Current trends and issues in nursing management- part1

Journal Published: August 14, 2014

Nursing is an art and a science. Nursing is the oldest of arts and youngest of professions. The
heritage of nursing includes the successes, advances and units as well as failures, regressions and
conflicts. Nursing was distinguished in its early history as a form of community services was
originally related to strong instinct to preserve and protect the family. Modern nursing involves
many activities, concepts and skills related to basic and social sciences, growth and development.
The opportunities for a nursing career are limitless. Nursing has its own identity as profession it
is no longer considered as a paramedical science. The issues of nursing profession were
identified by various earlier health committees constituted by the union government. There are
many issues occurring in nursing management. These were the obstacles to provide proper
nursing services to the patients and public at large and off course to the upliftment of the nursing
profession at large.
TRENDS
It is defined as the general direction in which something tends to move. Or it is a general
tendency or inclination or current style.
Trend is the event that occurs overtime and shows a series of fluctuation in its patterns.
(Stanhope Lancaster )
Nursing trends
It is the general direction towards which the different nursing events have moved and are
moving, as well as the opinions in and about our profession.
ISSUE
A point or matter of discussion, debate, or dispute or a matter of public concern. It can also be
defined as:
 A misgiving, objection, or complaint
 The essential point; crux
 A culminating point leading to a decision
FACTORS AFFECTING CURRENT NURSING TRENDS
Following are the international trends in nursing profession
o Health needs of society
o Awareness of health needs of the society
o Economic conditions – if money is available to pay for nursing service
o New developments in medicine
o New knowledge and procedures developed through research in science
o Need for specialization in medicine and nursing
o Opportunities for services and education abroad
o Changes in nursing education and the role of nursing student
o Increased industrialization
o Expansion of community health services
o Govt. support programmes
o Increased number of private nursing homes, private hospitals
o Necessary military services
o Development of nursing research
TRENDS IN NURSING MANAGEMENT
1. Changing Demographics and Increasing Diversity
2. The Technological Explosion
3. Globalization of the World’s Economy and Society
4. The Era of the Educated Consumer, Alternative Therapies and Genomics
5. Quality assurance in nursing care
6. Decentralised approach to care management
7. Interdisciplinary Education for Collaborative Practice
8. The Current Nursing Shortage/Opportunities for Lifelong Learning and Workforce
Development
9. Continuing nursing education
10. Evidence based practice
11. Nursing audits
12. Collective bargaining
13. Incentives for the health care professionals
14. Trend in span of authority
1. Changing Demographics and Increasing Diversity
With advances in public health and clinical care the average life span is increasing rapidly.
This poses a challenge the health care system’s ability to provide efficient and effective
continuing care. There is a significant increase in the diversity of the population which affects
the nature and the prevalence of illness and disease, requiring changes in practice that reflect and
respect diverse values and beliefs. Disparities in morbidity, mortality, and access to care among
population sectors have increased, even as socioeconomic and other factors have led to increased
violence and substance abuse. Ethnic and racial diversity of nursing institutes has increased
dramatically, creating a rich cultural environment for learning. Older aged students bring varying
college and work experiences, as well as more sophisticated expectations for their education.
Nursing practice, education, and research embraced and responded to these changing
demographics. Nurses are now focusing on spiritual health, as well as the physical and
psychosocial health of the population. Nurses must focus on spiritual health, as well as the
physical and psychosocial health of the population. There are preparations to confront the
challenges associated with today’s more mature student body, educational methods and policies,
curriculum, and clinical practice settings. Research priorities need to value and reflect the
diversity of the student body, as well as the population in general.
2. The Technological Explosion
There is reduction in distance through speedy communication. Advances in digital technology
have increased the applications of tele-health and telemedicine mobiles, e-line, video
conferences, bringing together patient and provider without physical proximity.
Nanotechnology is a new form of clinical diagnosis and treatment, which is capable of detecting
a wide range of diseases from very minute specimens. There is computerization for patient care
management. Easy reference on directions for patient care, record keeping, reporting,
compilation of information, stock monitoring, auditing are some of the functions which
computers have taken over ability to use computers for patient care management have become
essential qualification for nurses. Accessibility of clinical data across settings and time has
improved both outcomes and care management. Electronic recording replace traditional
documentation systems. Through the Internet, consumers will be increasingly armed with
information previously available only to clinicians. Electronic commerce will become routine for
transacting health care services and products. Nurses of the 21st century need to be skilled in the
use of computer technology. There is growing evidence of distance learning modalities for
continuing professional education, for e.g IGNOU is offering number of speciality courses. Even
in nursing education technically sophisticated preclinical simulation laboratories will stimulate
critical thinking and skill acquisition in a safe and user-friendly environment. Faster and more
flexible access to data and new means of observation and communication are having an impact
on how nursing research is conducted.

