Key Trends to Watch in 2018

What Will This Year Bring for Nurses?

Laura A. Stokowski, RN, MS


January 22, 2018

Everything that happens in healthcare affects nurses, from drug shortages to healthcare reform. This makes it hard to pinpoint the most important trends expected to influence the practice of nursing in 2018. With the help of nursing thought leaders, however, we've come up with a list of emerging or accelerating trends that nurses need to pay attention to this year, because they will affect key aspects of nursing, from education and licensure to clinical practice. What's on the horizon for nurses in 2018?

Clinical Trends

Trend: Nursing Leadership

Beverly Malone, PhD, RN, FAAN, who is CEO of the National League for Nursing, predicts that in 2018, nurses will increasingly be taking seats at the table. "We will see more nurses on boards across the country—more than we've ever seen before in healthcare. We have a tremendous need for gifted young nurses to step into those leadership roles." Although the bulk of practicing nurses have traditionally eschewed leadership positions, millennial nurses (those up to age 36) show the most interest in becoming nurse leaders.[1]

Bob Dent, DNP, MBA, RN, NEA-BC, CENP, FACHE, FAAN, Senior Vice President, Chief Operating Officer, and Chief Nursing Officer, Midland Memorial Hospital, and President, American Organization of Nurse Executives (AONE), agrees that leadership opportunities for nurses will increase. He added, "Areas across the care continuum—population health, academia, and other settings—will require more formal nursing leadership roles. Besides these more formal roles, nurses at the point of service are continually stepping up in patient care settings and across other healthcare settings. All nurses are leaders, regardless of formal titles."

Dr Dent has the following practical advice about leadership opportunities in nursing. "Nurses should lead from where they are. As opportunities arise or as passions for different roles come about, then pursue them. Have a minimum foundation with a BSN. Prospective nurse leaders should achieve certification in their areas of clinical expertise and a certification in leadership, such as AONE's Certified Nurse Manager and Leader designation. And nurses should be active members of their professional organizations. All of these activities should be part of a nurse's professional development plan."

Trend: Mentoring Emerging Leaders

With the onslaught of baby-boomer nurses retiring, mentoring programs are becoming increasingly critical to prepare younger nurses to fill their roles. In Louisiana, for example, nursing leaders started the Nurse Leader Institute to strengthen the leadership skills and networking opportunities for emerging nurse leaders. The Louisiana Action Coalition, which is part of the Future of Nursing: Campaign for Action, offers a 9-month mentorship program that pairs a younger nurse with a seasoned nurse in his or her area of practice or interest.

"It's imperative that nursing leaders who plan to retire within the next 5 years take an emerging leader and share as much of their knowledge and insight as possible," says Susan B. Hassmiller, PhD, RN, FAAN, senior adviser for nursing at the Robert Wood Johnson Foundation. "That way, the nursing profession will continue to thrive, despite the large numbers of nursing leaders retiring from the workforce."

Trend: Nurses Partnering With Leaders From Other Fields

Nurse leaders throughout the country are forming partnerships with leaders from other sectors to address the root causes that affect a person's health, from making healthy food available in low-income neighborhoods to opening wellness centers that help senior citizens age in place. "There is an increasing focus on paying attention to the factors that keep people healthy in the first place, including people's education level, employment status, how much stress they are living with, whether they have access to healthy food, and whether they have the transportation to get to healthcare appointments, rather than simply seeing people when they show up at the emergency department and are readmitted again and again to the hospital," says Dr Hassmiller. "Nurse leaders are forming partnerships with other leaders outside of healthcare to address some of these issues, and this is something that will need to continue if more people are to experience greater health and well-being."

Trend: Novel Clinical Roles

Chronic diseases and conditions (eg, heart disease, stroke, cancer, diabetes, kidney disease, obesity, and arthritis) affect one half of the adult population in the United States.[2] Many chronic diseases can be prevented with risk-reduction strategies, and nurses are the ideal healthcare professionals to promote lifestyle changes and healthy behaviors.

