Social determinants have been the focus of our profession since the dawning of nursing time. As health care providers, we know that health starts in our homes, schools, communities, and workplaces, which are heavily influenced by the availability of access to societal and economic opportunities. If I live closer to orchards or fields, I’m more likely to pay less for fresh fruits and vegetables. If there are low-cost medical providers near my work, I’m more likely to be seen before my illness exacerbates. The conditions of our environments shape not only our health but the overall quality of life we perceive. Having nurses actively engaged in the communities they serve can help improve these determinants.
Intending to create social and physical environments that promote good health for all, the Office of Disease Prevention and Health Promotion (DPHP) created HealthyPeople.gov to lay the blueprint for communities to address health issues and disparities among their people. Daily resources such as safe housing, local food markets with healthy choices, access to educational and economic opportunities, access to affordable health care, and the need for improved public safety are all examples of social determinants that improve with focused attention.
Enter the public health nurse. This specialized role focuses on improving population health by focusing on prevention while addressing the multi-focal determinants listed above. As community health nurses, these RNs apply systems-level thinking to assess not only the actual assets, needs, and opportunities of the individuals and communities, but also the potential needs and inequalities within the population. Then they take action. Yet, these actions are not reserved for the specialty of Public Health Nursing; as we have learned, these are actions for all nurses:
• Get educated: Learn the social determinants in your area that affect the population you serve. Is there a lack of medical care or access to dental services? What are the immunization rates in your neighborhood? How about safe, reliable public transportation from your community to essential services such as the grocery store? The more you know, the more efficient you will be in your efforts to make an impact.
• Get political: I’m not talking about red vs. blue politics or social media memes. Learn what policies are up for a vote in your local area and either volunteer to advocate for – or against – the policies that will affect the social determinants of your space. Seek nursing appointments or positions that help form social change for the community and beyond.
• Get cultural: Competence in other cultures includes allowing yourself to be vulnerable enough to say, “I don’t know – teach me.” Work within people’s cultural norms to highlight where you can add value to improve their quality of life. Don’t be afraid to ask clarifying questions.
• Get moving: Once you determine what or who needs your focused nursing attention, organize fundraisers, health fairs, or awareness around the issue. High rates of diabetes in your community? Consider cooking classes featuring healthy items you’d find in the local markets. Plan a ‘Mom’s Night Out’ with childcare so you can provide healthy snacks as you educate women in your neighborhood on hypertension or the importance of immunizations.
Nurses are the past, present, and future health care providers of our communities. We are charged with improving the lives of those around us and addressing – one by one, if needed – the social determinants that are negatively affecting lives. No matter our nursing specialty, we can all make a difference to move the needle to improve the social determinants of health.
Many of us with advanced degrees struggled with the decision to return to school. There is literally no perfect time to go back to school after you’ve accomplished the tremendous feat of RN licensure. There are hundreds of reasons not to return to the academic life, yet here you are still reading this article, so this might be the right time for you to plan your next degree. Now the question is, which degree to pursue? There are several considerations on whether you should hop into a BSN program or skip that step entirely and jump directly into the MSN journey.
First, let’s chat about your career aspirations. What kind of “nurse” do you want to be when you grow up (so to speak)? Do you want to remain at the bedside or perhaps be a Charge Nurse where you’re leading operations, supporting the bedside crew, and performing direct-patient care? Does your organization require a BSN to advance through the clinical ladder? Would you like to teach at a nursing assistant or LPN/LVN school? Would you like to be a public health nurse and lead community health events or provide in-home care? While most of these roles require a BSN (depending on the institution and state, of course), having an idea of where you want to go with your career path can lend insight into your next step.
You may have already entered “RN to BSN” into a
search engine, become completely overwhelmed with the over 54 million (yes,
million) results, closed your eyes with a sigh, and thought, “Not
today!” Well, it doesn’t have to be that confusing. If you’ve decided on a
BSN program, the next step is to decide on the format. If you’re the
I-need-to-work-this-school-thing-around-my-life person, then online programs
might be the best option. Or perhaps you know you’ll be more successful with
in-class accountability, so narrow your search for those programs. The cost can
range widely, such as the $5k at Winston-Salem State University (WSSU) in North
Carolina to nearly $22k at Ramapo College of New Jersey plus any additional
fees for clinical hours, so buyer beware.
Nurses considering the RN to MSN track are typically looking for more of an advanced-practice career such as teaching in nursing schools for ADN or BSN students, leadership roles in organizations, or becoming a nurse practitioner, a nurse-midwife, or clinical nurse specialist (CNS). There are also some newer and exciting (yes, I used the word exciting about education) MSN degrees specializing in informatics and innovation. Once you have decided that the MSN is the route for you, choose your focus and specialty area and then select your school. While the MSN is designed for the working professional, it’s still a considerable investment of time and money, so you want your advanced degree to be in something you’re interested in and will enjoy. As with the BSN programs, the cost can vary greatly from not only from school to school but also by specialty area.