3. Globalization of the World’s Economy and Society

With the “death of distance” in the spread of disease and the delivery of health care, posing both
extraordinary risks and benefits. Now there is potential for rapid disease transmission & potential
for dramatic improvements in health due to knowledge transfer between cultures and health care
systems. Nursing science needs to address health care issues, such as emerging and remerging
infections, that result from globalization. Nursing education and research must become more
internationally focused to disseminate information and benefit from the multicultural experience.
4. The Era of the Educated Consumer, Alternative Therapies and Genomics
Patient is a well-informed consumer – expects to participate in decisions affecting personal and
family health care. Previously unavailable information is now public information. Technological
advances in the treatment of disease have led to the need for ethical, informed decision making
by patients and families. People have knowledge about health promotion as well as disease
prevention and also there is an increased acceptance and demand for alternative and
complementary health options. The increased power of the consumer creates a heightened
demand for more sophisticated health education techniques. Voracious demand for alternative
therapies has begun to influence mainstream health care delivery. Increasingly, major health
systems are seeking ways to provide both, Western medicine as well as alternative therapies to
their patients. Alternative Therapies holds both promise and peril. Although it may unlock
behavioral and spiritual components of health and healing, risks of consumer fraud, therapeutic
conflict, and patient noncompliance are real. Increase in gene mapping will drive rapid advances
in the development of new drugs and the treatment and prevention of disease. Nursing research
has the potential to enhance knowledge regarding what constitutes a “healing” therapy. Nursing
education and practice must expand to include the implications of the emerging therapies from
both genetic research and alternative medicine, while managing ethical conflicts and questions.
5. Quality assurance in nursing care
Public knows their rights, human rights, commissions , protection acts and process etc, are
putting constant pressures on the professionals to deliver their best. Professionals cannot ignore
or be careless in discharging duties especially when it concerns people lives and health .Nurse
managers have to ensure delivery of quality care by practicing as per standards laid down by
their counsels and institutions.
6. Decentralised approach to care management
This makes each and every nurse responsible and accountable for the care of assigned patients
.This approach is found applicable and effective in terms of patients satisfaction, quality care and
smooth functioning of the units.The trend in span of authority appears to be towards large
numbers. This is not the result of efforts to increase the span but rather to reduce the number of
organizational levels for a given structure. Too many organizational levels impede
communication. This forces the executive to select subordinates with good potential or proven
executive ability.
7. Interdisciplinary Education for Collaborative Practice
There is a need for coordinated care and a significant increase in the use of midlevel providers,
such as ANPs, as part of the health care team. There is an increased collaboration between
nursing practice and nursing education.Team-based, interdisciplinary approaches are highly
effective for improving clinical outcomes and reducing cost. There is a growing need of teaching
methods that incorporate opportunities for interdisciplinary education and collaborative
practice.Now a days there is increased emphasis on collaboration between healthcare disciplines.
Also there is increased student and nurse mobility (including increased licensure
mobility),increased distance (online) learning. Schools of nursing providing ongoing
professional development for competence requirements. Also there is an increased teaching of
evidence-based practice.
8. The Current Nursing Shortage, Opportunities for Lifelong Learning and Workforce
Development
There is significant nursing manpower shortage both in acute and long-term care settings. That
results from many factors such as :
–nurses of the “baby boom” generation are beginning to retire.
–women today have numerous career opportunities; and
–perception of nursing as a “trade,” versus a “profession,” contributes to the lack of individuals.
As the age of entering students rises, the number of years of practice decreases also affects
supply. While the number of male and minority students has been steadily rising, their ranks are
still underrepresented. Workforce Development is a positive recent advances which includes the
opportunity to practice in a variety of clinical settings has resulted in dramatic increase in
opportunities for ANP`S, new careers in care management and case management. There is an
increasing interest in biotechnology, information technology, and pharmaceutical companies in
hiring skilled nursing professionals.Occupation attracted more women of superior class.Nursing
training in regional languages also started.There different levels of education –graduate, post
graduate & doctoral levels.
Continuing & in-service education is introduced for the working nurses.Nursing education must
partner with the health care industry to develop innovative short and long-term solutions that
address the nursing shortage, including aggressive student recruitment and the initiation of an
intense media/marketing campaign. The public image of the nursing role must be revitalized to
change outdated perceptions.

