Excerpt: Could the future of nursing look less like its present and more like its past? Observers of a consensus study under way at the National Academy of Medicine (NAM) could be excused for drawing that conclusion.
During the launch of the Future of Nursing 2020–2030 study, in March 2019, a reference to Lillian Wald’s 1915 call to nurses to seek out “the deep-lying basic causes of illness and misery” was one of several clues about that future. There’s also the committee’s charge to “chart a path for the nursing profession to help our nation create a culture of health, reduce health disparities, and improve the health and wellbeing of the U.S. population in the 21st century.” Given current evidence regarding the influence of social determinants in shaping health and exacerbating health disparities, there seems little doubt that the causes that animated Wald’s work will figure prominently in the NAM study committee’s vision of nursing’s future.
The World Health Organization has defined social determinants as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” Wald’s pioneering work to ameliorate these conditions for people living on New York City’s Lower East Side more than a century ago established her as the nation’s first public health nurse. She lived among the people she served and created an institution that attended to much more than their physical health. Holding classes on hygiene and baby care, creating places where children could play, offering vocational training, distributing food, and arranging for loans were among the many services Wald and her followers provided to neighborhood residents.Today, a number of forces—including pressure to slow the growth of health care costs—are driving health systems to explore what more they can do to keep people in their communities healthy. At the final NAM public meeting on the future of nursing, the committee heard about individuals and organizations that are in the vanguard of these efforts to advance health equity. These providers are addressing the social and economic conditions that produce population health disparities, and their approaches offer a preview of what nursing roles may look like in the decade ahead.
THE FUTURE IS TAKING SHAPE ON CHICAGO’S WEST SIDE
At Rush University Medical Center (RUMC) on Chicago’s West Side, nurses are integral to efforts to advance health equity. They have been engaged in nurse-designed programs to address food insecurity, and last year they took on a new responsibility: screening hospital inpatients for the social determinants of health.
“We don’t want to create mini social workers,” says Janice Phillips, PhD, RN, CENP, FAAN, RUMC’s director of nursing research and health equity, but she believes patients benefit when nurses are aware of the challenges that influence patients’ abilities to care for themselves. Asking frontline nurses to screen for the social determinants of health represents a shift in how nurses have traditionally seen their roles, and Phillips and her colleagues took steps to prepare the ground before pilot testing the screenings at the start of 2019. Phillips surveyed nurses across the Rush health system regarding their knowledge about and comfort with approaching patients to discuss their social needs. An impressive 768 nurses responded, giving Phillips valuable baseline information, which she shared, along with her thoughts on the subject, with the NAM study committee. Among her conclusions were that nurses need more education on the social determinants of health, and they “need to feel confident that, if they screen a patient for these factors or social needs, there will be appropriate resources in place to address those needs.”
Assignment: Under the banner Eye on the Future of Nursing, create a series of three articles exploring ways in which frontline nurses may be affected by recommendations of the forthcoming National Academy of Medicine Future of Nursing 2020–2030 study. Embracing a Role from Nursing’s Past
Client: Future of Nursing: Campaign for Action at AARP
Assignment: Recap public meetings of the Future of Nursing 2020-2030 study, an effort by the National Academy of Medicine to “chart a path for the nursing profession to help our nation create a culture of health, reduce health disparities, and improve the health and well-being of the U.S. population in the 21st century.”