Nursing: Changes Over the Generations

Nurses as mentors or models bridging the generational gap

Regarding nursing changes over the generations, what are the major challenges, when it comes to different generations of nursing? Is it ever possible to resolve all of the generational differences among nurses?

Realistically, any profession has generational encounters, at some point in time. Multiple generations may be involved. Effective resolution of generational differences is important. This is particularly true among nurses, who are working with other nurses from different generations of nursing. Many nurses have older nurses in their families who have influenced them, in one way or another. These nurses have served as role models for younger family members or have been a source of inspiration for younger nurses.

Times change and nursing trends come and go. This can raise issues, concerns or cause conflicts that require effective resolution, on various generational levels. In every generation of nursing, there has been a wide diversity of training for nurses. There are continual transitions in medicine and medical practice to contend with, too. Add to that, the ongoing changes that involve the essential principles of nursing care versus the basics of nursing practice. Even nurses begin to wonder at times, which generation is correct with regard to theory and practice and what is preferable.

At times, there can be direct confrontation between the different generations of nurses. This may involve ongoing ethical concerns regarding practice and principle, hospital or medical policy, as well as differing standards of professional conduct and various levels of professionalism. 

In every generation, there can be a shift in terms of economic priorities, with regard to nursing. The economy affects the financial status of nurses. One must ask if nurses have to be swayed by the economy of a region, country or by the global economy. Globally, the status of patients and their nursing care is affected. Quality nursing care should be a major priority in every generation, regardless of the state of a country's economy.

Nurses from every generation, may prefer some degree of permanency in nursing theory and practice, but non-permanency is one reality they have to contend with on a daily basis. Nurses have to cope with ongoing transitions in nursing and there is resistance to change. One generation might argue that the experiential aspect is more important than the theoretical aspect of nursing. Some nurses in each generation, may argue in favor of nursing theory, at the same time as others insist on experience or hands-on-practice. At what point do these issues come together?

Nurses are obligated to inquire into serious nursing issues and to know how they have been dealt with, in the past. They must be aware of how they are regarded in the present, but it is always in the light of the future. This involves continual research on the part of the nurses. There are continual changes in the use of equipment and supplies. Add to that, changes in various procedures, treatments, medication and the method of medication administration.

How important is their dress code is to nurses, in different generations. Nurses involved in establishing new trends as change is inevitable.

There is a need to assess past and present nursing skills, as these change, but who is qualified to assess this, in terms of different generations of nurses?

Basic academic requirements for entry into nursing programs, constantly undergo transition throughout the generations. From an academic perspective consider nursing texts, journals, videos, cds and dvds or other methods of teaching. Upgrading is essential in every generation.

There are new areas of concern for nurses, in each generation. For instance, in our era what role does long distance nursing play? What direction will it go in the future?

What is happening with computers in nursing at this time? What is the future of computers, or other electronic devices, in relation to nursing?

Nursing is considered to be a career, one in which nurses are expected to study for the rest of their lives, but who pays the cost? Will this ever change?

There are other questions that arise, too. For instance, what happens to the learning curve of nurses, as time progresses? It may be higher in new generations of nurses, than it is in prior generations. The opposite can be true depending upon the dedication of the nurses.

Nurses have always been in high demand, regardless of the era. This will continue to be true in the future. 

While there are many jobs, are they accessible to the previous generations of nurses or are they only there for the new graduates, in each successive generation?

What about staffing and the various nursing roles that invariably demand stamina in excess? In reality, few hospitals have sufficient staff, when examined on a basis of a patient-staff ratio. Insufficient staff means excessive demands on nurses, regardless of their generation. Stamina levels diminish when there is a workload that is not appropriate, regardless of the generation of the nurses.

In every decade, there is a continual transition in terms of scheduling and the length of shifts. Nurses bounce back and forth between eight, ten and twelve hour shifts, depending upon where they work. Which is more appropriate or practical, in each generation?

Can nurses survive financially in every era? Pay equity controversy invariably enters into the generational picture. How should salary levels be calculated? Should pay scales be established, based upon years of experience and expertise or merely upon academic credentials?

What about the insistence on university degrees in nursing? There is an increasing demand for university degrees, but is there appropriate monetary remuneration for such? The nurses without degrees, even those with years of experience, can be phased out.