The image of nursing has always been one of dedication, service to the patient, and selflessness.
Now as nursing profession, the issue of collective bargaining has become more important.
Collective bargaining is the uniting of the employees for the purpose of increasing their ability to
influence their employer and to improve the working conditions. Collective bargaining is based
on the principle that there is greater strength in large numbers. The nurses who have joined
nursing unions have increased. Nursing practices have often been defined and controlled by other
groups also such as physician and hospital administrators. These groups saw the potential power
of an organized large group of well educated and dedicated nurses and feared the time when they
would become independent. Even though , in area of the country where collective bargaining of
health care workers is not the part of the system, many hospital administrators react to any
unionization attempts on the part of nurses with hostility and resistance.

Concept of supportive supervision is coming up. Supportive supervision is a process that

promotes quality at all levels of the health system by strengthening relationships within the
system, focusing on the resolution of problems, and helping to optimize the allocation of
resources. It focuses on problem solving on the spot with the joint participation of the supervisee
and supervisor.
Financial incentives are integral to the employment contract. It has been quoted in a study by
Hongoro and Normand that at least half of the variation in turnover can be attributed to financial
incentives. Now a day there is rise in performance linked payments. In one country in
Africa,Nurses and officials posted in remote health facilities in areas of high HIV prevalence are
given a 31% bonus if they stay on for more then 3 years. Also non financial incentives are also
been introduced into the work place as it has been seen that financial incentives are not enough
to motivate the employees e.g of non financial incentives are as follows:
 Career and professional development (inservice education programmes, study leave)
 Workload management
 Overtime payments
 Letter of appreciation to the good worker or for their extraordinary performance(best nurse
award)
 Flexible working arrangements
 Positive working environment
 Access to benefits and support(Child care leave, housing loan, Earned leave )
9. Continuing nursing education
It has become essential to keep up with the changing needs of patient care. Nurses have to
continuously update themselves with new and innovative approaches in patient care
management. For this they should enable themselves with workshops, seminars, short term
training programmes, attend conferences, make use of library, subscribe and read periodicals and
books. Discussion on bedside and supportive supervision helps to keep abreast with newer
techniques and information.

10. Evidence based practice

There has been a significant Advancement in Nursing Science and Research. The growing body
of nursing research provides a scientific basis for patient care and should be regularly used by the
nurses. Most studies concern health behaviors, symptom management, & improvement of
patients’ and families’ experiences with illness, treatment, and disease prevention. There is lack
in focus on the scholarship and science of nursing as top priorities. Doctorally prepared nursing
professionals are not being produced in large enough numbers to meet the growing need. There
is need for enhanced mentorship for new researchers to strengthen skills and capacity to conduct
meaningful nursing research.

11. Nursing audits

A careful review of nursing care and its effectiveness is done by the administrators of nursing
services. Not only clinical improvements but also emotional aspects of the patient need to be
measured to decide the quality of nursing care given.

