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One Take on the Top 10 Issues Facing Nursing

Excerpts of this article are from Shawn Kennedy, MA, RN, Editor-in-Chief for the American Journal of Nursing

At the most recent Sigma Theta Tau International (STTI) biennial meeting in Gaylord Texas, there was a seminar and discussion of the top 10 issues facing nursing, led by STTI’s publications director Renee Wilmeth. The issues were compiled from responses provided by 30 nursing leaders, and were presented in question form:

1) Is evidence-based practice (EBP) helpful or harmful? (Amazing how many interpretations there were of EBP, some of them—as I know from our EBP series—quite incorrect.)
2) What is the long-term impact of technology on nursing?
3) Can we all agree that a bachelor’s degree should be the minimum level for entry into practice? (General agreement here, despite concerns regarding the adequacy of financial support for achieving this goal.)
4) DNP vs PhD: separate but equal? (Not much discussion—I think no one wanted to really get into this.)
5) How do nurses get a seat at the policy table?
6) How do nurses cope with the growing ethical demands of practice? (This generated the most discussion, especially around whether society should provide unlimited costly care to those whose personal choices contribute to their health problems.)
7) How do we fix the workplace culture of nursing?
8) What role do nurse leaders play in the profession?
9) What are we doing about the widening workforce age gap?
10) How do we make the profession as diverse as the population for whom it cares?

What do you think? Would you agree that these are the ‘top 10’ issues? What’s missing? What’s here that shouldn’t be? We would love to hear your opinions, please share them here.