From an administration point of view, which is better for a hospital, a nursing home or a community nursing organization, new graduates or older graduates? Who should be in management and who should be in non-management nursing positions? Who makes the decision in each generation?

From a spiritual direction, does religion play a part in the old school of thought and the new school or is the spiritual realm of nursing relegated to generations past? Should this change?

From a health status perspective, what about nursing injuries or age and health related issues? Are there viable pension plans for nurses? What happens to nurses who are injured at work? What is the future of semi-retired nurses? What is the fate of nurses who contract different diseases?

It is little wonder there is always some degree of frustration, anger and complacency among nurses, but in reality, every generation has changes, challenges or confrontations to contend with.

Many nurses from previous generations have wisdom in excess to contribute to nursing and yet, where does this fit into the nursing picture? What happens to the nursing expertise, skills and nursing education that nurses have to offer to the younger generation?

Many times, nursing comes down to nurses as mentors versus models. The ideal nurse does not exist, but may be perceived as the mentor and the model for the next generation. New graduates take on the role of model nurse, but are soon into burnout from stress and work overload. Over time, they are destined to become phased out. They become the next generation, as the new graduates are turned out en masse, by new nursing programs.

In conclusion, it is apparent that there has to be a healthy balance maintained between nurses of every generation. There should not be a gap between generations of nurses, but it is almost impossible to prevent that from happening, at some time. Continuity between the generations is vital, regardless of change.

Somehow, a healthy balance must be maintained between different generations of nurses. If the balance is not maintained, there may be a loss of vision regarding nursing, what it represents and means to nurses, as well how it affects everyone else in various communities around the world.

Modern day aspirations of prospective nurses are always something to consider. What inspires young men and women to become nurses is equally important, in every generation. This reality will not change.

One must ask if nursing in different generations is designed to meet the needs of the nurses or does it just meet the needs of the patients? Is this focus any different now, than it has been in previous generations?

Where is nursing headed in the future with respect to change?

It is apparent that in nursing, there are numerous changes and challenges encountered over the generations. While it is possible to find effective resolution, this is always going to be an ongoing process of bridging the generational gap.

Nursing: Why do Canadian Nurses Move to the United States?

Canadian nurses: Employment in the United States

Canadian nurses move to the United States for many different reasons. Employment as nurses, in the United States is one of them. From a Canadian perspective, because nurses are professional people with high levels of academic training, employment recruiters from the United States and other countries of the world, seek to hire Canadian nurses.

Many new graduates take advantage of the employment opportunities offered in the United States. Why is this? For Canadian nurses, the transition to employment in the United States opens a vast horizon of opportunity. Any Canadian nurse, who is an optimist at heart, will find an opportunity and take advantage of it.

Globally, there is a high demand for nurses. This is true in Canada, the United States and other countries around the world. Opportunities for employment are everywhere, but for new graduates who are actively seeking employment, it can be easier to move to the United States, than it is to move elsewhere. This has to do with language, lifestyle, liberty and freedom.

In nursing, the written and spoken language of the country, where nurses are employed is extremely important. English is the primary language in both Canada and the United States. Many of the other major languages of the world are spoken by people in the United States. The majority of nurses from Canada would not have to learn a second language, in order to work in the United States, but, Canadian nurses, who have second languages, know that they will be comfortable with them, when employed in the United States.

The lifestyles of Canadians and Americans are similar, in many ways. This means that there is no major transition needed with respect to how nurses live. Moving to any strange country involves changes. If nurses do not have to focus on changing life styles, the focus can be on the pursuit of their nursing careers.

The issue of liberty and freedom is one of the major reasons why nurses choose to work in the United States, as opposed to another parts of the world. Canadians value liberty and freedom highly, as do Americans.

The United States is a safe country to live and work in, whereas many other countries of the world are not. Raising young families in the majority of foreign countries can be a frightening experience for new graduates, particularly if they are war-torn countries. Canadians nurses are people who prefer to live in peace, as do Americans.

There is a wide diversity of nursing experience offered to Canadian nurses interested in working in the United States. These experiences may not be available in Canada. This can make nursing in the United States, appealing to Canadian nurses.

