IOWA Alumni Magazine | October 2014
The Future of Nursing
UI nurses prepare to meet the booming demands of America's health care system.

Most college freshmen harbor some uncertainties about how their eventual career will work out. For fledgling nurses at the UI, reassurance is at hand.

With more than 3 million registered nurses in the U.S., nurses already represent the largest sector of all health care professions. Thanks to the growing number of Baby Boomers reaching retirement age and health care reform expanding Americans' access to health coverage, job opportunities are set to increase even further, with demand outstripping supply.

To address this demand, the UI College of Nursing offers a first-year seminar to provide the most promising health care leaders of tomorrow with an early introduction to the field. "The Distinctiveness of the Nursing Profession" course is open to high-achieving students admitted into the college's early decision program. One of the first universities to offer such a program, the UI admitted out of high school this year 64 nursing students who earned at least a 3.8 GPA and met other academic criteria. Starting their core nursing courses a semester earlier and guaranteed admission into the college, these students can complete their bachelor of science in nursing (B.S.N.) degree in four years. They also make an immediate connection to the College of Nursing community, interacting during their first semester with future peers and professors.

UI College of Nursing Associate Dean Ellen Cram says the early decision program helps attract bright students and spreads out demands on the college's resources. According to an American Association of Colleges of Nursing report, nursing schools across the country turned away nearly 80,000 qualified applicants in 2012 due to limited faculty, facility, and financial resources. In Iowa, state law requires one faculty member for every eight students in a direct clinical course. As a member of the College of Nursing's admissions committee, Cram says it's difficult to decline capable students in the wake of a nationwide nursing shortage.

The UI course helps show new nursing students why they couldn't have picked a better time to go into the field. Sophomore Emily Koepnick was drawn to nursing because of its emphasis on patient care and interaction. After taking the first-year seminar last year, which included class visits from specialist nurses working in OB/GYN, geriatrics, pediatrics, and anesthesia, she realized the extensive career opportunities. "Every week, I'd have a new plan," she says, "because they'd sell me so well on what they do."

While registered nurses primarily direct and coordinate patient care, as well as research and evaluate a patient's condition to optimize treatment, advanced degrees open up jobs as nurse practitioners, certified nurse-midwives, clinical nurse specialists, and certified registered nurse anesthetists. Though 60 percent of nurses work in a hospital setting, they're also found in community and public health centers, homes, long-term care facilities, schools, and prisons. "Not many degrees have this level of portability and flexibility," says Cram, "and if you decide to move, there's no doubt you can get a job tomorrow."

Plus, part of the distinctiveness of this profession is the unprecedented public respect and affection that nurses enjoy. In 2013, for the 11th straight year, a Gallup poll found that Americans rate nurses as the most honest and ethical professionals. Nonetheless, common, inaccurate stereotypes about the naughty nurse or physician's handmaiden persist in the media. As the UI class makes clear, nurses follow a strict code of ethics and carry significant responsibility for patient safety. Plus, nurses and physicians need to work collaboratively rather than in a hierarchy for the best patient outcomes.

Of course, the field of nursing has changed dramatically in the past 50 years. In the 1960s, nurses wore the standard uniform of a dress, stockings, and a pillbox hat, while they focused on soothing patients and taking care of their hygienic needs. Today, nurses in scrubs have assumed some sophisticated responsibilities once reserved for physicians, such as interpreting data and independently responding to changes in patients' conditions. They've also taken on more specialized roles, focus more on patient advocacy, and learned to use new technology to measure vital signs, record patient information, and administer medicine.

As nurses don't work in isolation, the UI class invites doctors, physical therapists, pharmacists, and other health care professionals to talk with students about their occupations. These guest speakers often express their appreciation for nurses' strength as mediators among patients and other health care staff. "Nurses are the glue that holds the health team together," says Cram. "They are the patient's advocate and the eyes and ears of the health care team, responsible for understanding the patient's physical, psychological, and spiritual needs."

As patients place their lives in the hands of nurses, trust is crucial to the relationship. Both the International Council of Nurses and the American Nurses Association have developed a code of ethics that emphasizes showing compassion, respect, and a commitment to all patients; serving as an advocate for their health and safety; providing them with the best care; and striving to advance the quality of health care as a whole.

Students in the UI class use these guiding principles to examine challenging situations they may encounter in their practice—especially when a patient's values don't align with their own. In discussions about how to help patients decide whether to forgo treatment, students identify the need to find out whether the patients value quality of life over duration, their tolerance for pain, and willingness to try every available treatment option. They learn that by asking the right questions, a nurse can help a patient articulate what's most important to them in their care.

For further exploration, the students view a movie that raises a thought-provoking ethical dilemma. Last year's class watched Sister's Keeper, in which a couple decides to have a second child for the purpose of giving her tissue—and, eventually, her kidney—to their dying eldest child. The younger child sues her parents for the right to make her own medical decisions. After watching the film, UI students split up into groups to defend the different perspectives of the characters and determine what values influenced their positions.

Integrity is key to a profession built on caring for the sick, injured, and vulnerable. So, the first-year seminar also shows UI students how to properly attribute their sources when doing research, covers the consequences of misconduct, and acclimates them to reviewing the college's honor code before every exam. Research shows that students who cheat in the classroom are likely to continue the cycle of unethical behavior, perhaps lying about a blood pressure reading they didn't take or stealing from a patient. By immediately laying out expectations for students, Cram says the college encourages future nurses to instead develop a pattern of integrity.

With health care's growing demands and rapid technological advancements, nurses also must be devoted to lifelong learning. While about half of nurses now hold a B.S.N. degree, the 2010 "Future of Nursing" report from the Robert Wood Johnson Foundation and the Institute of Medicine called for 80 percent to reach that level of education by 2020. Currently, only 26 percent of Iowa nurses hold B.S.N. degrees, which ranks 49th in the nation.

The report also recommends doubling the amount of nurses with a doctorate by 2020. Currently, less than one percent of nurses seek that level of education, yet the demand for nursing instructors and nurse practitioners has never been higher. By establishing these advanced education goals, the report's action committee hopes that nurses will aspire to go above and beyond the licensing standards in their state.

That's certainly the goal for Emily Koepnick, who plans to become a nurse practitioner. Regardless of the path that UI College of Nursing students take, they will help shape the future of an ever-changing, growing profession—one that's based on enduring principles of care and trust.

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