Article Discusses Nursing's Role in Healthcare and Advancement in Evolving Healthcare Environment

Though recent economic events may have mitigated the short-term concerns of a nursing shortage, long-term risks remain, with projections that by 2025, the demand for nurses will exceed our supply at a magnitude not experienced since the adoption of Medicaid/Medicare in the 1960s. Moreover, although 77% of nurses responding to a national survey reported that they were satisfied with their jobs, only 18% of nurses reported that they were actively engaged (defined as psychological commitment to job and workplace) in their work. Therefore, efforts to improve the clinical work environment, the safety culture, and the nursing education infrastructure are necessary. This article explores the opportunity for change by: 1) examining nursing's history in professional practice and its journey as an evolving profession, and 2) mapping the growth of hospitals and the advancement of nursing's role in the US, specifically in the context of the healthcare organization. For example, in addition to responsibility for individual patients, nurses also are "keepers" of the organization, with "24/7" responsibility for the structures, processes, and outcomes of care delivery.

Ultimately, nursing's goals as a profession and those of the healthcare system align as both nursing and the organization are held accountable for the quality of their work in terms of patient, nurse and organizational outcomes. The author suggests that focusing on both the evolution of professional practice and hospitals, as well as the organizational environment in which they function provides the lens from which to move toward creating a new culture of nursing engagement.

Fasoli D. The Culture of Nursing Engagement: A Historical Perspective. Nursing Administration Quarterly Jan-Mar 2010;34(1):18-29.

Dr. Fasoli is part of HSR&D's Center for Health Quality, Outcomes, and Economic Research in Bedford, MA.