The United States is a country that welcomes Canadian nurses, while other countries around the world are less receptive to nurses of different nationalities, who work in their countries. Feeling welcome in the country where nurses work is important. Canadian nurses are loved and treated with respect in the United States.

Many nurses have family members who are American citizens. Others may live or work in the United States and close contact with them is possible. Travel back and forth, from Canada to the United States is seldom an issue of concern for nurses. 

Most Canadian nurses have a high degree of knowledge about many parts of the United States.

Diversity of climate is another reason why many Canadian nurses seek to work in the United States. There is a wider range of weather and for those who prefer a warmer climate, moving to the United States, has distinct advantages in the winter months when there are extremely cold temperatures, in many parts of Canada.

There is a wide range of academic facilities in the United States. These offer a variety of nursing programs that may not be in Canada. Nurses seeking advanced education, can choose from a multiplicity of universities and colleges. Canadian nurses are always seeking to upgrade or advance their education, as are most nurses, worldwide.

The United States offers an open door to Canadian nurses. Thus, these are some of the reasons, why Canadian nurses might choose to move to the United States to work. For nurses who make that choice, Canada will always remain home to them. After all, Canadian nurses are still Canadians, at heart.

Nursing: Writing Opportunities at Helium

Registered nurses: Unite and write:

Helium is to be commended, as it is carving a unique, literary pathway by the introduction of a new ‘Certified Professional Nurse’ writer's badge for registered nurses.

Many registered nurses have advanced literary skills, as the result of many years of studying, in various fields of endeavor. Helium is introducing this new badge in 2009 AD, to encourage registered nurses everywhere to write and publish articles on their website, http://www.helium.com.

For many women and men, nursing is professional career that requires a lifetime of sincere dedication. A nurse's life style has to include continual education and upgrading. Many nurses acquire years of experience or accumulate high levels of professional expertise, through involvement with academic research.

Registered nurses receive little acknowledgment, recognition or financial remuneration for their work. Unfortunately, the efforts that they exert on behalf of others may go unnoticed.

The option of writing articles for Helium, presents a wonderful opportunity for registered nurses everywhere, particularly those who wish to share their knowledge or wisdom about nursing concerns with other registered nurses.

Many people around the world are seeking information on various health related topics or other issues of concern and interest. Do these articles have to be nursing related articles? Not necessarily. Registered nurses have a wide variety of interests.

Health involves many aspects of life which include the spiritual, mental, emotional and physical realms of people's lives. Healing, health, happiness and wholeness are vital areas of inquiry, with respect to human well being.

Health is not just about base survival, but basic survival. Basic survival, in many parts of the globe, is becoming increasingly difficult, particularly because of the current, global economic meltdown.

People need the information that nurses can share with them, even if it is sent to them via the Internet, through articles that have been written and published by nurses. One article has the potential of saving many lives. 

Nurses are essentially helpers and everyone stands in need of help, at one time or another in their lives.

Addressing global nursing concerns in nursing is important. Teaching the essential principles of heath to people, must be continually addressed by nurses everywhere, in every era.

Nurses demonstrate a love for humankind that far surpasses that found in many other careers or occupations. When people are in need of care, nurses are there for them, even though not always in the way that they expect or demand.

Young people everywhere always need a new source of inspiration. With more nurses, the world would be a better place.

All registered nurses who currently have valid certification are encouraged to submit articles to Helium. If you are a registered nurse, who likes to write articles, short stories or poetry, consider writing articles and publishing your work on Helium. You will be glad that you did.

Consider this a call to nurses everywhere. Registered nurses: Unite and write!

Nursing: Nursing Challenges in Poverty Stricken Areas

Nurses need to be aware: Challenges encountered in poverty stricken areas

Every country of the world has poverty-stricken areas. These present unique challenges to nurses, whether they are new graduates, experienced nurses dedicated to their profession or those trying to help others. 

Learning the root cause of poverty, in a specific location is crucial for nurses seeking employment there. A full awareness of existing problems is essential.

What are some of the leading causes of poverty?

Poverty can be the result of people living in an isolated location. Perhaps a village, town or city, is in a remote part of a country. This could be a mountainous region or a desert. It may be an outpost in the wilderness.

