The Future of Nursing Practice Centers Around Equality and Informatics

Nurses are one of the key forces driving change in the healthcare industry today through informatics and embracing technology in the clinical setting. Their end game—making sure the best care is provided equally to all who need it.

“The nursing workforce is working to address social determinants of health and health equity more comprehensively, regardless of practice setting,” said Vicky Tiase, PhD, RN-BC, nurse informaticist and director of research science, New-York Presbyterian Hospital and the HIMSS Nursing Informatics Committee Chair.

To achieve this goal, nurses must have all the tools they need. To this end, discussions about the future of nursing practice center around the scope of practice, compensation, education/training, technology, informatics and nurses’ well-being.

Scope of Practice

The global pandemic expanded nursing practice in many ways, including the growth of telehealth. Moving toward the future means continuing many of the changes made in the last year, rather than rolling things back to the way they were before.

“The biggest message is ensuring that nurses are practicing at the top of their license and have full scope of practice,” Tiase said. 

In the U.S., there are 27 states that do not allow full practice authority for nurse practitioners. A lot of those restrictions were lifted during COVID-19, along with them being able to get equal pay for providing that care.

“It’s one of the things we’ve seen reverting, which is unfortunate,” Tiase said. 

Joyce Sensmeier, MS, RN-BC, FHIMSS, FAAN, senior advisor, informatics, HIMSS, noted that she also thinks that telehealth reimbursement modifications should continue post-pandemic.

“It enabled more people to access care. That should continue,” she said. “About half of all nurses in the U.S. leverage telehealth in their practice. It makes it easier to follow up with patients remotely.”

Another change in nursing practice regulations during the pandemic that she hopes will stay is a reduced amount of required documentation.

“These changes allowed nurses to be more present in the room with the patients,” Sensmeier said. “We should look at what is the difference from before and during the pandemic and see what modifications we can keep.”

Compensation

Tiase added that another area where nurse’s pay is being discussed is when it comes to the extra work they are doing when it comes to data collecting and identifying social determinants of health.

“We have to figure out the payment model so nurses are compensated for this work,” Tiase said. “We have nurses that are already doing these really important activities, but we need to ensure this is financed properly moving forward.”

Sensmeier is an advocate of the use of a unique nurse identifier in EHRs to help put a value on nursing care.

“Nurses are assigned an NCSBN ID [National Council of State Boards of Nursing ID] when they take the NCLEX exam—it’s unique, publicly available and free, the nurse doesn’t have to do anything extra to obtain one,” Sensmeier said. “We just have to use it.”

Identifiers help healthcare organizations track nursing practices in the following areas:

• Billing
• Staffing
• Resource planning

Sensmeier said that these identifiers are an important part of introducing interoperability.

“We can’t really identify the nurse across multiple hospital systems without a unique identifier,” she said. “Our goal is to have everyone encourage the use of the NCSBN ID.”

Technology and Informatics

Another piece of the future of nursing practice is the involvement in developing technology that impacts patient care and clinical settings. Nurses are working directly with developers to determine how new tech will fit into the nursing process and workflow.

“There are so many benefits to having nurses involved,” Tiase said. “Talk to the bedside nurses and they will tell you what problems need to be solved.”

Developers are starting to add nurses early in the process to ensure the technology is needed and functions properly.

“Market suppliers now realize that if they put in systems that haven’t been analyzed by nurses, they won’t be successful,” Sensmeier said. “You need that expert workforce that knows how to implement and test technology in the real healthcare environment. The perfect person for that is the nurse is because we’re so focused on quality and we want no harm to come to our patients.”

Sensmeier notes this is an exciting time as digital health continues to increase and improve bedside technology for nurses.

“We’re going to be using emerging technologies, such as voice recognition. For example, if a nurse can make rounds and speak into a device and document, that’s going to streamline that documentation process and make it more accurate,” Sensmeier said.

New technology and more data mean clinicians are developing their informatics skills to help develop, implement and use these innovations within nursing practice.

Education

As informatics becomes an essential part of healthcare systems, Tiase noted that this should be prioritized in nursing practice education.

“Informatics should not be a separate, single course on the side. It should be incorporated and integrated throughout the curriculum,” she said. “All nurses having baseline informatics skills is absolutely critical.”

Tiase added that nurses need to be trained on how to provide personal care to patients using technology.

“Nurses are going to be using telehealth more to connect with rural and underserved patients, that’s going to be interesting to watch and hopefully we’ll see that integrated into the curriculum,” she said.

According to Sensmeier, nursing programs are updating their curricula to meet the new AACN requirements.

“Nursing programs today have limited informatics programs that need to be expanded and interwoven into the entire curriculum,” she said.

And the faculty may need to have further informatics education as well.

“Nursing has evolved in its use of technology, and we need to ensure we have the faculty that can  bring education to the next level,” Sensmeier said.

Wellness

Another area that Tiase believes is important to the future of nursing practice is the well-being of nurses themselves.

“Given what we’ve gone through in the past year, it’s more important than ever,” Tiase said.

With all the new technology being added to the workspace of nursing practice, it’s important that it is making their job more efficient. And when asking them to do more data collecting and complex work around supporting equity, healthcare organizations need to ensure they have enough support to do their jobs.

“It can’t just be that we are asking nurses to collect more data. Or use yet another piece of technology, we have to figure out how to take something away, or make something else we’re doing more efficient,” Tiase said. “And we need to make sure we’re using the data to make things better.”

Sensmeier added that the pandemic shone a light on the importance of the well-being of nurses.

“The pandemic showed just how challenging it is for nurses right now. I think moving forward, hospitals are going to have to consider better staffing ratios and increased pay for nurses or there will be supply challenges,” Sensmeier said. “It’s important to understand the importance and value of nurses.”