NurseWeek:

On the horizon
Future nurses will have broader skills

Mary Cain, MPH

Interview by Melissa Gaskill
August 14, 2000


	You've read the article. Now tell us what you think. Related site Institute for the Future

The Institute for the Future in Menlo Park is an independent, nonprofit research firm specializing in long-term forecasting, alternative futures scenarios and the effect of new products and next-generation technologies on society and business.

For more than 30 years, the Institute has forecast trends for corporations, government groups and nonprofit organizations.

Mary Cain, a director on the Institute’s health care team, focuses on health care and the effects of consumer behavior, technological innovation and the Internet. She has a master’s in health policy and administration from the University of California, Berkeley.

In the future, will more nurses work in hospitals?

We definitely will see an increased shift away from the hospital setting to more skilled nursing settings. We forecast a 17 percent drop in the number of hospital beds between now and 2010.

I also see a greater role for nurse practitioners working as health care providers, which is of major importance, because they work so much in outpatient settings.

Will nurses become more like NPs?

There are a couple of things going on – the RN population is aging out of the workforce and being replaced either with LVNs or BSNs.

At the same time, there is a trend toward using physician extenders, most often in underserved and outpatient settings, leading to an increased demand for NPs and PAs in primary care. Rather than nurses becoming more like NPs, you’ll have a higher demand for NPs.

Nurse practitioners function as physician extenders and sometimes physician substitutes, so as the role of physicians changes, [the role of] nurses will, as well. Nurses often are there to provide more than clinical support. They provide the emotional support that physicians do not, and we see that probably increasing.

So will nurses need more or less training?

I see almost a split in the skills in demand, at the LVN level or the NP level.

Will nurses see higher pay?

In medicine in general we see a pretty consistent rate of increase in pay. Because of the significant demand for cost containment and a shift to outpatient settings, you’re seeing fewer people in the hospital, but their level of illness is increasing. Specially trained nurses working with those individuals require higher pay.

In terms of attracting RNs, we are less hopeful. Again, the nursing workforce has aged, and that could be a problem in the future.

What strategies do you see as being successful in combating the shortage?

I think a certain amount of attention is being paid to the work setting.

Frankly, we’ll still have a significant number of nurses, but they are moving more from the hospital into the outpatient setting.

Those settings are less stressful, which could improve the situation.

We’ve projected an increase of 30 percent in nursing homes and 44 percent in community health settings by 2010. I think the question is not so much that there will be a shortage [of nurses] but a shift in where they practice.

What will nurses be wearing?

I think a larger trend is an increased engagement of consumers with their health care, more of a consultative relationship with their physicians. So in that sense, the white coat and nursing uniform and trappings of the profession become less important, and the ability of the professional to relate to the patient in a way that meets their needs more important.

Also, in terms of ergonomics, much like the tools we use, the nature of the uniform and comfort are going to become more important in terms of the quality of the work environment.

Are there new skills that will be needed?

With the focus on primary care, the ability to take care of the entire patient – as opposed to a disease process or episode – is vital. We see an expansion of the definition of health care beyond disease management into the entire person.

Also, there is a need to be able to talk to people about their lives and to spend more time with them. In general, nurses have greater skill at that than physicians. Nurses are much better at customer service, and that is vital to their success in the future. There will be some monitoring that nurses have provided over time that will be augmented with technology, with an increasing use of sensors.

Nurses will be in more of an oversight position, managing that technology. They’ll have an entirely new set of technical skills related to that technology.

What are the most significant changes you see in nursing?

Certainly the shift in setting that I’ve mentioned, and the shift in technology, which will enhance that move. I think the role of patient education in nursing is a big one.

Patients are going to demand information about treatment options, the disease itself, and how they can engage and share decision making.

Nurses are going to play a bigger role in that. Their role as advocates will become one of the most significant things they do.