Sometimes poverty results from a high level of unemployment in an area, due to economic changes. Poverty can be the direct result of the closure of businesses that support people living in an area. For example, a mine or a mill might be closed.

Poverty occurs quickly, in parts of the world affected by natural disasters like floods, hurricanes or earthquakes. People, who are victims of war, are forced to flee for their lives. They may have to leave everything behind and many times, cannot return to their homes.

Poverty can be the result of people living an inappropriate lifestyle. This could be related to a high level of alcohol consumption or drug abuse. Over-population can lead to poverty linked to violence and crime.

People who live in poverty stricken areas need nursing care, perhaps more so than people in other areas. 

Some of the major challenges that confront registered nurses, who consider nursing in poverty stricken areas include the following:

Limited accessibility:

Many poverty stricken areas are inaccessible, while others may only be accessible, at certain times of the year. Numerous places can be reached only by traveling miles of treacherous highways, roadways or pathways. Some cannot be reached other than by air or water. Being able to access the location where nurses seek employment is essential. This may entail the use of different modes of transportation or require many hours of travel. Appropriate inquiry with respect to the accessibility of a poverty stricken area is always important.

Restricted or limited communication:

Many poverty stricken areas of the world have restricted or limited communication. This means that nurses choosing to work there, may be unable to access other medical professionals or medical resources. It can mean minimal contact with families and friends. Sometimes, there is no outside contact with anyone or it may be limited to communication by mail, radio, telephone or computer. When considering nursing in a poverty stricken area, the nurse should ascertain what methods of communication are available and what restrictions or limitations exist, with respect to various modes of communication, prior to consenting to accept employment.

Lack of medical facilities:

Many poverty stricken areas have no medical facilities or ones that are less than adequate. In extreme situations, there may be no hospitals or the existing ones fail to provide appropriate medical care.

Spending time doing serious research about existing medical facilities, in a poverty stricken area, is recommended. At times, nurses can be instrumental in helping to establish new medical facilities, in an area where they are needed.

Shortage of medical personnel:

Because the shortage of qualified medical professionals is a global problem, both doctors and registered nurses are needed, everywhere. Nurses may be forced to work alone or have to find other nurses in the vicinity. There may not be any doctors. Sometimes, the closest physicians are miles away. Nurses with extensive experience, may be able to function well on their own in this kind of a scenario. New graduates may have difficulty working without others to assist or advise them. It is a good idea to find out if there will be other medical personnel available, before going to any poverty stricken area.

Lack of medicine and medical supplies:

A poverty stricken area often has no medicine or other medical supplies, because the people living in the area are too poor to pay for them. Most remote areas have a shortage of medicine and medical supplies. Bringing them into an area may be difficult or impossible, particularly in times of bad weather, natural disasters or war. Nurses going to poverty stricken areas may be able to bring medicine and medical supplies, but not always. Sometimes, these can be obtained through donations from different organizations, in emergency situations. Awareness of what is available with regard to medicine and medical supplies, is essential.

Clean water problems:

Clean water is a serous concern for many poverty stricken areas. There is a tremendous need for good wells or a viable, clean water source. The water in many areas may have to be boiled, prior to human consumption. People living in poverty cannot afford to purchase bottled water. Digging wells can be costly. Before entering a poverty stricken zone, nurses must find out if clean water is available. Clean water is important for the health of the nurses, as well as for those living in the area. Nurses can assist poverty stricken communities to educate their people about the necessity of clean water or they may be able to help them obtain financial assistance from outside agencies with regard to establishing viable clean water sources.

Sanitation problems:

Many poverty stricken areas have poor sanitation, which invariably results in health related problems including illnesses or diseases. This may be a direct result of the lack of education. In order for nurses to function effectively in poverty stricken areas, their health must be a primary concern. Good sanitation is crucial with respect to everyone's health. Nurses are aware of this, but many people may not be, and thus, education may be a primary factor with regard to change for the better.

Food, clothing and housing issues:

Many people in poverty stricken areas lack the basic necessities for survival as they have no food, clothing or shelter. Their housing is inadequate, at best. Nurses going into poverty stricken areas require food, clothing and shelter, in order to survive. At times, even their needs are not adequately met in poverty stricken areas, particularly in disaster scenarios. Being aware of what is happening is important for nurses, as they can place their own lives in jeopardy by trying to help others.

