The Future of Nursing. What about the Present?

Last month, the Institute of Medicine [IOM] issued a report called "The Future of Nursing: Leading Change, Advancing Health." The report stated that nurses should “assume leadership roles in redesigning care in the United States” and organizations “should remove scope of practice barriers that hinder nurses from practicing to the full extent of their education and training.” IOM also said more nurses should obtain advanced degrees and proposed creating “a residency program to help nurses transition from education to practice and additional opportunities for lifelong learning.” A number of other suggestions were made including elevating nurses to a “full” partnership level with other health care professional [doctors?].

This has generated some predictably positive responses from organized nursing and from the Center for Medicare and Medicaid Services (CMS) chief, Donald Berwick, MD, who effusively praised the report during a fawning speech to nursing leaders in Washington.

Not everyone agrees. IOM member George Lundberg, MD, blogged that if nurses want to be doctors, they should go to medical school. This received some passionate comments from both sides.

Here is my take. I currently work in an excellent non-teaching [no MD resident trainees] community hospital. There are some great nurses, many of whom function at the level of junior residents. But my experience in general over the last few years is that the level of nursing care has declined. As an aside, I think some of the problems can be traced to the nurses’ burden of inordinate amounts of “charting” mandated by various agencies and facilitated by point and click electronic medical records. Trust me, no one reads these mountains of redundant and mostly irrelevant data.

I don’t need a “partner.” While I am delighted when a sharp nurse alerts me to something important or suggests a change in treatment based on an observation, what I need is a nurse who knows the following: what medications my patient is on and why; what procedure he’s had and why; what his intake and output was over the last 24 hours; whether he has any new complaints; if anything out of the ordinary has occurred; how to give an enema, etc.

If nurses are going to assume some other lofty role, will someone please tell me who is going to take care of my patients at the bedside?

Full Disclosure: I am happily married to a nurse and have been for almost 37 years.