"They are right," she said, "but they are the same old things we've always done. Everybody keeps talking about 'thinking outside of the box.' We throw those words around like it's something easy to do. We keep coming back to solving [the nursing shortage] the same way we've solved shortages in the past."

After she completed a fellowship at the Wharton School of Business in Pennsylvania, Sanford learned to think in a new way about the crisis: Start by looking at the future, then figure out ways to solve the problems.

Businesses have long used planning to stimulate new ways of looking at problems. Now, a number of nurses around the country are following suit. They are letting their imaginations run wild, coming up with visions right out of a "Star Trek" script. As a result, they say, they are seeing their profession in a new light.

"We had fun with this," said Lois Barry, MPH, RN, project manager for the Electronic Learning in Nursing Education project in Corpus Christi, Texas. Barry worked with nurse educators from three schools of nursing to develop four visions of nursing in the next few decades. The exercise was part of the creation of an online nursing curriculum for the schools.

Their scenarios included the dissolution of the board of nursing in favor of a "board of the healing arts," a "geographic registered nurse" who serves clients from a "blimp mobile" and a 102-year-old woman with an internal biotechnology chip that advises her to drink more orange juice when her vitamin C levels drop.

To create the scenarios, the group researched trends in nursing and looked at examples of scenario planning by futurist groups. "All of this is possible and all the technology is there," Barry said. "We were just letting go and envisioning what could be, what might be. We were trying to think way outside the box."

As a result of the planning, she said, the group thought a lot about how to produce a nurse that the world would need for the next 50 years. The scenarios showed them that RNs in the future will need to be adept at technology and prepared for more decision-making in the field.

"It helped us to decide where we needed to go in terms of an online curriculum," Barry said.

Group dynamics play an important part in scenario planning, too, with each person bouncing ideas off the others, said Marge Hegge, Ed.D., RN, director of the South Dakota Colleagues in Caring Project at South Dakota State University.

Her group of 22 nurse leaders worked with Art Kleiner, a facilitator who has done future scenarios for other professionals. He asked the group to create some possibilities, then asked them, "Is there any other way this could be done?"

Once they loosened up, the ideas got wilder, Hegge said. On the fourth day of the workshop they came up with a "hip cruise." Wealthy people who needed hip replacements would take a cruise on a luxury ship with spas and hair salons. They'd have the surgery the first day. On the second and third days they would work with physical therapists, get tans, sit in deck chairs and talk with their built-in support group, come home "a million dollars later and be good as new," Hegge said.

Sanford and four other nurse executives in her program at Wharton decided to begin their planning by looking at population statistics. They made a startling discovery. With 77 million baby boomers, followed by two generations of 44 million people, "there's no way that we'll have enough nurses to continue to do things the way they are now," Sanford said.

In fact, all of society will be dealing with a shrinking workforce in the next 20 years, she said. "No profession will have enough people."

Using those numbers as their starting point, Sanford's group began envisioning different possibilities for nursing. Through their research, they concluded that out of necessity, technology would have to do many things that nurses do now. "When we turn to technology, it's like a circle," she said. Technology will do the job because there aren't enough people, and then the people won't be needed.
But the group did not believe nursing would become obsolete. "I do think there will be enough jobs for anyone who wants one in health care," Sanford said. "I think nurses will be doing more psychosocial stuff, talking to people about how they feel about things, making sure people don't feel discouraged with all the machines around them."

Like the future, visions of the future constantly are subject to change, Barry said. When her group developed its scenarios about a year ago, a nursing shortage was not much in the picture, she said.

"If we did the scenarios today," she said, "it would be a different ball of wax."

Here is an example of one scenario written by nurses as part of the Electronic Learning in Nursing Education project:

2030-RN as organizer

The Jones family lives in Bishop, Texas. Mr. Jones, while at home, cuts his right hand. It is bleeding profusely. He goes into his office and dials the geographic registered nurse to determine a course of action. Rebecca, the nurse, who owns the Coastal Bend Health Corp. and is familiar with the Jones family, has facilitated health-related care for this family since 2020 on a contract basis.

In her "blimp mobile," she views Mr. Jones' hand and directs his wife to give emergency treatment, which will prevent and limit infection.

Previous strategies and services for the family included education about strategies for longevity, a family timeline for strategies, quarterly consultation for evaluation of implementation of strategies and redesign plans.

Rebecca is skilled in the operation of telemedicine technology in negotiation of client service with direct caregivers, insurance companies and health care agencies.

A visual image of Mr. Jones' hand is sent to an orthopedic surgeon for further analysis of the extent of the injury and a suture robot is sent to Bishop to sew Mr. Jones' hand.