Antonia Villarruel, PhD, RN, FAAN, Dean, University of Pennsylvania School of Nursing, notes that nurses must be ready to provide care in unlikely places, such as drugstores and retail outlets, because "we see care shifting away from the hospital and into a more home-based and community-based care model. The use of automated hovering (technology to monitor real-time activities and symptoms) has further reduced place and in-person interactions, resulting in greater flexibility for patients and nurses, meaningful patient engagement in all aspects of their care, and more opportunities for nurses. In addition, attention to transitions in care, such as hospital to home, home to hospital, and home to hospice, provide a great opportunity to safely lead teams of caregivers to ensure safe transitions. Opportunities at all levels for care coordination will continue to grow. Nurses need to be able to traverse the landscape—from home, school, community, primary care, acute care, hospice, et cetera—to support patients and families. The use of technology will not replace nurses; rather, it will open up new opportunities to communicate and support patients and families in a variety of settings."

Trend: Nursing Innovation

Joanne Disch, PhD, RN, FAAN, Professor ad Honorem, University of Minnesota School of Nursing, explains why nursing innovation in healthcare is a trend that is expected to grow. "Healthcare is experiencing an ongoing push for cost-effective, high-quality, accessible, and personalized services. Nurses are exceptionally well poised to respond to these trends because these qualities typify nursing. The American Academy of Nursing has recognized a wide range of nurse-designed initiatives that are already transforming the health of Americans,[3] such as the following:

  • INSIGHTS into Children's Temperament, a comprehensive 10-week intervention to enhance the social, emotional, and intellectual development of low-income children;

  • 11th Street Family Health Services, an inner-city clinic, community center, and outreach facility that provides comprehensive, transdisciplinary care to residents of public housing communities and other vulnerable populations;

  • SeniorWISE (Wisdom Is Simply Exploration), a program that enables older adults to function independently by helping them deal with memory lapses and maintain the ability to engage in daily activities, such as dialing the pharmacy to order a prescription refill; and

  • The Complex Care Center, an integrated approach to serving patients who routinely visit emergency departments to deal with their complex needs.

These innovations are among more than 50 nursing solutions whose creators have been recognized as Edge Runners—practical innovators who lead the way in bringing new thinking and new methods to healthcare challenges. This type of innovation is one of the powerful trends that is improving the quality and accessibility of healthcare today."

Professional Practice Trends

Trend: Mobility for Nurses

By now, most nurses should be aware of the new enhanced nurse licensure compact (eNLC) if it affects their licensure. Nurses in 26 eNLC states (Arizona, Arkansas, Delaware, Florida, Georgia, Idaho, Iowa, Kentucky, Maine, Maryland, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, and Wyoming) may obtain a nursing license that enables them, as of January 18, 2018, to practice, in person or via telehealth, in any of the other states in the eNLC. The law applies only to RNs and licensed practical or vocational nurses, but not to advanced practice nurses.[4]

Dr Malone views the eNLC, an initiative of the National Council of State Boards of Nursing, as a facilitator of another important trend: the use of telehealth by nurses. "The multistate compacts will open more opportunities for nurses to use telehealth technology to provide care. A nurse in Virginia will be able to provide some types of care, through telehealth, to patients in many other states."

Trend: Diversity in the Nursing Profession

Slowly but surely, the nurse workforce is mirroring the diversity in the patient population. A recent study[5] from New York University found a significant increase in the proportion of men and nonwhite minorities making up the nursing profession since 2004. Progress in this area is critical, according to Dr Malone. "Diversity and inclusion will continue to challenge the profession of nursing, but they also pose an opportunity for our nursing leaders. Nurses take care of everyone. A more diverse nursing workforce is needed to reduce health disparities among minority populations."[6]

Trend: Scope of Practice Debate

Dr Malone predicts that practicing to the full extent of the nurse's education, certification, and licensure will continue to be a key trend this year.

