Journal of Nursing Management, 2015, 23, 409–410

Editorial Nurses do not have proprietary rights on caring: but we do on clinical practice models

Across the world, a perfect storm is intensifying for nursing creating many challenges but also exceptional opportunities. The increasing numbers of individuals with chronic and complex conditions and fiscal constraints are challenges to human resources for health and the increasing demand for universal health care coverage. These factors defy existing models and paradigms of caregiving requiring innovative solutions. (Ooms et al. 2014). Paradoxically never before have nurses been so welleducated and their skill set aligned with the demands for evidence-based, person-centered care. We as a profession are ready to rise to these challenges and it is our time (Davidson et al. 2013, Daly et al. 2014). In decades gone by, nurses and their role were much more homogenous and foreseeable. The majority of nurses were educated in hospital settings and their role was much more predictable and controllable. Health care was primarily provided in hospital settings and physicians largely determined nurses’ scope of practice. However, times have changed, nurses are now not just highly skilled but educated and do their work in a range of settings – from the bedside to the boardroom (Shaffer et al. 2014). Moreover, they continue to develop and evolve innovative ways of delivering care and improving patient outcomes. The role of patients in health care is also changing. Increasingly patients and their families are engaged in caregiving and delivery as partners, not merely the recipients of care (McMullen et al. 2014). Importantly, the importance of informal caregiving and family caregiving are becoming critical in caring for the many individuals requiring ongoing care in the community (Shah et al. 2014). In the United States alone, it is estimated that informal caregivers contribute care estimated to be at a value of $522 billion and replacing this with skilled nursing care would cost $642 billion a year (Chari et al. 2015). This altered milieu requires a new suite of skills: counselling rather than didactic education; shared decision making rather than prescriptive planning; and tailoring and targeting care delivery models rather than expecting patients to comply and adhere to our

DOI: 10.1111/jonm.12299 ª 2015 John Wiley & Sons Ltd

traditional ways of working (Barry & Edgman-Levitan 2012). In response to these challenges, there have been calls to increase the numbers of baccalaureate-prepared nurses prepared to undertake and coordinate increasingly complex care models. However, both the supply and demand of these nurses, as well as costs, have challenged an all baccalaureate-prepared nurse workforce. Increasingly, there is heterogeneity in workforce delivery models and varying levels of nurses are employed as well as technical assistance and nursing aides (Auerbach et al. 2015). We also have additional levels of health care workers, such as physician’s assistants (Dill et al. 2013). The trend towards diversification and heterogeneity in the workforce is a global phenomenon (Kerry & Mullan 2014). Moreover, in the community we are increasingly dependent on community health care workers who play a critical role in brokering care, community engagement and care delivery (Islam et al. 2015). Increasing diversification of the nursing workforce has increased discussion and debate on the protected role of ‘nursing’ as well turf issues in care delivery. Similarly to how nurses have embraced tasks and skills previously attributed to physicians, we also need to loosen the reins on our hold on the proprietary rights of caregiving. We have to be open and responsive to sharing the field with a diverse and heterogeneous cadre of health care workers, as well as family members. Many of these individuals have the knowledge, skills and capabilities to care for the increasing numbers of individuals requiring health care. We need to embrace our new co-workers. As the health care environment rapidly changes and the fabric of the health care workforce becomes more diverse we need to accommodate changes, be prepared to negotiate and strive for health care that is equitable and accessible. In this new environment, we cannot and should not release our important leadership role in the clinical practice environment. The community looks to us for

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leadership and we cannot negate our important role in maintaining clinical standards. This will require new ways of working and collaboration and engagement with our communities. The interprofessional practice and education focus of many academic and clinical institutions is an important step in valuing the dimensions that each of us brings to the health care encounter (Reeves et al. 2008). However, these models focus only on the professions we need to look beyond to the increasing heterogeneity of the health care workforce (Edwards et al. 2014). Increasing the diversity of the health workforce can attract a range of responses from welcoming to contempt. But rather than shunning the new cadres of health care workers we need to look at supporting and developing them, embracing them as part of the care team and identify standards for evidence-based, ethical practice that promotes the safety and quality of clinical care. This requires nurses who are skilled leaders, expert clinicians and scientists who can shape models of care to meet the needs of patients and their families, not the demands of health care professionals. Developing and evaluating innovative models of care delivery including a range of health care professionals is critical in addressing the challenges of contemporary health care. Nurses should rise to this important challenge to ensure we maintain our important role in promoting clinical standards and safeguarding the quality of care. Patricia M. Davidson R N , P h D Dean and Professor, Johns Hopkins University & Faculty of Health University of Technology Sydney, Sydney, New South Wales, Australia E-mail: [email protected] Huiyun Du R N , P h D School of Nursing & Midwifery Flinders University, South Australia, Australia E-mail: [email protected]

References Auerbach D.I., Buerhaus P.I. & Staiger D.O. (2015) Do associate degree registered nurses fare differently in the nurse labor market compared to baccalaureate-prepared RNs? Nursing 33, 8.

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ª 2015 John Wiley & Sons Ltd Journal of Nursing Management, 2015, 23, 409–410