The Future of Infusion Nursing A Global Approach

Sharon M. Weinstein

OVERVIEW

With well over 3 million members, the nursing profession is the largest segment of the nation’s health care workforce. Nurses have the opportunity to practice in many settings, including hospitals, schools, homes, long-term care facilities, and community health centers. The educational level of nurses is diverse and extends from the licensed practical nurse to the nurse scientist. Our profession is at a significant time in history. Profound changes in science, technology, patient awareness, advocacy, and our health care environment have led to this change. Nursing, and more importantly, the nurse responsible for infusion therapy, a pivotal health care professional, is highly valued for specialized knowledge, skill, and caring in improving the health status of diverse populations.

The role of nurses in practice, academia, and science will become more critical as an aging population, a challenging environment, and expanded roles define our future. Nurses in clinical practice will continue to enrich nursing education through collaboration and
create partnerships between service and academia to enhance education and practice. The role of the infusion specialist has never been more powerful; by partnering with other professionals, institutions, and communities, you make a tremendous difference in achieving quality infusion outcomes.

STRATEGIC PARTNERING

Strategic partnering enables infusion nurses to extend their scope of practice and professional network. Teambuilding, partnering, outreach, and collaboration are terms of the new millennium. Such terms suggest a continuing trend in health care. Partnering and collaboration are the hallmark of many successful models implemented by practice and academic health care settings worldwide. Strategic partnering, within and beyond institutions, provides opportunities for personal and professional growth, outreach, and collaboration (Weinstein, 2004).

Collaboration with like-minded professionals enables each of us to grow as health care professionals. In 2008, the Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) launched a 2-year initiative to respond to the need to assess and transform the nursing profession. The IOM appointed the Committee on the RWJF Initiative on the Future of Nursing, at the IOM, with the purpose of producing a report that would make recommendations for an action-oriented blueprint for the future of nursing. The committee considered nurses across roles, settings, and education levels in its effort to envision the future of the profession. Through its deliberations, the committee developed four key messages that may be seen in Box 24-1.

NURSING IMAGE

Nurses are often seen as a trusted profession. Yet, nursing sometimes suffers from the contagion of negative perspective that comes from nurses themselves as often as from others. We hear what is wrong with nursing and rarely what is really great about the profession. The general public is aware of the many reasons nursing is considered a hard job, but few could describe why nurses love their work. As nurses, we need to communicate this positive and gratifying part of our experience to balance negative messages. The impression of nursing is improving as a result of programs that celebrate nursing’s successes and accomplishments—for example, the Magnet Recognition Program of the American Nurses Credentialing Center.

BOX 24-1 KEY MESSAGES FROM THE IOM REPORT

Nurses should practice to the full extent of their education and training.
Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
Nurses should be full partners, with physicians/licensed independent practitioners (LIPs) and other health care professionals, in redesigning health care in the United States.
Effective workforce planning and policy making require better data collection and an improved information infrastructure.

www.iom.edu/nursing

THE ENVIRONMENT

The environments in which we practice impact how we perceive the profession and our role. Workforce and workplace are critical factors for consideration.

Workforce

Opportunities abound for the nursing profession to intervene and make changes to address current staffing and patient safety problems and the growing nursing shortage. Today’s nursing workforce is composed of staff and nursing leaders from four different generational cohorts. Generational diversity, including workforce differences in attitudes, beliefs, work habits, and expectations, has proven challenging for nursing leaders. The nursing workforce will continue to be age diverse for years to come; this is especially true of the infusion nursing workforce. Box 24-2 defines the generational characteristics of these cohorts.

The millennium has become the metaphor for the challenges and opportunities now available to the nursing profession and to those preparing the next generation of nurses. Trends have been driven by forces in demographics, diversity, and more (Table 24-1).

Workplace

Now, more than ever before, we give credence to the term “employer of choice.” The American Nurse Credentialing Center’s Magnet Recognition Program has made us all aware of the ideal work environment in which nurses are respected for what they bring to the clinical setting. Through clustered components of magnetism, transformational leadership is identified at the organizational level. In the midst of crisis management, leaders may lose sight of the need to care for their employees. And generous compensation and benefits, creative work arrangements, and healthy work environments cannot compete with the forces of our personal lives at times. These forces can make the most capable and motivated worker powerless and ineffective. So, it appears that the pursuit of balance is a delicate act that lies in the hands of the individual.

BOX 24-2 GENERATIONAL CHARACTERISTICS

Veterans (1925-1945)

Hard working, financially conservative, respectful of authority disciplined

Baby Boomers (1946-1964)

Strong work ethic, value individualism, empowered in the work setting

Gen X (1963-1980)

Value self-reliance and work-life balance, less loyal to corporate

Millennials, also known as Generation Y (1980-2000)

Global generation, accept multiculturalism, technology driven, communicative (via technology), expect more mentoring/coaching

