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| What's Hot — Where Will Your Career
Be in Five Years? Carol Dunbar, APRN, BN |
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| Learn important basics
to keep in mind when thinking about your nursing future. One of the finest selling points for a career in nursing is its unlimited range of employment opportunities. Whether it’s acute or long-term care, or inpatient or outpatient care, nursing holds the promise of finding a perfect practice setting for everyone. Nurses have the flexibility to move from one specialty area to another. They can take on different roles or move to a new practice setting, often without interrupting their employment within the same facility. But what is predicted for nursing during the next five years? Will there be job trends in specialty areas? Where will employment opportunities arise? The Future Is Here “Nurses and health care facilities need to prepare for the future,” says Jackie Wilhelm, RN, BSN, manager of staffing in human resources at Northwest Memorial Hospital in Chicago. Wilhelm sees three trends that will influence nursing practice in the near future. “There is our aging population,” she explains. “There are the advances in technology, and there is the increasing influence of managed care.” Wilhelm also sees a growing trend toward outpatient care, and with it, a change in nursing practice. “The RN will have to be able to perform more complex and varied tasks and will have to teach the family how to care for the patient at home. The nurses in these settings will be caring for the whole family.” Beth Brooks, RN, PhD, CHE, associate dean for academic outreach for the College of Nursing, University of Illinois, in Chicago, identifies two trends that will have a impact on nursing. “Geriatric care, whether in the home, assisted living, or an acute care facility,” Brooks says, “will be a growing field. There will be a need for advanced practice geriatric specialists in almost every health care setting. With an ever-increasing number of individuals with chronic conditions, our [focus] will not be on a cure, but rather helping patients live with what they have.” Brooks predicts that the other trend in job growth for nurses will be in the field of technology. “Many hospitals are far behind when it comes to information systems. There is a need for an understanding of clinical processes in the development of software, in training for staff, in research on data, and HIPPA concerns. And now, with wireless technology, facilities that could not afford to rewire for computers may be able to bypass that step.” Money Matters An easy way to understand the trend of the health care job market is to look at where the dollars will be. According to a recent report, hospitals will concentrate efforts and capital on service lines that yield high margin, high quality, and high volume.1 “To remain viable health care institutions try to maximize the dollars that are coming in,” says Michael Impollonia, RN, MSN, CNA, manager of nurse recruitment, retention, and employee health services at Mount Sinai Hospital in New York, and president of The Greater NY Association of Nurse Recruiters. At Mount Sinai, that means OR nursing. “We currently run 36 ORs, and we are trying to open more,” says Impollonia. The OR is one of the most difficult areas for recruiting, according to Impollonia, who adds, “It can take a nurse a year to orient to all the specialty surgeries within the area.” According to the U.S. Department of Health and Human Services, the population group of those 65 years and older is expected to grow 54% between 2000 and 2020. This group will also spend three times as much on health care, on average, than those younger than 65.2 Keeping these aging baby boomers in mind, nurse recruiters predict that certain specialty areas will continue to see a demand for nurses.1 “Cardiac nursing at all levels is a great career choice,” says Karen Hanson, RN, C, recruitment coordinator for Valley Health System in Ridgewood, N.J., and president of the New Jersey Association of Healthcare Recruiters. “We are always expanding services, from telemetry to cardiac surgery intensive care. The Valley Hospital, which is part of the Valley Health System, uses nurses with all levels of education and experience to fill these positions, from new graduates on the telemetry and step-down units, to nurse practitioners who manage care in the CSICU. Mary Marczyk, RN, MSN, nurse recruiter at Thomas Jefferson University Hospital in Philadelphia, sees a continued need for evening and night supervisors, nurse managers, and nurse case managers. “Interventional radiology is a growing area,” adds Marczyk, “where experienced nurses with critical care skills and advanced cardiac life support training are needed.” Marczyk says there is also a need for BSNs who are interested in working in research and as transplant coordinators. Toni Copp, human resources manager and nurse recruiter at Loyola University Health System in Maywood, Ill., expects job opportunities in quality and outcome measurement. “We are working with schools,” says Copp, “to have them develop classes on quality measurement and technology in the nursing curriculums.” Emergency departments and critical care areas continue to offer almost unlimited nursing opportunities. “There are always a variety of opportunities in both areas,” says Karin Weisenberger, RN, MS, director of human resources at Winthrop University Hospital in Mineola, N.Y., and president of the Nassau-Suffolk Nurse Recruiter Association. “We can talk about job trends, but we must also look at needs, and these are two areas where there will always be a need for experienced