Dr. Sharon Vasuthevan is an Education Executive at Life Healthcare Group. With a PhD in Nursing and as a Registered Nurse, she has presented papers at conferences worldwide and published in nursing journals. She supervises Master’s and doctoral candidates as a research associate of Nelson Mandela University. Dr. Vasuthevan has held leadership roles in various nursing organizations and specializes in nurse leadership, education, quality, and health information systems. She has driven projects involving automation of nursing tasks and prioritized e-learning in nursing education.
This year the International Council for Nurses selected an important theme for International Nurses’ Day, “Our Nurses’, our future”. It’s a critical time of reflection for nursing as a profession and we move forward which led me to the title of my editorial. What did the leaders of yesteryear do, differently? The leadership at the time amongst women and in nursing was about courage, empowerment and elevation of the status of women and nurses, albeit that it was not as inclusive as it should be.
Nursing as a profession at the time, was fairly subservient, with nurses taking instructions from the doctor and having very little autonomy. Clinical practice was excellent with nurses giving the best care to their patients. It may not have been evidenced based but they delivered to the best of their ability under the circumstances. Matrons were formidable people who had so much power and were autocratic at so many levels.
The discipline in nursing was paramount to remaining in the profession. Uniforms were white and starched and nursing caps were worn to keep the hair in order. These later changed to become more ornamental and much smaller. The working hours were long and many senior nurses would share that they worked 12 days before they got a weekend off.
Training was strict. There were penalties at so many levels. Many senior nurses recall the preliminary exams after being in training for 3 months. If you failed, you were asked to leave. It was their way of weeding out the bad apples early in training. So while much of this sounds archaic and foreign to many of you, it built a solid foundation for the nursing profession. Nursing was a disciplined profession where the patient came first. The important thing to remember about yesteryear was nurses were known for their caring ability. Care and compassion is what drove many nurses to remain in the profession. It is no wonder that they called them the ladies with the lamp.
So, that brings me to nursing today.
Women are emancipated and are occupying senior roles and there are changing family dynamics with the breadwinner not necessarily the man of the family. But have they become totally accepted? Do we truly have gender equity and how does this play out in the various spaces, at home, in the boardroom, on the golf course to mention a few? People and communities want value for their money. They want the best possible care and will express their dissatisfaction publicly. Against this landscape, nursing is also facing serious challenges today.
We have great nurse leaders today as well. The principles that guide nursing leadership today are innovation, globalization, research, and change. We are beginning to see more nurse leaders in executive roles and taking on senior roles at universities. We have had and continue to have deans, deputy vice chancellors and vice chancellors who started out as nurses.
But I also ask myself, what would the leaders of yesteryear do differently around the changes in nursing education. How can we collectively manage the current situation that seems to be exacerbating the shortage of nurses in most countries. What would we have to do differently, in order to make nursing a disciplined profession focussed on the best patient outcomes. Perhaps, some food for thought for us.
In terms of our nursing practice, we have made strides in moving into evidence based practice and critical thinking. The notion of do because I say so, does not work any longer. The nurse of today is questioning protocols and doctor’s orders. They want to be part of the multidisciplinary team and make a contribution to the plan of care.
But we also see many more adverse events. Perhaps, we can take comfort and say it is because we have improved measures and records today. But clinical competence of nursing practitioners are often questioned and we must take responsibility for ensuring the delivery of safe patient care. The caring aspect of nursing is being monitored, measured and critiqued on a daily basis. Unfortunately, most often our report card does not look as great as we would like. What will we need to do differently to change our scores?
The education of nurses in nursing colleges has been with us forever and perhaps, based on the numbers, it was necessary to adopt this mode of provider and delivery. However, this also leads to isolation of the education of nurses. Unlike their university counterparts, nurses trained at colleges are not exposed to other students or disciplines. This may not augur well in terms of interprofessional education, which is being discussed in more health related education circles.
So, a snapshot of nursing today indicates that we have made strides in nursing leadership, evidence based practice, research and nursing education with more nurses acquiring masters and doctoral degrees. But it is going to take collective leadership and focus for us to manage the change in qualifications, regulation and improved practice in nursing. We are the generation that have always been hard on ourselves and had difficulty celebrating our achievements. That takes me to the future of nursing. The generation who will review our legacy.
Once again, it is going to be influenced by the political landscape. Better informed communities making informed choices and demands. People who will not accept the status quo and will want change. Women will continue to move up the ladder and take on more roles. The challenge will be whether they will come into their own. Will women be supportive of other women in the workplace? There will be new issues on the table then with the future generation demanding work life balance, flexible working conditions and corporates moving into virtual offices.
Leadership in nursing will also take on a new look and feel. The future generation of nurse leaders are going to be critical of their predecessors and would expect change to happen more expediently. Young nurses are going to speak out and may be less inclined to throw caution to the wind.
Hospital and community settings will also be different. People are already becoming better informed and making their own diagnoses prior to consulting their doctors. Dr Google is always the first point of consultation and if there is any concern, they will proceed to the doctor. Technology is going to be a major disruptor. Access to information and services is going to be so much easier. Online check in will progress from airports to hospitals, and clinics. Electronic health care records are going to allow patients to have access to their own history and move with their records to any practitioner.
Patients will have choice and Quality will be the only differentiator. Hospitals and clinics will need to publish their clinical and quality outcomes, and patients will choose the facility they wish to make use of. Everyone is looking for the ideal experience, so measurements of patient/customer experience will continue to increase and healthcare will become more competitive. Patients will shop around for quality and price in the future before they choose a healthcare provider.
With changes in society and healthcare delivery systems, education of nurses will also need to change. Interprofessional education will become more necessary, as health professionals will work in teams. Students will have access to the latest devices and books may become a thing of the past. No lugging of big bags with books and notes, just one device with everything on it. The concept of travel light comes to mind. I believe nurses will be better educated and will demand higher salaries with improved education, so there will be an introduction of healthcare technicians to take over the administrative and non-clinical tasks .
Clinical competence will be critical for nurses and healthcare professionals with increase in litigation. Patients know their rights and will be well versed with the responsibilities of nurses and other healthcare professionals. The nurse patient relationship will change with a demand for more patient information and follow up care. Families will also become very involved in the care of their loved ones, and home care will be in demand. Institutional care will be limited to acute care and with reduced length of stay. The future sounds like an adventure and I believe it is going to make a difference to healthcare delivery globally.
In conclusion, each period comes with its own achievements and challenges. Yester year was about courage, growth and empowerment of women and elevated education of nurses. Today, it is about innovation, career progression for women, internationalization, evidenced based practice, and research. Tomorrow is going to be about increased technology, casualization of formal employment, work life balance, transformed healthcare and empowered patients and communities.