Well, I agree with 5, 7, 8, 9, and 10. I would rank them in importance as: 
8, 7, 5 9, 10. 
I notice that staffing ratios are not mentioned, and yet this is the number 1 issue for bedside nurses. 
My question would be- if we do not address the priorities of working nurses, how do we expect to empower or organizations to get a seat at the policy table? 
The BSN entry is a fallacy- too few schools to provide the number of nurses we need, and too few faculty as well. 
Let's get our "work units" empowered, and THEN we can start making long term changes such as the BSN entry. 
As for nursing "leaders", it constantly amazes me how few leaders bedside nurses can name. Seems there are none for them.
Posted @ Tuesday, November 08, 2011 2:14 PM by Dr. John Silver RN
ADN or BSN? Why is there such a huge debate we all have to pass the same test to get your license. Plus a nurs gains must of there knowledge and ability on the job. I've seen LPN's that knew more and were better nurses then a nurse with a BSN. We are all nurses, we all got into this careers to help people so lets stop fighting over stuff like this and focus on how we can better serve the people that are in our care.
Posted @ Wednesday, November 09, 2011 6:43 AM by
Thanks for the thoughtful comments on this article. We figured this would spur some rigorous debate. Please continue to offer additional thoughts as this list could grow as evidenced by Dr. Silver's comment about staffing ratios. This is an important topic and we may try to do a follow up to this in one of our upcoming eNewsletters.
Posted @ Wednesday, November 09, 2011 9:16 AM by Phoebe Taylor
The growing number of elderly people worldwide with complex medical conditions and chronic diseases will had a significant impact on nursing education and practice. Therfore, I believe that all nursing schools curriculums should be changed to meet the demands we will face with an increase in the number of elderly persons to care for. Nurses will need enhanced skills to meet the growing healthcare demands of older patients. I think that the requirements in baccalaureate programs should include Psychiatric, Medical/Surgical, Community Health, Gerontology, and a choice between Maternity and Pediatrics. Most nurses never practice in the maternity or pediatric nursing areas. Nor is their knowledge kept up- to- date to be used even in casual conversation with those dealing with problems in these areas if they do not work in these areas.  
The growing number of elderly persons is also a major concern causing gerontology content to be added to some nursing programs. In light of this demographic shift, 25% of nursing programs now offer courses in gerontology. Several are also considering making gerontology one of the speciality areas of study. It is the general knowledge in the profession that nurses will be more likely to encounter geriatric clients after graduation rather than a psychiatric, maternity or pediatrics client. Stand alone courses in geriatrics are very important in helping students to understand the importance of geriatric nursing by placing a value on the topic of gerontology (Morris & Eliadi, 2011).  
Years ago, I informally proposed that gerontology be added in the health care reform discussion as away to decrease the burden of healthcare cost. Nurses unprepared to care for geriatric clients are costly to the work place in several ways. Nurses inexperienced in working with the older clients become frustrated on the job and are responsible for the large number of turnovers in the long term care facilities. They also are not able to assess their conditions appropriately causing a large number of hospital admissions. Geriatric clients cared for inappropriately in acute care setting contributes to also increase healthcare cost. A good example of this is an elderly disabled person’s development of decubiti ulcers during hospital stays.  
Morris, K., Eliadi, C.(2011). Are Changing Demographics Influencing the Trend of Nursing Curricula in Massachusetts BSN Programs? RN Journal. Retrieved from 
Posted @ Wednesday, November 09, 2011 3:38 PM by Debra Powell
#7, #8 and #10 Are All Related  
It is the managers who create the work environment. Most of them are responsible for hiring the nurses who work on their units and can definitely take steps to improve negative behaviors that determine the culture. I would go on to say that the mangers are the individuals that have the most influence on nursing’s ability to resolve many of these issues. 
I also believe that mangers across the board should be required to inservices yearly on the overall issues and goals in the profession and the nursing leadership’s strategic plans to solve the problems that we face. Their hiring practitioners are too restrictive for person deemed qualified to practice. Experienced nurses should be allowed to change speciality areas and to gain expertise in two areas. It would particularly true in rural and less populated areas. For example, it is depressing to think of a nurse who went to nursing school because she wanted to work in the nursery but since no opening existed took a job in an unrelated area. Now after working there for years is denied the chance to work in the nursery because she has no work experience in the area and instead a new graduate is given the position. I managers were more lienant in their hiring practices, it would serve to motivate and excite nurses. Many of those who retire after being burnt out in working certain areas, I believe would return. I also do not believe that liency in hiring when it comes to RNs is a show of irresponsibility in hiring.  
This would be a great help towards alleviating the nursing shortage and add to the numbers. Managers need to see that keeping all nurses actively engaged is a necessity and means “fewer deaths, lower-failure to rescue incidents, lower rates of infection, and shorter hospital stays. These problems are not only increasing work loads but also health care expenditures. 
Posted @ Wednesday, November 09, 2011 3:52 PM by Debra Powell
We always think what issues facing the nursing profession but in the top of that we should consider the caring part of the profession and how to bring it to the forefront.Our clients are always complain of the level of caring especially direct care
Posted @ Saturday, November 12, 2011 1:17 AM by Daad Shokeh
I am disappointed to see that out of ten, only one had anything remotely related directly to patient care. Top concern should be nurse-to-patient ratio. Patient care is compromised with too few nurses.
Posted @ Tuesday, April 03, 2012 11:18 AM by Nancy
Staffing ratios, staffing ratios, staffing ratios. 
THIS is the dominant topic for bedside nurses, and not just here in the U.S.. The recent MEDSCAPE poll of 20,000 nurses from around the world also show this to be true. 
Sadly, nursing administration has only limited influence in determining these ratios.
Posted @ Tuesday, April 03, 2012 1:38 PM by John Silver PhD RN
Missing! Patient Centered Care. The majority of floor nurses work in hospitals, home health, and hospice. Every time a hospital along with governing agencies seets out new guidelines and goals the administrators of the hospital develop the strategies and the tactical responsibilities lye on RN’s. RN’s have two roles: Independent, oversight and general care of the patient coupled with countless and repetative paperwork generated either technology or the old fashion way (leaving the nurse to basicaly document by exception because their isn’t time to document appropriately)–The second role is dependent, carrying out Physician orders
Posted @ Wednesday, June 26, 2013 3:48 AM by asim
I agree with most but with "1" I think it is helpful although it might delay actions, they are top issues in addition to workforce issues and scope of practice
Posted @ Wednesday, June 26, 2013 5:05 AM by Daad Shokeh
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