nurses.” Specialized Opportunities “We are seeing a huge growth in ambulatory surgery and a substantial growth in orthopedic surgery,” says Lucille Milo Bock, health care recruiter at New York Methodist Hospital in Brooklyn, N.Y., and president of the Brooklyn, Queens, Staten Island Association of Healthcare Recruiters.” To help patients with this transition, New York Methodist has created a patient advisor role. With an assigned caseload, RNs will follow each of the ambulatory patients, from preadmission testing and teaching to postoperative recovery at home. Even though hospital costs account for 18% of the increase in health care costs, hospitals are operating more efficiently than they did five years ago.3 And there are new specialized nursing roles that can help to streamline patient care. “We are seeing huge growth in ambulatory surgery and a substantial growth in orthopedic surgery,” says Lucille Milo Bock, director of human resources at New York Methodist Hospital, Brooklyn, N.Y., and president of the Brooklyn, Queens, Staten Island Association of Healthcare Recruiters. New York Methodist Hospital has created a nursing role called patient adviser. These nurses have an assigned caseload and follow each ambulatory patient from preadmission testing and teaching to postoperative recovery at home. New York Methodist has also created a nursing assessment specialist role. “These nurses will conduct nursing assessments at the bedside, and then create an allied health treatment care plan,” Bock explains. Other hospitals, like The Valley Hospital, have created positions for nurses on an admission team. These nurses float throughout the hospital, assisting nursing staff on various units with the admission process. There is always a need for better coordination of care. A new nursing role, disease management coordinator, has been created at The Valley Health System to help coordinate care for oncology patients. “These patients often have many facets to their care, and it can be overwhelming for them and their families,” says Hanson. “With this new coordinator position, a nurse will be in place to make sure that no details are missed.” Hospitals have historically been the largest employer of RNs and continue to be so today. The Institute of Medicine reported in 2003 that most hospital nurses work on inpatient units, with 57.3% of RNs working in critical care and specialty units.4 Over the past decade, nurses have seen hospital lengths of stay decrease, and outpatient treatment options grow. Thus patients being tested in hospitals are more acutely ill than those of a few years ago and require nurses with advanced skills and expertise. Many health care facilities are answering this need by hiring more advanced practice nurses (APNs) and clinical nurse specialists (CNSs) to work with patients and train staff. “Here at Mt. Sinai, we have 160 nurse practitioners in every setting throughout the hospital,” says Impollonia. Marczyk predicts that the need for advanced practice nurses will continue to grow. “We see increasing positions in inpatient and outpatient care,” says Marczyk. “We are using NPs to cover the hours that have become restricted for medical residents, and we have clinical nurse specialists assigned to every unit.” The Philadelphia hospital is using advanced practice nurses in preadmission testing, the emergency department, and university health services. “Another hot, new trend in advanced practice,” says Brooks, “is the Doctor of Nursing Practice.” Experienced NPs will move on to get their doctorates in a specialty area. “Their focus will be in clinical practice,” Brooks says, “rather than the research focus of the PhD.” How Happy Are You? Trends in health care may come and go, but patient satisfaction will always remain a top priority. Health care leaders recognize that there is a direct link between patient and employee satisfaction.1 With that in mind, recruiters are working to help place new graduates and experienced nurses in the best situation for success. “We have programs to help experienced nurses transition to new places, such as the ED or critical care,” says Impollonia, “but we also consider new grads for every clinical area, other than the ED.” Impollonia explains that the days of having to do that year of adult med/surg are over. “If they know what they want to do and they know their career goals, then we are here to help them succeed,” he adds. “With 16 schools of nursing coming into Mt. Sinai for clinical rotations, we have our own minor league system. When these new grads come to work here, they often have a specialty area already in mind.” Mind the Basics Whether or not you have a specific career plan, there are important basics to keep in mind when thinking about your nursing future.
In reality, the real trend in nursing may be that nurses have a choice. “It’s a buyer’s market,” Impollonia admits. Perhaps now, more than ever, nurses really do have a career with unlimited possibilities. Carol Dunbar, APRN, BN, is a contributing writer for Nursing Spectrum. References 1. HealthCast tactics: a blueprint for the future. PricewaterhouseCoopers website. Available at: www.pwchealth.com/hctactics.html. Accessed August 12, 2004. 2. Projected Supply, Demand, and Shortage of Registered Nurses: 2000-2020. U.S. Department of Health and Human Services. Available at: bhpr.hrsa.gov/healthworkforce/ reports/rnproject/report.htm. Accessed August 12, 2004. 3. Wood D. Industry trends will affect nurses.
Nursezone.com 4. Keeping patients safe: transforming the work environment of nurses 2004. Institute of Medicine of The National Academies website. Available at: www.iom.edu/report.asp?id=16173. Accessed August 12, 2004. |