These are just some of the major challenges that nurses must consider, when seeking employment in poverty stricken areas of the world. Nursing in any area is never easy and becomes more complicated when people live in poverty.

Coping with people can be difficult, as they can have high stress levels when they are living in poverty. There may be a sense of anger, hopelessness and utter despair. Nurses may become frustrated, discouraged and disillusioned, over time. It is not the same as nursing in a world where everything that nurses need to take care of their patients, is right at hand.

New graduates have high ideals with respect to their prospective careers. Many young nurses glamorize or romanticize nursing. Culture shock must be considered when new nurses leave well-ordered, nursing programs and hospital environments. For nurses, it is not always easy to go through the kind of adjustments necessary to work in poverty stricken areas.

In conclusion, one must suggest that many nurses are in a position to carve new pathways of life, as well as offer fresh hope and help for people, by entering into employment in poverty stricken areas, where they are so desperately needed.

Should nurses work in poverty stricken areas? Yes, but only if and when they are aware of the situation which they are entering into and are prepared to accept serious challenges.

What Does The Registered Nurse Shortage Mean for Home Care?

Home care nursing: A trend of the future

What does the registered nurse shortage mean for home care? This is a legitimate question and must not be ignored. The population of the world is growing in leaps and bounds with increasing numbers of people needing to be cared for at home, for many different reasons.

The registered nurse shortage means that in some instances, people are not going to be able to receive professional nursing care from registered nurses, at home. They may be forced to seek other, non-professional levels of nursing care. Some may need to find family members or friends able to care for them. Others will have to learn how to do their own nursing care. Others may not receive any care, which could prove to be a frightening experience.

When people are able to employ registered nurses for home care, they generally thrive.

Registered nurses have the training and experience that enables them to nurse people, who need to be cared for, in their own homes. When people are not able to obtain appropriate professional nursing care by registered nurses, the scenario becomes difficult. It may prove to be a life-threatening situation, depending upon the circumstances and the level of nursing care they require. Currently, there is a serious shortage of registered nurses, in home care, everywhere. 

What does all of this mean for the future of home care?

More critical care hospitals are sending patients home, as quickly as possible, because of bed shortages. Nursing homes are overflowing and so are other nursing care facilities. There is no place for patients to go other than to their own homes, the homes of others, hospices or shelters. Upon discharge, many patients require high levels of professional nursing care only administered by registered nurses. What are they to do? This is an area of serious concern that needs to be addressed.

The majority of people are not qualified to nurse others on a professional level, although they may nurse them on a non-professional level or assist them, in other ways. Many people know how to do basic nursing care, but may not realize that they have that knowledge. Some people who need nursing care, try to take on the responsibility for their own care. Many people are not able to take care of themselves properly..

Registered nurses are in high demand for home care. Currently, that demand is not being met. Unless changes are made now, the demands for professional nursing care will not be met in the future, either. The shortage of registered nurses will continue to grow. Standards of home care and levels of home nursing care will decline.

Why is there such a shortage of registered nurses for home care? In reality, there is a shortage of registered nurses everywhere, not just in home care. One reason for the serious shortage of registered nurses involves the lack of government funding for registered nurse education. In many educational facilities, there is a lack of interest in training registered nurses, because non-health related, educational programs are taking precedence to nursing programs.

Educational needs can take priority over health care needs. The majority of nursing programs have been relegated to colleges and universities, in lieu of hospitals. While taking nursing programs, prospective, registered nurses are placed in various, hospital settings, nursing homes and agencies to gain hands-on nursing experience. In terms of the allotment of funding, the academic facilities may take precedence over the health care facilities.

Funding for training registered nurses, should be based upon actual, health care needs, not just education or health care. In many countries, there is a lack of educational facilities to train registered nurses and a shortage of health care facilities. Neither education nor health care are taken into consideration. This can prove to be a tragic scenario. It becomes increasingly obvious that it is not just patients in need of home care who suffer because of the shortage of registered nurses.

What can be done about the shortage of nurses for home care?

In terms of government funding, maintaining a healthy balance between education and health care is vital. If people are educated in other fields, but are not given proper health care education or health care because of a shortage of registered nurses, this could result in serious, long term, health problems or health related crisis situations, in various parts of the world.