But even as more states adopt the advanced practice registered nurse (APRN) consensus model, giving APRNs more practice authority, APRNs in some areas will continue to face a worrisome trend, says Dr Disch. "Ongoing efforts to constrain the scope of practice of APRNs is limiting access to high-quality healthcare.[7] These efforts include restrictive state practice acts, organizational privileging regulations, physician oversight by restrictive 'collaborative practice agreements,' and ongoing resistance from medical groups (such as the American Medical Association) to the full use of APRNs by the Veterans Health Administration[8] or the Physicians Foundation in expansion of nurse practitioner privileges.[9]"

"Nurses have a long history of offering pragmatic, high-quality, reasonably priced and personalized services that meet patient and family needs in every setting in which healthcare is practiced," Dr Disch continued. Efforts by legislative, regulatory, organizational, and professional organizations would better serve the public by reducing barriers and increasing access, rather than unnecessarily limiting the scope of practice of these well-qualified and highly respected healthcare providers."

Trend: Nurse Retirements Fuel a Nursing Shortage

The mass age-related exodus of nurses from the profession has already begun. According to Peter Buerhaus, PhD, RN, FAAN, "This trend will continue to accelerate as the largest groups of baby-boomer RNs reach their mid- to late 60s. The departure of such a large cohort of experienced RNs from the workforce means that patient care settings and other organizations that depend on RNs will face a significant loss of nursing knowledge and expertise that will be felt for many years to come."[10]

A recent survey found that the percentage of nurses planning to retire in less than a year has risen significantly—to 27% in 2017, up from 16% in 2015.[1] Furthermore, 73% of baby-boomer nurses who are planning to retire say they will do so in 3 years or less, and these vacancies will create a tremendous strain on the ability to deliver timely, quality patient care.[1]

The silver lining might be jobs for new nurses. Jobs for RNs are growing faster than the average for all occupations.[11] In fact, healthcare has just officially become the largest employer in the United States, surpassing retail and manufacturing industries,[12] although the recent scaling back of the Affordable Care Act (ACA) provisions might put the brakes on this trend.[13] For now, job growth is being driven not just by the wave of retiring baby-boomer nurses, but by the aging of the population in general. Whether early-career nurses are able to find jobs quickly after graduating is unknown, but it's a good bet that new nurses will have to be more comfortable with geriatric care than ever before.

But at the same time, an unfortunate consequence of the nursing shortage could be that hundreds of thousands of nurses who devoted their careers to taking care of patients may find that no one answers the call bell for them when they become patients.

Nursing Education Trends

Trend: BSN in 10

Remember the Future of Nursing report,[14] which specified that 80% of nurses should have bachelor's degrees in nursing (BSN) by 2020? We didn't achieve that benchmark, but at least one state so far is taking a giant step toward that goal. New York recently passed the "BSN in 10" law that requires nurses without a BSN to earn a baccalaureate within 10 years to maintain their licenses. So-called "market forces" (for example, hiring only BSN-prepared nurses[15]) alone haven't encouraged enough nurses to earn BSN degrees. It is hoped that this new legislation will speed up progress toward the 80% goal.

Eileen Sullivan-Marx, PhD, RN, FAAN, Dean, New York University Rory Meyers College of Nursing, was instrumental in getting this bill through the New York legislature. She explains that New York's bold action is likely to be a trendsetter for the entire country. "It's not a pejorative mandate; it's about patient safety and the health of our state. We want to see this happen nationally. Every state is watching this closely."

The mandate doesn't apply to nurses who are licensed before the law goes into effect, so it will probably take many years before the outcome of this mandate is known. Still, Dr Sullivan-Marx believes that the law will boost career opportunities for nurses. "Without a mandate, many nurses end their education. This law will encourage employers to support their associate degree nurses in pursuing higher degrees."

It will also affect the choices made by students entering college, says Dr Sullivan-Marx. "Academic counselors have been telling students that they don't need a BSN to practice nursing. Now, they will look at this and recommend that prospective nurses take the baccalaureate route right off the mark."

Trend: Community College Baccalaureate

Hand-in-hand with the BSN in 10 trend is the opportunity for nurses to earn bachelor's degrees at community colleges, which traditionally have offered only associate's degrees in nursing. Although at least 25 states allow their community colleges to offer the BSN, very few have done so.[16] That is changing. Many community colleagues throughout the country are gearing up to offer much sought-after RN-to-BSN degree programs. This will greatly expand opportunities for the academic progression of the country's nurses, especially for those living and working in rural areas.

