In 1988 I gave a speech on trends in nursing to the College of Nursing at the University of Nebraska/Omaha. Recently I came across that speech and was disturbed by my predictions—not that I was so off base, but that I was so right since most of my predictions were quite pessimistic. I have often considered myself to be a visionary, but now I wonder if I have Old Testament-like prophecy skills. Like those prophets, the doom and gloom I foretold was fulfilled, unfortunately.
Some of my predictions in 1988 were:
1. The nursing shortage will not abate. This is not like any nursing shortage our profession has weathered in the past, because the demand for nursing services is escalating, and the supply of candidates for nursing schools is rapidly diminishing. The old supply/demand economics principle will become very familiar to everyone in health care and to the nation.
2. Competition between nursing schools for students and money will continue to escalate as fewer students choose to enter nursing.
3. The shift from retrospective reimbursement to prospective payment in health care will lead to early discharge from hospitals. The need for nurses to give complex care in alternative care settings will grow.
4. There will be more and more older people being taken care of by fewer and fewer younger people.
5. Health care costs will continue to increase because of the expense of technology, and because all those older people will have health problems of greater complexity.
6. Nurses will become more accountable as studies correlate patient morbidity and mortality to nursing care.
7. Due to greater competition between health care providers, business strategies will become important tools in overcoming the problems of access, cost, and quality.
8. More nurses will develop independent entrepreneurships as they seek more control over their lives and styles of practice.
9. Technologic advances will present ethical dilemmas never before encountered. We will have to give more attention to the skills of logic and more time in our nursing school curricula to ethics, economics, religion, administration, sexuality, and political implications than is currently necessary.
10. Nursing will be evaluated in terms of outcomes and quality, not processes and procedures.
Not all of these predictions in 1988 took a great deal of clairvoyance. Many were quite obvious, given the early warning signs present at that time. What really bothers me, though, is that whatever we did to prevent that future failed. It has actually turned out to be much worse than I had imagined.
I often hear people comment on how glad they are they don’t need hospitalization right now because of the current nursing shortage. We nurses know, though, that they "ain’t seen nothin’ yet!" The situation will become much worse. At the risk of being proven right again, I have to predict that:
1. Given the nature of the current generation of 16-24 year olds, it is unlikely that nursing will make a comeback soon. They are not interested in stability, job security, and becoming a part of an organization. They like rapid change, opportunities for independence and owning their own businesses, and careers that allow them to set their own schedules. (Thank you, Nancy Patterson, for bringing this generational characteristic to my attention.)
2. Professional nursing care will eventually become so scarce in the United States that it will disappear altogether in some circumstances, particularly settings serving patients with low risk problems or where unlicensed personnel can be rapidly educated at minimal levels to fill low priority needs.
3. Patients needing hospitalization will have to make arrangements for some of their own bedside care before admission by lining up family and friends to stay with them around the clock to monitor their safety and to provide basic assistance. Of course, these laypeople will not be able to manage adequately and there will be many accidents.
4. The United States will hit a national nursing shortage crisis so severe that legislation will be necessary to limit malpractice suits to protect the health care system.
5. Nursing care will be rationed. Only the rich who can afford to hire private nurses at high costs will have ready access to nurses.
6. Businesses will add nursing care as an employee benefit and will hire their own nursing staffs, or contract with nursing agencies to provide such services.
7. The nursing shortage will become a national political campaign issue, but not much will happen as a result. It will be up to health care providers to solve the problem. We will see some employers turning to very desperate measures disguised as creative "solutions," such as a return to open wards where one RN can see all the patients at once, or cameras in every patient room feeding live video to a "sitter" who can monitor patients (or other methods of electronic monitoring).
8. A BSN will continue to be the ideal level of preparation for the Registered Nurse, but the movement will lose even more ground because of its lack of popularity with desperate employers or high schoolers wanting fast careers. Many BSN schools will close or become ADN-to-BSN or ADN-to-MSN programs.
I surely do hope I’m wrong this time.