Training more registered nurses, must be regarded as a priority in the realm of education, as well as in the health care field. Additional levels of non-professional, home care education may need to be introduced. More people should be trained to become non-professional home caregivers.

It may be possible to determine and establish a global, home care criterion that designates an appropriate ratio of registered nurses per capita, specifically for home care. There could be a percentage of registered nurses designated for home care, based upon the population of an area. If that number is not met in a certain area, requests or demands could be made for the training of more registered nurses.

Registered nurses are educators, able to teach and train others to do many nursing treatments and procedures. Additional courses in education and health care could be introduced, for that purpose. Registered nurses need to be encouraged to teach and train others for home care. Many of their tasks could be taken over by non-professional caregivers, including family members. This would help to reduce the current home care work load being carried by registered nurses. People everywhere should be encouraged to learn more basic, home care nursing skills. Community, school or high school programs could be established around the world, for this purpose.

In conclusion, there is a shortage of registered nurses and home care is adversely affected by that shortage. Advancing education and health care education is crucial, but a healthy balance must be maintained between the two. One cannot take precedence over the other. Home care by registered nurses should be evaluated and assessed on a per capita basis, based on health care needs.

Home care nursing is the trend of the future, so more people need to learn basic home care nursing, so that people everywhere are cared for properly, in their homes. It is everyone's responsibility, not just that of registered nurses.

The shortage of registered nurses will continue to affect home care, but the insistence on maintaining professional standards of nursing care in people's homes is vital. Where professional care cannot be obtained due to shortages of registered nurses, non-professionals should be trained, under the guidance of registered nurses. Registered nurses can educate more people to become non-professional home care givers on various levels. 

Increased home care nursing, should be welcomed as a new trend of the future.

What is the Future of Palliative Care Nursing?

An open door for palliative care nursing

The future of palliative care nursing is a relevant question for registered nurses, especially for those newly trained and beginning their careers during difficult economic times. To respond to the question appropriately, be aware of what palliative care nursing entails.

What is palliative care?

The word palliate originated in the year 1588 AD, with the Latin word pallium, meaning to cloak or to conceal. In medical terms, palliation refers to the moderation or abatement of the intensity of a disease or illness, as its severity is reduced. (1)

Palliative care nursing is nursing care administered to terminally ill patients in hospitals, nursing homes, private homes and hostels. Palliative care nurses are trained to take care of dying patients, in a way that relieves them of their symptoms, as much as possible, when it becomes evident that an illness or disease cannot be cured. For many terminally ill patients, this entails long term nursing care.

If there is just one word that is used to describe palliative care nursing, it is compassion. Terminally ill or dying patients are kept as comfortable as possible, through nursing care, concern and compassion of palliative care nurses, who are highly specialized and able to provide advanced levels of professional care for their patients.

Some registered nurses take specific courses in palliative care nursing. Many have previous experience in doctor's offices, private duty nursing or one-to-one care. Others come from medical or surgical nursing backgrounds. Palliative care nurses have a high degree of expertise in specialty areas like emergency, intensive care or step-down units. Some palliative care nurses are highly specialized in pediatric palliative care.

Palliative care nurses frequently enroll in university or college courses, like death and dying, religious studies or philosophy. Questions related to death and dying are important to terminally ill patients, regardless of their background or culture. Each culture has its own unique understanding of topics like the meaning of life and death, how to prepare for death, what happens at the time of death or when a person passes away. Many palliative care nurses minister to dying patients with regard to their spiritual needs.

A large majority of palliative care patients are cancer patients. This means that they may have to undergo surgery, chemotherapy, radiation or other medical treatments. The physicians, palliative care nurses and other care givers, work together as palliative care teams.

Many palliative nurses have training as professional counselors. Counseling skills are needed for palliative care nursing, as patients and family members have difficulty coping with terminal illness or the remission of an illness. What happens when a patient and his or her family expect the patient to die and then the patient lives? This can happen.

Often palliative care patients require special medications, treatments or procedures. Palliative care nurses administer medication regularly to people in severe pain. Medication may be by intravenous therapy, injections, sublingual, dermal, oral or rectal administration. Narcotics are also given. Patients may become addicted to them or other kinds of painkillers and thus, drug addiction counseling is needed.

