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Growing Pressures

Pressures on the nursing profession reflect rapid changes in American society and in the health care system, including:

  1. The increasing diversity of patients, families, and nurses
  2. Hospital patients who are sicker and have more complex chronic conditions and hard-to-treat infections
  3. Ethical issues persist across the lifespan for patients of all ages
  4. A growing number of patients in all settings—hospitals, nursing homes, rehabilitation centers, at home—who suffer from dementia
  5. Rapid technological changes including electronic data and record-keeping that require advanced skills
  6. Growing emphasis on disease prevention, personal responsibility for health, and public health approaches, without commensurate increases in public health budgets or size of the workforce
  7. Increasing tension between individual interests and the interests of populations of patients, communities, and the broader society—that is, between personal health care and public health
  8. Pressures to make care more efficient and less costly that are shifting the locus of care from hospitals to the community
  9. New payment models that put pressure on all health care organizations

Nurses feel these pressures and the intense array of ethical issues that they raise. At the same time, research shows that patients and health care organizations fare better when nurses can be reflective, and are supported in their work environments in the practice of high-quality, ethical care.

At this time of rapid evolution, the need for action tempered with thoughtful discussion and analysis is urgent. Nursing needs to be effectively engaged, in order to assure that the solutions to our health care dilemmas represent the values of the profession and sustain nursing’s place in the inter-professional and public dialog.


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