12. Collective bargaining

The image of nursing has always been one of dedication, service to the patient, and
selflessness. Now as nursing profession, the issue of collective bargaining has become more
important. Collective bargaining is the uniting of the employees for the pupose of
increasing their ability to influence their employer and to improve the working conditions.
Collective bargaining is based on the principle that there is greater strength in large
numbers. The nurses who have joined nursing unions have increased. Nursing practices
have often been defined and controlled by other groups also such as physician and hospital
administrators. These groups saw the potential power of an organized large group of well
educated and dedicated nurses and feared the time when they would become independent.
Even though , in area of the country where collective bargaining of health care workers is
not the part of the system, many hospital admISSUES IN NURSING ADMINISTRATION,
NURSING PRACTICE AND , NURSING EDUCATION
ISSUES IN NURSING PRACTICE
 Status of nursing in society in the health care delivery system.
 Renewal of nursing registration
 Diploma Vs degree in nursing for registration to practice nursing
 Nursing care standards
 Values reflected in our nursing performances.
 Attitude, human approach.
 Higher education for senior positions in nursing
 Nurse patient ratio
 Different levels of nurses that we need in our country.
 Quality in nursing v/s education and practice.
 Define and delineation of nursing functions at the different level.
 Non availability of health care programme of nurses.
 Non involvement of nurses in nursing matters.
 Poor pay structures.
 Many hospitals in India had no nurses at all.
 Lack of security and safety.
 Less promotional opportunities
 Harassment by other personnels
 Inadequate supplies
 INC has put forward the purposal to review nurse’s cadre to the health ministry.
 There are number of ethical issues related to nursing practice. By very nature of ethical
dilemma,there can never be one correct solution. Still there are number of ethical issues that
nurses are facing today for eg. Don`t resuscitate orders, Starting and withdrawing life support
system, need to disclosure HIV positive status to his wife against his wishes.

ISSUES IN NURSING EDUCATION

 Nursing Training schools multiplied.
 Lack of independent building for schools and colleges
 Lack of independent principal for schools and colleges
 Inadequate hostel facilities for students
 Shortage of qualified teachers in nursing
 Inadequate library facilities
 No UGC pay scales for college teachers in nursing
 Very less or no stipend for nursing students
 Less supply of A.V. aids
 Less promotional opportunities for teachers of both schools and colleges
 Insufficient efforts to prepare nurses for the job they are accepted to perform in their work
field in terms of appropriate skills, knowledge and right attitude and the desired behaviour
patterns reflecting the values for caring.

ISSUES IN NURSING ADMINISTRATION

Nursing as a profession has flourished from the time of Florance nightingale till present day
nursing. At some levels in nursing, the question of professionalism takes on immense
significance. However, to the busy staff nurse- who is trying to allocate client assignment for a
shift , distribute the medications at 9am to 24 clients ;and supervises ward aide, nursing students-
the issue may not seem very significant at all. There are number of issues related to the nursing
administration few of them are as follows:
 One of the concerns that plagued nurses and nursing almost from its development as a
separate health care speciality is the relatively large amount of personal responsibility
shouldered by nurses combined with a relatively small amount of control over their practice.
 Non involvement of nursing administrators in planning and decision making in hospital
administration
 Lack of knowledge in management among nursing administrators
 Interference of non nursing personnel in nursing administration
 No written nursing policies or manuals
 No proper job description for various nursing cadres.
 No organized staff development programs for nurses like orientation, in-service education,
continuing education etc.
 No special incentives
 Inefficiency of nursing councils of state and union to maintain standards in nursing

Conclusion: It has been rightly said “The Decisions that you make and the actions that you
take upon the earth are the means by which you evolve.” By demonstrating their knowledge
in nursing practice , education and administration nurses can demonstrate their expert power.
This knowledge may increase the amount of respect that they are given by physicians and the
society as such along with personal professional satisfaction.
“Today’s issues are tomorrow’s trends”
.