Many palliative care patients are frightened by the treatments and procedures that they have to undergo. Many are too ill to live and yet, they are afraid to die. Many dying patients cling desperately to life, even while they watch their lives slipping away. They realize their inability to control what is happening in their lives.

Dying patients may find that their families are not supportive. There are mixed feelings of hopelessness and helplessness. Palliative care nurses assist patients and families to cope with these kinds of scenarios. Patients experience mood swings and depression, as a result of transitions in inter-personal relationships. Registered nurses, assuming the responsibility for the care of palliative patients, assist them and their families in numerous ways.

Many times, terminal illness involves serious financial concerns or legal matters. Long term nursing care is costly and ongoing financial assistance is often required. Legal counsel may be needed to resolve non-nursing issues like power of attorney, wills or estate settlements. Palliative care nurses assist patients and families to obtain proper assistance.

For younger nurses, who are seeking direction in their nursing careers, palliative care nursing is a legitimate pathway to pursue. Palliative care nursing can be difficult for young nurses emotionally, as they tend to be idealistic and have the expectation of having the patients they care for, live and not die. Coping with death and dying is never easy for any nurses, but death is a reality that must be dealt with in palliative care nursing.

Obtaining experience in multiple areas of nursing, before specializing in palliative care nursing is a good idea for new nurses. The expectations and demands on nurses are extremely high, particularly when the terminally ill patients are cared for at home. Palliative care nurses often have to work alone without the guidance, support or assistance of other nurses. Palliative care is a more realistic direction for older, more experienced registered nurses.

Many palliative care nurses relate well to people and love their patients. Palliative care patients and their families can become dependent on their nurses and become attached to them, because of the high levels of compassion and concern they demonstrate. Palliative care nurses focus on quality care nursing and are excellent nurses with outstanding inter-personal relationship skills.

Many families are appreciative of palliative care nurses, but there may be instances where fear, anger and frustration are projected onto palliative care nurses. People perceive nurses as being able to save the lives of others, but unfortunately that is not always possible. Some people do not comprehend or appreciate the kind of care that palliative care nurses give. Patients or family members may refuse treatments recommended by physicians, as well as the care given by palliative care nurses, because of utter despair.

What is the future of palliative care nurses?

In conclusion, one must suggest that palliative care nurses are needed, because people will always require compassion, concern and quality nursing care, when they are terminally ill. More palliative care nurses should be trained, in the future. The horizon for palliative care nursing is wide open for registered nurses, who choose to pursue this direction in nursing.

(1) Webster's Ninth Collegiate Dictionary, Merriam-Webster Inc., Springfield, Mass., 1983

Nursing: What is the Future of Doctor's Office Nursing?

Doctor's office nursing: An expanding horizon

"What is the future of doctor's office nursing?" is a timely question, for this era. Responding involves taking a close look at the changing roles and responsibilities of registered nurses working with doctors, in their offices.

Doctor's office nursing offers a rapidly expanding horizon of employment for prospective registered nurses, for a number of different reasons. The health care field is constantly growing and changing. The population of the world is exploding and there is a marked shortage of health care professionals, on every level.

There is already a shortage of practicing doctors in every country of the world. There are not enough doctors being trained to meet the future demands of global health care.

A cry for help resounds around the world.

"If not doctors, then who will provide our health care? Is there anyone able to meet that need? Who can fill the gap in our health care system?"

"Will this demand have to be met by nurse practitioners and registered nurses?"

It would appear that nurse practitioners and other registered nurses, as health care professionals, will be called to help meet the increasing demand for global health care, in the near future. There will be a need for more doctors' office nurses and the future of doctor's office nursing is assured.

Registered nurses have always had an open door for employment in the majority of doctor's offices. Not all doctors require registered nurses, but registered nurses have always worked in conjunction with doctors in their offices in many areas of health care, all around the world. This will continue as a trend into the future.

On the whole, working in doctor's offices can be a rewarding and a wonderful experience for registered nurses. It can be a demanding job intellectually, emotionally, spiritually and physically. Registered nurses employed in doctor's offices may experience fear or frustration and have feelings of helplessness, because the needs of people are not being met, in many parts of the world.