No matter which pathway you choose, I want to reinforce that
all nurses, no matter what the title or the pedigree papers state, should
always act in a professional manner. As we are the most trusted profession in
America, we hold an obligation to our patients, to the communities we serve,
and to ourselves to keep the bar very high. Social
media is a blessing and a curse in many ways of allowing people a glimpse
into our private lives, so whether you are a diploma nurse on up to a DNP, the
piece of paper does not make one professional. Make sure you are
choosing to represent our profession at all times positively.
Being a nurse is part of our identity. It’s not something that we only recognize when we’re clocked into the corporate payroll. We are nurses first, and we build on those skills as we gain wisdom and knowledge through many pathways such as mentors, colleagues, organizations, and formal education. Choose your next step based on where you see yourself heading within the profession of nursing, yet know that education is an investment in yourself that is earned and can never be taken.
Nurses have always played a critical role at the bedside while bearing witness to numerous changes in technology. In the past 50 years alone, the advancements seem unfathomable to nurses of the not-so-distant past such as “test-tube” babies, medical lasers, the artificial heart, genome mapping, CT and MRI imaging, angioplasty, dialysis, endoscopic procedures, bionic prosthetics, the internet and health information technology (IT), the electronic health record (EHR), and robotic surgeries. However, as health care races toward telemedicine and artificial intelligence, nurses must strategically position themselves to stay relevant.
In a recent article in Nursing Management, the author stated: “Artificial Intelligence (AI) is a branch of computer science dealing with the simulation of intelligent behavior in computers. Combining the experience, knowledge, and human touch of clinicians with the power of AI will improve the quality of patient care and lower its cost.” While most nurses have been immersed in the EHR for a decade (or more, depending on the organization), the industry still struggles with quality vs. quantity of input data that will allow for valid information mining, utilizing AI to identify areas of risk, or even the pending decline of a patient.
However, the question of quality data is often reviewed by those who are responsible for an organization’s health care IT. Many nurses who jumped into the AI and innovative world of informatics struggle with orchestrating what constitutes valuable data the bedside nurse is required to input versus each discipline’s desire to have the information captured. For example, while it is important to the dietician to know which brand of tube feeding was administered to the patient, does it truly add value enough to warrant one more line on the 1,000+ EHR rows for the nurse to capture? Preserving documentation requirements to the essential data points will not only help bedside nurses save precious time, but also allow for predictability models to work in the background to anticipate patients who may decline.
Bedside nurses are the key to AI as it relates to predictability models and telemedicine. Data points such as temperature, blood pressure, and physical assessment values, entered into the EHR in a timely manner, can literally make the difference between life and death as the health information technology is scanning thousands of factors to provide outcome information. Getting nurses onboard with real-time, accurate documentation (not just copying the assessment from the previous shift) is essential. “Nurses are viewing AI as telling them what to do instead of using the insights AI provides as part of their clinical decision,” states Dan Weberg, PhD, RN. “In order for nurses to stay relevant, we need to figure a way to incorporate new technology directly into practice. AI isn’t making decisions for us as nurses, it’s making us super nurses!”
Dr. Weberg, who has worked as an innovation specialist for multiple health systems and academic institutions across the U.S., states that nurses need to demand a seat at the innovation table. Each year, more and more institutions are developing smart health apps that directly affect nursing. Yet the absence of the nurse in the concept and design is palpable. Many times, nurses are not brought into a project until it is time to implement the technology, which is a challenging time to make any nurse-recommended changes. When technology is designed and implemented without nursing input, workarounds are created, which can lead to the innovation not being used to its full capacity.
The lack of enthusiasm and embracement of technology may
start in nursing schools, according to Dr. Weberg. “There is a gap between the
traditional, old-school methods of teaching students how to be nurses and
actual innovation in practice. Academia needs to foster a healthy relationship
between nursing and advancing technology if we want to remain relevant.” One
would assume that as nurses are sworn to advocate for and protect patients,
embracing technology that improves patient outcomes should be obvious.
When artificial intelligence and modern technology are infused with the art of medicine, patients are safer. In a study conducted by the Institute of Medicine in 2000, it was found that 10% of medical diagnoses were wrong. The report, called To Err is Human, called for technological advances such as physician order entry to reduce the guessing game in deciphering clinician handwriting. Since that report nearly 20 years ago, many studies have proven that there are less medication errors, less adverse drug reactions, and improved compliance to evidence-based practice guidelines with the integration of health information technology.
As health care technology continues to evolve at a rapid pace, it is not just the encompassing profession of nursing that needs to be in on the change. Bedside nurses can strive to become “super users” in their departments as subject-matter experts in any technology or innovation that is being designed and implemented. Staying one step ahead and developing a mindset of improvement and innovation can be powerful. For the nurses who complain that “things are always changing too much” who long for the trifold, 2-sided, chart-in-the-color-of-your-shift days, that ship has sailed – and good riddance. The future of nursing is aglow with the megahertz light of innovation to improve the lives of nurses, patients, and the communities we serve.