The trends and challenges in nursing practice in the 21st century

1. Seminar on Nursing Management:
Nursing Practice in the
21st Century: Trends &
Challenges
SPEAKER: PAMELA M. VEROY RN, MAN
NOVEMBER 18, 2018 @ DAVAO DOCTORS COLLEGE DAVAO CITY
9:00AM – 12 NN

2. NURSING SERVICE
“One of the most demanding work environments
across multiple industries, the nurse practice
environment is drowned with concerns over health
safety issues, including job-related injuries and stress,
physical assaults, threats, and verbal abuse.” -
(Henriksen, 2016).

3. Nurse Manager
 Nurse managers are recognized as leaders who
have the ability to create practice environments that
influence the quality of patient care, nurse job
satisfaction levels, and the achievement of
performance goals (Zori, Nosek, & Musil, 2010).

4. The primary goal of nurse managers
 The primary goal of nurse managers is to create a well-
structured nursing departments, ensure that the
organizational context supports the work of nurses, and
provide skilled coaching to assist nurses in maximizing their
performance processes to have positive combined effect
(Hackman, 2010).

5. Stated Questions?
 What are the issues and challenges in the nursing profession
in this current period?
 What changes takes place under the nursing leadership and
management?
 What transformation and scientific approaches that brought
light to the nurse leaders?

6. 1. Issues and challenges in the
nursing profession
Nursing practice in the 21st century faces a number of challenges, and
these are:
 1a.- growing population of hospitalized patients who are older and more
acutely ill,
 1b.- increasing healthcare costs,
 1c. - the need to stay current with rapid advances in medical knowledge
and technology. These challenges are complicated by an existing
 1d. - shortage of nurses, and aging nurse workforce

7. 1a.- Growing hospitalized elderly population and more
acutely ill
 The elderly, or those older than 65 years, currently represent 12.5% of the
U.S. population, and are projected to increase to 20% of the population
by 2030—growing from 35 million to 72 million in number (He,
Sengupta, Velkoff, et al., 2005).
 Targeting the care needs of the hospitalized elderly and awareness of
risks for illness-related complications are urgent concerns for managing
acute health care conditions in this population

8. 1a.- Growing hospitalized elderly population and more
acutely ill
 Half of the hospitalized adult were > 65 y.o.
 vulnerability to hospital-associated complications,
 A primary focus for improvement in health care is on
promoting patient safety and avoiding injuries to patients
(Institute of Medicine, 2001).

9. 1a.- Growing hospitalized elderly population and more
acutely ill
 A research conducted by Kleinpell, Fletcher, and Jennings
(2008) entitled: ‘Reducing Functional Decline in Hospitalized
Elderly’ examined hospitalized elderly with acute illness and
its impact from hospitalization.
 There is significant correlation in the functional decline of
elderly after discharge from hospital confinement.
 KEY POINT: Specialty geriatric nursing care can positively
impact elder care in the hospital setting.

10. 1a.- Growing hospitalized elderly population and more
acutely ill
A conducted study in Europe:
 To investigating the influence of frailty on access to health care
 Outcome: The frail elderly increase their primary and hospital care
utilization before the onset of disability.
 Nursing implications based on the evidence-based result is to promote
healthier aging and to reduce the burden on health systems.
Source:
Ilinca, S., & Calciolari, S. (2014). The patterns of health care utilization by elderly Europeans: frailty and its
implications for health systems. Health services research, 50(1), 305-20.

11. 1a.- Growing hospitalized elderly population and more
acutely ill
Nursing Labor Force Are Aging too
 Population ageing affects inflows to and outflows from the labor force.
 Groups entering the labor market are smaller due to the low fertility levels
in the last decades of the 20th century.
 Older workers = Baby boomers
 Population and labor force ageing as well as shrinking of the working-age
population make employment a key issue in policy responses to
demographic change (Population ageing in Europe Facts, implications
and policies Research and Innovation, n.d.).

12. 1a.- Growing hospitalized elderly population and
more acutely ill
 In the Philippines, the number of older people is increasing
rapidly, faster than growth in the total population (Perez,
1999, December).
 In one decade, this grew to 6.5 million older people or about
6.9% of the total population (national Statistics Office, 2000).
 The National Statistics Office projects that by 2030, older
people will make up around 11.5 % of the total population,
from 4.6 million (60 yrs. Older) in 2000.

