1. Patterson, Miki PhD(c), NP, ONC, NAON, President

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What will the nurse of the future look like? We know all about the nursing shortage and that by 2010, there won't be enough health care workers to deliver care as it's known today (Buerhaus, Donelan, Ulrich, Norman, & Dittus, 2006). We know that the need for orthopedic nurses will increase in response to an aging population, an increased incidence of osteoporosis, and rising obesity in young people. These issues lead many more people to require joint replacement, joint revisions and fracture treatment. At a recent meeting of the Nursing Organization Alliance (NOA), I joined nursing leaders and executive directors of over 70 nursing organizations to discuss global nursing issues and to work on solutions together. One such issue was the healthcare of the future.

Figure. Miki Patters... - Click to enlarge in new windowFigure. Miki Patterson, PhD(c), NP, ONC, NAON, President, 2006-2007

At the NOA meeting the Association of Nurse Executives (AONE) expressed the need to define nursing work of the future, roles of the future nurse, and educational preparation for the professional nurse of the future. The future system for delivering patient care was illustrated as centered on the person/family/population, with future nurses ultimately working in partnership with people/families/populations to help them manage their journeys of care across settings with changing multidisciplinary care teams.


This model of care shifts the focus from nurses knowing a specific body of knowledge to knowing how to access this knowledge. Instead of owning a toolbox, the RN will know how to access a world of toolboxes. Nurses will expand their use of technology, critical thinking and critical synthesis of the information accessed. They will need to coordinate and negotiate care across multiple levels, disciplines and settings. When required, nurses will establish both real-time and virtual relationships with patients.


In this highly complex healthcare-delivery system, registered professional nurses of the future will be different from today's nurses. They will be educated at the baccalaureate level, be technically savvy, and have had some virtual education, whether clinical simulation or distance learning. They will have developed abilities to access a variety of toolboxes, to think critically, and to rapidly synthesize large volumes of information.


For this future, the best and brightest people must be recruited into nursing and some things need to change. First, we need to pave the way to require that all future registered professional nurses have a BSN. Evidence tells us that educated nurses make a big difference in patient outcomes. Death rates were almost twice as high at hospitals where less than 10% of nurses had bachelor's degrees as at hospitals where over 70% did (Aiken, Clarke, Cheung, Sloane, & Silber, 2003). For every 10% increase in BSNs, death rates and failure-to-rescue rates drop by 5% (Fagin, Maralo, Mason, 2003). In this increasingly complex system with fewer available RNs, it makes sense to have them prepared at the highest level possible.


Second, the image and value of nursing needs to be improved. No longer should we accept media portrayals of nurses that are disparaging, incorrect or absent. Such portrayals are seen weekly in TV programs like "House" and "Gray's Anatomy" where residents and attending physicians are seen doing nurses' work. You may see a piece of a nurse such as an arm or back of a head. Contemptible remarks are made about nurses, and they are valued only as a person with an exciting love life, not for the valuable work they do. I do applaud "ER" for presenting Eve Payton, a highly educated nurse who knew her research and saved lives. Though she was portrayed with a slightly battleaxe image, it was a step in the right direction. Media needs to portray nurses as educated, intelligent people, saving lives and improving patient outcomes. As nurses, we need to speak up or write our objections when we see these disparaging or inaccurate portrayals. Check out for more information.


The value of nursing also needs to be brought to the public's attention. Research shows if a nurse's patient load increases from 4 to 8 patients, the mortality rate increases by up to 31% (AHRQ, 2004; Aiken, Clarke, Sloane, Sochalski, & Silber, 2002). Nurses also need to educate medical students and administrators on the nurse's role because they too believe the media portrayals.


We also need to think about how NAON as an organization will provide for the nurse of the future. At the NOA meeting, we talked about the role of nursing associations in building the toolboxes for instant access of information. NAON will need to build the orthopedic nurses toolbox and partner with other nursing specialties such as gerontology, pediatric and developmental disabilities to be sure we are providing the most comprehensive and up-to-date information to our members.




AHRQ. (2004). Hospital Nurse Staffing and Quality of Care, 2006, from[Context Link]


Aiken, L. H., Clarke, S. P., Cheung, R. B., Sloane, D. M., & Silber, J. H. (2003). Educational levels of hospital nurses and surgical patient mortality. JAMA., 290(12), 1617-1623. [Context Link]


Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA., 288(16), 1987-1993. [Context Link]


Buerhaus, P. I., Donelan, K., Ulrich, B. T., Norman, L., & Dittus, R. (2006). State of the registered nurse workforce in the United States. Nursing Economics, 24(1), 6-12. [Context Link]


Fagin, C., Maralo, P., & Mason, D. (2003). Aiken places another major study in JAMA, linking bachelor's-prepared nurses with lower mortality; much of elite media yawns, from,[Context Link]