Trend: Interprofessional Education

Interprofessional healthcare education occurs when two or more professions learn with, about, and from each other to enable effective collaboration and improve health.[17] It's not a new concept, but it is a trend that is expected to continue in 2018. According to Dr Villarruel, "There is an increasing demand for interprofessional education—in the classroom or simulation lab, and at clinical sites. This trend positively impacts transition to practice and requires opportunities for synergy across a multitude of health professions. In addition, a greater recognition of the social determinants of health by healthcare providers is needed for more meaningful community engagement and a greater understanding of the context of care."

Healthcare Policy Trends

Trend: Upheaval in Healthcare Reform

Dr Villarruel predicts that this year will bring "a great deal of uneasiness in healthcare as debates continue about the ACA and tax reform, and how each affects the affordability of healthcare. This chaos provides opportunities for nurses to lead as the emphasis will continue to be on value-based healthcare as well as costs. Furthermore, increased recognition and attention to the many factors that influence health (at home, school, community, and neighborhoods) will result in a continued emphasis on creating healthy environments for all people."

Dr Villarruel emphasizes that the policies of our elected leaders will affect current and future nurses. "Policy, action, and advocacy are needed on many fronts. Policy changes threaten healthcare coverage for our most vulnerable populations (women, children, elders, working poor). Tax reform will have a devastating effect on graduate education in particular, and threatens our ability to address workforce needs in practice, research, and education. Policy action is still required in many states to allow advance practice nurses to practice to the full extent of their license, education, and training. This remains a critical strategy to facilitate access to care, manage increasing healthcare costs, and also allow flexibility in care delivery through technology (eg, remote visits, telehealth)."

It's obvious that the new administration is intent on dismantling the ACA, but we don't yet know what effect this will have on hospitals and healthcare. Buerhaus and colleagues[13] predict that the overall effect will be fewer Americans with adequate healthcare insurance, and a return to the days when hospitals were burdened with uncompensated care. How will this affect nurses? It could affect their bank accounts, or even their jobs. Greater financial pressure on hospitals could lower RN wages and prompt hospital closures.[13]

Trend: Health System Mergers

Catherine Alicia Georges, EdD, RN, FAAN, professor and chairperson of nursing at the City University of New York, points out another major trend in the healthcare landscape that savvy nurses need to be aware of. "Nurses, especially those in acute care institutions, need to expect and understand the continued mergers of large health systems across the country and the impact that these mergers will have on the health/hospital workforces, which of course includes nurses. With these mergers, there is an expectation that on the basis of a current review of hospital billing and charges by Centers for Medicare & Medicaid Services and other payors, that these health systems will be moving rapidly to amplify their community-based/ambulatory and primary care centers. The increase in payors becoming providers will continue to escalate. Nurses need to prepare now to be retooled for this inevitable movement."

Hospital and health system mergers are not exactly new, so we have some idea of what to expect. We are in uncharted territory, however, with a vertical merger such as that of the pharmaceutical chain CVS and insurance provider Aetna. Will this result in "healthcare utopia," as suggested by those involved in the merger,[18] or the death of hospitals as we know them?[19] Nurses are mentioned in discussions about how such mergers can reshape healthcare, so whether you view this as anathema to our current system or a possible new employment opportunity, it's something we need to pay attention to.

Many more trends will influence the profession and practice of nursing, such the effect of social media platforms bringing nurses together under common causes, and wearable technology devices to monitor personal health and diagnose disease. What trends do you think will be important this year?

Acknowledgment: The author would like to thank the nursing thought leaders who contributed their views and expertise to this article: Beverly Malone, PhD, RN, FAAN; Bob Dent, DNP, MBA, RN, NEA-BC, CENP, FACHE, FAAN; Susan B. Hassmiller, PhD, RN, FAAN; Joanne Disch, PhD, RN, FAAN; Peter I. Buerhaus, PhD, RN, FAAN; Eileen Sullivan-Marx, PhD, RN, FAAN; Antonia Villarruel, PhD, RN, FAAN; and Catherine Alicia Georges, EdD, RN, FAAN.


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