TABLE 24-1 TEN TRENDS TO WATCH THAT IMPACT NURSING

Demographics and diversity	Growing life span Increase in acute and chronic conditions Disparities in morbidity, mortality, and access Student demographics
Technology	The information age Processing capacity and speed Affordability Digital technology Distance learning
Globalization	Communication The “death of distance” Emerging and re-emerging infections
An educated consumer	Shared decision making Public information Media and Internet Health promotion and prevention Wellness Alternative therapies Complementary medicine Palliative and end-of-life advances
Population-based care	Managed care Accountable care organizations Patient care ratios
Cost	Gross national product Underinsured and uninsured Options Reimbursement challenges Advanced nurse practitioners Physicians/LIPs
Policy and regulatory issues	Increases in regulation at the state and federal levels Shared responsibility for the Medicaid program
Collaborative practice	Interdisciplinary teams of health care providers Leadership and competence
Workforce	Cyclical shortages New career opportunities Care management Geriatric care managers Public image Command of technology
Science and research	Health behaviors Symptom management Disease prevention Nursing role
*Adapted from Heller, B. R., Oros, M. T., & Durney-Crowley, J. (2011). National league for nursing. http://www.nln.org/nlnjournal/infotrends.htm

Every day, nurses in all clinical settings are faced with the challenges of a changing patient population, a changing work environment, and changing tools with which to do their jobs. Patient and worker safety are key concerns, especially for those who specialize in infusion nursing. On a global level, professional societies have embraced the relationship of healthful practice environments to health outcomes. Based on the conviction, supported by evidence, that quality health care workplaces provide quality patient care, the International Council of Nurses (ICN) launched a global call to address and improve the serious deficiencies currently existing in the health work environment in all regions. The delivery of safe, high-quality, and efficient health services depends on the competence of health workers and a work environment that supports performance excellence. Publication of an information and action toolkit entitled, “Quality workplaces = quality patient care” provides data on positive practice environments to all health stakeholders who are interested in improving the delivery of quality services.

Nurses need, and deserve, a positive practice environment consistent with scope of practice, professional licensure, and local culture. Evidence supports the fact that job satisfaction is enhanced when corporate culture supports clinical practice, diversity, leadership, and continuous learning.

Although workplace stress cannot be completely eliminated, the negative stressors can be reduced when nurses make caring for themselves a priority. Self-care can be a barrier to stress-related illness and contribute to your overall well-being. Self-care begins with you! To maintain the delicate balancing act, you must manage your actions and personal/professional life. The universe exists in a state of balance, as should we. We can do anything we wish, but should always do it to moderation, never to excess. Should we do things to excess, they can become addictive, which drains energy and may become negative. Being balanced allows us to act better in situations. If we are sat on the fence, so to speak, we can jump off either way should we desire to.

Goal setting is tantamount to success and well-conceived goals are accompanied by action plans aimed at completion. To get to any goal, break it down into a number of small steps. If you have many small successes, then this will lead to a big success. Remember that a journey towards any destination starts with a single step, and then a second and a third, and as many as required until you reach that destination. Remember to reward and praise yourself for your successes, however small they are. By acknowledging them, you increase your power and will to succeed, strengthening your belief in yourself (Weinstein, 2008).

Safety Implications

Significant pressures are being placed on health care delivery systems to improve patient care outcomes and lower costs in an environment of diminishing resources. The IOM’s landmark report attributed medication errors to faulty health care policy/procedure systems as opposed to individual error. Numerous studies have shown that information technology can enhance weak systems. For nursing, information technology plays a key role in protecting patients by eliminating nursing mistakes and protecting nurses by reducing their negative exposure. Information technology is dependent upon user expertise. Nursing is in a unique position to address the challenges of today’s health system with respect to outcomes and patient/staff safety.

Changing Technologies

Advances in technology continue to affect our practice as well as patient outcomes, regardless of the clinical setting in which care is delivered. Infusion nurses are often the driving force behind innovations that better meet the needs of their patients and those within the medical community. Infusion nurses are credited with the adaptation of vascular access devices from continuous setups to intermittent devices. The term “what if” has led to the creation of multiple technologies such as securement locking devices and taping techniques that have transformed the practice, generated better outcomes, and facilitated the growth of the specialty. This process will continue as a new generation of infusion nurses offers information through surveys, focus groups, market research, and more. As the primary source of patient education, the infusion nurse can contribute greatly to the learning process. As the end user, the infusion nurse’s input impacts technology and the quality of products available to us.

Research

This edition of Plumer included references to research topics that are currently being explored or that should be developed in an effort to grow the specialty practice. New research ensures sound evidence for practice. Funding may be available through grants and scholarships from professional societies, foundations, and industry. Closing the gap between research and practice requires knowledge, commitment, resilience, and confidence that this will further nursing’s agenda within the health care arena—especially infusion nursing.

Credentialing

Every day, the delivery of health care becomes more complex as new treatments are discovered and new technologies for diagnosing and treating disease are developed. Today’s patients are sicker than ever before. The depth and breadth of knowledge required of the professional are not completely met by the entry-level nursing education available. Today’s consumer needs and deserves more.

To better meet the needs of today’s patients, nurses often seek additional education and validation of their clinical expertise. Advanced practice requires advanced learning, including baccalaureate and master’s degrees, post-master’s training, and doctoral degrees. Certification validates one’s knowledge, professional skills, and clinical expertise. Requirements for specialty certifications vary, but all include a practice component and an identified body of required knowledge or testing blueprint.

Certification is defined as a process by which a nongovernmental agency validates an individual’s knowledge related to a specific area of practice. The National Commission for Certifying Agencies set forth certain basic requirements for all certification examinations,
including the requirement that testing reflects current practice in the specialty and measures specified aspects of this practice.

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