Nursing in the 21 Century

The use of information technology in distance education to provide educational access to a wider audience of nurses both in the United States and abroad will increase dramatically. In addition, information technology will assume a significant role in informing and educating patients as well as in monitoring and managing their illnesses.

Amidst the fundamental changes occurring in managed care, a new system of health care delivery may emerge, but expect the concepts of appropriate utilization, cost-control, and quality monitoring to prevail. Under this changing system, a great acceleration of the shifting of hospital-based clinical services to the community and the home will occur. Also, as baby boomers age, opportunities for nursing will proliferate. In the context of a new health care delivery system, nurses will demonstrate evidence-based (outcomes) practice.

As multicultural and ethnic diversity in society continues to influence nursing, the need for education to prepare nurses who can deliver health care in a culturally sensitive and appropriate manner intensifies. To remain fiscally viable, health care organizations must plan, develop, and implement strategies that will ensure that health care givers are culturally competent to meet the health care needs of diverse patients.

With such increasing societal diversity, disparities in the health status of our different populations are becoming more evident. The health of the nation depends on addressing these disparities and promoting health for all sectors of the population. Nursing and its research need to identify diverse health behaviors and learn ways to enhance health promotion and disease prevention for all. A collaborative effort between individuals, families, communities, health care agencies, and policy makers must exist to ensure the best outcomes.

"Amidst a shortage of nurses, nursing has to address and act on a significant concern: attracting and retaining high-ability and high-achieving men and women."

In spite of the vibrant economy, the number of the medically uninsured and underserved keeps growing, from 34.6 million in 1991 to 43.4 million today. The greatest number of this population is the working poor who cannot afford health insurance or whose employers do not offer health insurance. Nursing as a health care profession, in keeping with its social contract, must focus and work to alleviate this problem in concert with other health care disciplines.

Nursing also has to address the changing demographics of the pool of future nurses. The unprecedented educational and professional opportunities for women during the past 25 years have affected nursing significantly. Amidst a shortage of nurses, nursing has to address and act on a significant concern: attracting and retaining high-ability and high-achieving men and women. Furthermore, nursing education, in particular, has to come to grips with the implications of the graying of its professorate on the teaching and development of the science of nursing.

The looming shortage of nursing faculty compels nursing education to revolutionize its traditional approach of requiring work experience between the bachelor's, master's, and doctoral degrees. To replenish its graying professoriate, nursing education needs to implement a system change to allow young and bright baccalaureate nursing graduates to immediately pursue doctoral nursing degrees. This more direct path will substantially decrease time to prepare nurses for academic and research roles, and in effect, provide them more time to develop and sustain their academic and research careers after the doctoral program. As a faculty member involved in the planning of the nursing doctoral program at APU, I will keep this revolutionary concept alive in our deliberations.

Finally, rapid and complex scientific and technological changes require the preparation of leaders in nursing education, practice, and research who possess an array of competencies: technical, critical-thinking, problem-solving, teamwork, communication, and interpersonal skills. With these competencies, nursing leaders can expect to participate in interdisciplinary collaboration with other health care professionals to identify, analyze, and work toward solutions for the complex health care needs of a multicultural and ethnically diverse American public. The 21^st century portends radical challenges and opportunities in nursing education, practice, and research. As a faculty member, I am committed to educating the new generation of nurses to be leaders in an increasingly multifaceted health care environment.

Felicitas A. dela Cruz, RN, DNSc, is professor, and director of Nursing Research.