key: cord-0026586-stsq3zj2 authors: Hooper, Vallire D. title: The Future of Nursing 2022: It Is Time for Us to Take the Lead date: 2022-02-01 journal: J Perianesth Nurs DOI: 10.1016/j.jopan.2021.12.001 sha: ebedc84db8b4484d0b11c665146dcaa7dee00d88 doc_id: 26586 cord_uid: stsq3zj2 nan The Future of Nursing 2022: It Is Time for Us to Take the Lead Welcome to 2022. For better or worse, another year has come and gone, yet the COVID-19 global pandemic that ensconced itself in early 2020 continues to besiege both our personal and professional lives two years later. Nurses, particularly bedside nurses, who started the early pandemic as "heroes," are now relegated to warm bodies that should be available to staff hospital beds. Disrespected by their communities, and sadly, more profusely disrespected by the hospitals and health systems that employ them. A recent survey conducted by the American Association of Critical Care Nurses (AACN) revealed that two thirds of critical care nurses have, or are considering leaving their jobs. 1 According to another survey, one in five health care workers have left their jobs, 2 with 62% of hospitals reporting a nurse vacancy rate of 7.5% or higher. 3 There is currently much focus on possible solutions to the everaccelerating nursing shortage. Unfortunately, the bulk of this attention appears to be on increasing the pipeline of nursing graduates, with what appears to be only a secondary focus on addressing the work environment in which nurses provide care. While increasing the number of nursing graduates is an admirable recommendation that may make sense from a number's perspective, the reality is that increasing the number of nursing graduates is a mere band aid that will do nothing to stop the exodus from the profession. Such a suggestion, is quite frankly, disrespectful to current nurses and all who may consider the nursing profession as a future career choice. Increasing the number of nursing graduates, without significant interventions in the environment in which they will work, is nothing more than sending lambs into slaughter. As all perianesthesia nurses know, you can administer all of the fluids and blood infusions in the world, but if you do not ascertain and repair the source of the hemorrhage, you will ultimately lose the patient. William Sage, MD, in a supplementary comment to the Future of Nursing 2020-2030 report 4 identifies the issue most succinctly: "COVID-19 has also revealed profound problems with the financing and delivery of American health care, presenting both challenges and opportunities for nursing, and has reopened old wounds about lack of voice and subordination in professional hierarchies." 4. p. 423 I propose that the solution to the nursing shortage rests not with producing more nurses, but with systematically examining the environment in which nursing care is delivered, with a particular emphasis on the acute care environment. Sage 4 posits that "the nursing profession is an economic force for health improvement." We, as a profession, must embrace this reality and own our power. Nursing is not a cost center. . ...nursing is THE ONLY revenue center that keeps hospitals open. Patients are admitted to the hospital for one, and only one reason: the need for 24/7 nursing care. Without nursing, there is no hospital, there are no surgeries, there is no care. Until hospital systems recognize and respect this reality, until they financially compensate the nurse for the critical skill sets that we bring to the table, the nursing shortage will continue to persist. Nurses should compose the majority of every hospital board; nurses should drive every major financial decision. Just as physicians are paid for clinical tasks, so too should nurses. Nursing care must be pulled out of the room cost and translated to a revenue generator. A hospital is not defined by the number of beds that it houses; it should only be classified by the number of nurses that it has to provide patient care. That being said, unless we as nurses lead the charge in making these recommendations a reality, our plight will never improve, and we will leave those following in our footsteps with the same reality. . ...the same challenges. This revolution in perspective will not be an easy task. Sage 4 recommends that the nursing profession must work to identify, measure, and be rewarded for the patient and public benefits of all nursing care, at all levels. This will require a collaborative effort between bedside nurses, nurse administrators, and nurse scientists. It will require support from our physician colleagues. It will require changes in hospital billing and reimbursement. And it will require policy change at the national level. Nursing care has been bundled into the hospital charge since the inception of hospital care. The foundational work of identifying every task, every intervention, every nuance of every shift, of every patient encounter, will require a new perspective. . ..and a new approach to both care delivery and reimbursement. How might this work start in the perianesthesia setting? What is the work that you do, on a daily basis, to positively impact patient care and patient outcomes? Tasks should be easy enough to identify: a blood draw, an IV start, extubation, vital signs, oxygen administration, medication administration, etc. But how do you account for those subtle interventions or actions that you take on a daily basis. How do you quantify and reimburse for preoperative or discharge patient education? What about the call to anesthesia or the surgeon with concerns about preoperative labs, urinary output, respiratory depression, oversedation, etc. What is it that we do? To be reimbursed for our care, we must first clearly identify what that care is. It will be challenging work, but I know that we have the depth and breadth within ASPAN to accomplish this. The future of nursing is an open book. Our future will look very different than that of previous generations. It will look much different than the profession in which many of us started 20, 30, or 40 years ago. The future is ours to write, but if we don't step up and take Survey: 2/3 of Critical Care Nurses Consider Quitting Due to COVID-19. WebMD Health News Why Healthcare Workers are Quitting in Droves. The Atlantic Nurses are Leaving the Profession, and Replacing Them Won't be Easy. The Conversation National Academies of Sciences, Engineering, and Medicine. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity control, I can assure you that others will. If we want to be the creator of our future, we must be willing to do the work and own our future. We must assert ourselves. We must step up. We must insist. The future of nursing 2022: it is yours for the taking. I dare you to step up and take the lead.