Nursing: no greater calling

1 September 2012

Sharon Myoji Schnare, a United States-based family and women’s health nurse practitioner addressed the recent primary health care nurses' conference* about the brave new world opening up to nursing.

New technology, expensive drugs, and ethical dilemmas will all help shape the future of nursing, believes Sharon Myoji Schnare.

But nurses are also at a critical point of deciding how nursing as a profession will shape the future of health care.

Directing health policy, managing nurse-led specialist units in diabetes to rehabilitation, and doing the hard science, as well as using other’s research to advance nursing practice were some of the roles she saw growing for nurses in the future.

Schnare opened her keynote speech on the Future of Nursing by saying one of her objectives was to remind nurses of how important their role is, and the profound impact they have on patients’ lives.

“I believe there is no greater calling.”

She also called on nurses to return to their roots and remember why they became nurses and what gives them the greatest satisfaction in their work.

Schnare has been a nurse practitioner for more than 25 of her 33 years in nursing –specialising in family health and women’s health. She’s run a private NP practice serving uninsured families, as well as for state health providers, is a clinical educator for the University of Washington’s nursing school, the director of a women’s health NP training programme, and sits on the editorial boards of a number of journals on reproductive health and contraception. Her contributions to advancement of nursing practice have been recognised by the American Academy of Nurse Practitioners and the National Family Planning and Reproductive Health Association.

She sees the future increasingly including more ethical dilemmas about who will receive and who will pay for increasingly more technical care and new, often expensive, medications.

That pressure was increasingly making its mark on the uninsured patient group she cares for.

“I’ve never seen so many sick people in my whole career.”

This includes a 27-year-old woman with kidney failure who was peeing blood and only able to get one day dialysis a week. The young woman was living in a car with her partner and a trip to ER can see her leaving with a $10,000 bill.

“Where will we stand with this ethical dilemma?”

Schnare says nursing is at a critical point of deciding how the profession can create its own future.

“We want nurses to stand up and tell policy makers about what they do.”

She says she is well aware that nurses are very busy, but they have the ability to be voices for their patients.

“Nurses must lead governmental task forces that will be pivotal to assessing, improving, managing, and funding health care for all citizens.”

Nursing also had to be prepared for what the future would ask of the profession – which includes nursing education needing to provide continual clinical education to keep up with the rapid pace of change – and for nurses to be flexible and ingenious.

“Nurses are really good at plugging holes or stretching things,” says Schnare.

Nurses will also have to be good at analysing data both everyday data emerging from pathology and radiology and also searching out and carrying out statistical analysis to decide whether research data is valid and useful to their practice. Nursing research is also no longer limited to theories with nurses doing research in the “hard sciences” like, for example, in her own field, the impact of vaginal flora bacterial colonisation.

Technology will keep advancing, including nanotechnology, robot technology, and three-D printers that can create devices designed to individual specifications in minutes.

“We need to embrace technology without forgetting the power of our presence with our patients,” says Schnare.

But increasingly expensive technology and new medications will create ethical dilemmas and the potential for this “brave new world” of nursing to see widening division between patients who can and cannot afford health care.

Nurses will also face ethical challenges around cost containment in the health sector.

“Where will we have to cut services and at what cost to our patients and to ourselves.

“It’s a brave new world in nursing, but that’s okay because nurses are brave,” says Schnare. “If we weren’t brave at the start, we have trained to be courageous. We’re ready to roll up our sleeves and take on these dilemmas.”

She says barriers in the way of nursing’s future potential could include “educational hierarchies” that need to be reminded that clinical experience matters as well as educational “status”.

“Do I believe in education – you bet I do. But we really need to appreciate all nurses, whatever their qualifications … my best nursing and midwifery teachers did not have master’s degrees.”

Education also has to conform to working nurses needs by being flexible in their delivery and affordable. Plus, education needs to forward-thinking to anticipate future niches for nursing, including technology-linked opportunities, nurse inventers, and independent nurse practitioners.

Nurse entrepreneurs are another trend for the future. Schnare sees nurses managing centres for health excellence and designing and owning specialised facilities like hospice care. Or like a friend of hers, offering a specialist niche continence care service to provide bladder training for elderly women so they can stay independent in their own homes.

Schnare also envisages the trend continuing for nurses to choose and pursue specialties and subspecialty services, including specialist technical skills.

“The times of generalist nurses may fade as acute specialisation becomes necessary.”

She says examples of technical specialties include colposcopy, which she has been doing for decades, and some NPs in the States are doing vasectomies.

“Let’s push the box a little. We can expand our scope if we want it.”

This brave new world must also include improved salaries for nurses, especially those with specialised skills.

“Do not be hooked by the idea that being a technician makes us whole,” concludes Schnare. “Never negate the power of compassion and loving kindness in care for our patients … for we are lost as a profession without it.”

*Sharon Myoji Schnare was a keynote speaker at Shaping the Flow, the Inaugural Conference of the NZ College of Primary Health Care Nurses NZNO held in Hamilton, August 2012