Take this one step further in a positive direction.

Registered nurses are currently required to obtain higher levels of nursing education than has ever been demanded previously. In the past, many registered nurses attained nursing diplomas from various schools of nursing. Gradually, these schools of nursing have been phased out, in lieu of higher nursing education, on a college or a university level.

Registered nurses with advanced education, experience and training have always been employed in numerous areas of extended health care under the guidance of doctors. In many instances, the doctors assessed the skills, experience and level of expertise of registered nurses. They decided what the registered nurses were qualified to do. If necessary, the nurses received further training.

As an example consider the role of mid-wives.

Often, the qualifications of registered nurses employed as midwives were subject to scrutiny and severe criticism, by others in the medical profession. Midwives were not regarded as having attained sufficient medical training to assume the role of doctors with regard to maternity care and the delivery or care of new born babies.

As a result of this controversial issue and other questions about what registered nurses could and should be allowed to do, registered nurses began to seek additional training. They recognized the feasibility of establishing a new category of registered nurses, called nurse practitioners.

The official recognition of registered nurses as nurse practitioners, took place in 1965. These nurse practitioners were highly educated registered nurses with Master's degrees. Increased educational opportunities in nursing have allowed the role of the professional nurse practitioner to expand even further. Today, this field is broader in scope.

How does this fit into the picture with respect to the future of doctor's office nursing? The horizon of nursing in doctor's offices is expanding, but probably not in the way that many people expected to see it happen. In the future, there will be room for registered nurses to work in doctor's offices. Many registered nurses will more than likely go that route. A more advanced horizon awaits registered nurses with the desire to seek higher levels of nursing education.

For those undergoing training as registered nurses now, rather than do that, why not become nurse practitioners? Certification and licensure as professional nurse practitioners, enables registered nurses to work on an entirely different level with doctors.

For new registered nurses, seeking future employment in doctor's offices is a valid option, but attaining a higher level of nursing education enables the same registered nurses to be employed as nurse practitioners.

The opportunity is there for both women and men, who demonstrate the interest, courage, commitment and dedication to pursue that career option.

Doctor's office nursing demands registered nurses with a high level of interpersonal relationships skills, as there is continuous interaction with patients. Registered nurses have to love people to thrive in this work environment. They meet and greet dozens of people during the course of a day. They must have a high level of concern and compassion, coupled with high standards of nursing care. Quality nursing care is important in doctors' offices because these offices set an example for communities. Doctor's office nursing demands a high level of energy from registered nurses because of the rapid turnover of patients. Seeing new patients every five to ten minutes for hours at a time, entails a lot of work. Good organizational skills are needed by registered nurses, as each patient has unique, health care needs that must be met in the doctor's offices. For example, in a family practice office, the registered nurse may be taking blood pressures, doing dressings, giving injections and doing well baby care or a collection of medical tests, treatments or procedures.

If the doctor's offices are highly specialized, more advanced skills may have to be acquired by registered nurses, in order to assist the doctors. Even a variety of lab skills may be needed, if there are no laboratory facilities available.

In a doctor's office, telephone and office skills are vital, as registered nurses replace receptionists or 

clerks who book appointments, file various kinds of medical reports or other clerical work.

There are continual changes in the field of medicine and registered nurses must stay current with regard to what is happening. Medications, procedures and treatments are always in a state of transition and registered nurses discuss these with patients. Sometimes patients need teaching, counseling, guidance or reassurance.

Good communication skills are vital, as appointments have to be booked with other doctors. Staff 

scheduling, bookkeeping and payroll issues may be part of their job. There are times when registered nurses assist in the orientation and training of new doctors.

Computer technology is enhancing doctor's office work for registered nurses, everywhere in the world. Continual technological advances in computer require ongoing training for everyone, so this may also become the task of registered nurses in doctor's offices.

For those registered nurses who are seeking future employment in doctor's office settings, placement in a doctor's office, while in training, is an option to consider.

Working in a doctor's office can be an excellent learning experience for registered nurses, but for those seeking to go beyond that experience, there is a rapidly expanding horizon of discovery, with increasing challenges for registered nurses as nurse practitioners, on a global level. Consider it a challenge of our time.