improving symptom management and patients' and families' experiences with illness, improving illness treatment and prevention, and reining in costs. We face a need for research mentorship, both here in the United States and beyond our borders, and more focus on the scholarship and science of nursing in schools of nursing.


Finally, as we move into an uncertain future, we know for certain that many of our consumers of care are better informed, more committed to being active decision makers and care managers, and often more willing to try alternative, complementary, and palliative treatment options. We need to hop on the bus so we can better understand and support their choices.


So, what does the crystal ball tell us? Change is inevitable. The future is already here. As nurses, we are important players in the transformation of healthcare and professional education, albeit sometimes reluctantly. More than 20 years ago, Peter Drucker said "The best way to predict the future is to create it" (, accessed December 27, 2014). The crystal ball is simply a tool to support creativity.

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