13. 1a.- Growing hospitalized elderly population and more
acutely ill
In Philippines
- Elderly living in poverty (13.2 percent in 2015) – by Phil.
Statistics Authority
- Age discrimination “barriers to employment”
- Still a contributor to society
- - call centers
- - consultancy works (Professionals)
- But some begging on the streets.
- Nursing Implications: Family caregiving

14. 1a.- Growing hospitalized elderly population and more
acutely ill
 Many predictions in previous years had said that the Philippines is far
from having an aging population as the country is expected to get a
boost from a "young population."
 In 2014, for instance, a study by Moody’s Investors Service showed that
the Philippines will continue to enjoy the benefits of a young population
at least until 2030.
 The study predicted that the percentage of elderly people (65 and above)
in the Philippines will most likely grow to 4.9 percent by 2020; 5.6 percent
by 2025 and 6.3 percent by 2030.
Source: Commission in Population, 2018

15. 1a.- Growing hospitalized elderly population and more
acutely ill

16. 1b.- Increasing healthcare costs
There are five factors (Dieleman et al., 2017)
 population size,
 population aging,
 disease prevalence or incidence,
 service utilization, or service price related to health care spending
(exposure);
 changes in health care spending in the United States from 1996 to 2013
(outcome)
(Data on the five factors for 155 health conditions and six types of care
ambulatory, inpatient, prescriptions acquired in retail settings, nursing facility,
emergency departments and dental care)

17. 1b.- Increasing healthcare costs
Factors contributing to the increasing cost of health care services, and in
turn, health care premiums.
 • Greater Demand for Services
 • New Technology
 • Prescription Drugs
 • Cost Shift Due to Under-Funded Public Programs
 • Government Regulation & Mandates
 • Medical Malpractice Liability
Nursing Implication: quality nursing care vs health capital expenditures
Source: (Rising Health Care Costs What Factors are Driving Increases?, n.d.)

18. 1b.- Increasing healthcare costs
Philippines by Phil. Statistics Authority

19. 1b.- Increasing healthcare costs
Philippines
Healthcare cost
 More than half of out-of-pocket
(OOP) amounting to Php 186.6 or 50.1
percent went to pharmacies.
 Private general hospitals came in
second at Php 97.5 billion or 26.1
percent;
 followed by providers of ambulatory
health care at Php 50.3 billion or 13.5
percent.
Household got highest
contribution

20. 1b.- Increasing healthcare costs
 Conducted study – correlation between healthcare cost and nursing
service
 A study conducted to determine the connection between nursing
diagnosis and the use of healthcare resources. The result revealed a
significant correlation between expenses and all the demographic variables
(age, sex, type of healthcare affiliation, types of prescription charge) and
nursing diagnosis. The nursing diagnosis can provide information of the
utilization of healthcare resources (Company-Sancho, Estupiñán-Ramírez,
Sánchez-Janáriz, & Tristancho-Ajamil, 2017).

21. 1b.- Increasing healthcare costs
Philippines
 Blog: A compilation of health guide to reduce healthcare cost.
 The practical solutions for the Filipinos to reduce spending health
treatment in out-of-pocket (“The Ultimate Guide to Reduce Your
Healthcare Costs in the Philippines,” 2017).
Source:
 The Ultimate Guide to Reduce Your Healthcare Costs in the Philippines (2017, August). Retrieved from
http://www.moneygirlphilippines.com/ultimate-guide-reduce-healthcare-costs-philippines/

22. 1c. – Updating current & rapid advances in medical knowledge and
technology.
 The healthcare landscape is becoming more advanced and efficient, and
the field of nursing has adapted along with the advances technology
 Require education, training, and a period of adoption for nurses
 Evolving care delivery processes in such areas of the hospital
 = as intensive care units (ICUs), emergency/trauma treatment, and
recovery rooms have created a need for nurses with advanced clinically
and technically skills.

23. 1c. – Updating current & rapid advances in medical knowledge and
technology.
Health Technology (Betencourt, 2018)
 1. Vein Finding Tool
 2. Stethee “SMART” Stethoscope – FDA-cleared Stethee Pro features
technology to capture and analyze heart and lung sounds data via
Bluetooth thru smartphone applications (Apple iOS and Google Android
devices.
 3. Cheap Monitors Blood Sugar Levels - Its artificial intelligence algorithm
then triggers its software to either administer glucose or insulin via the
drip that a patient is connected to. The drip is connected to a screen. The
screen shows the metrics for the patient.
 4. Patent Monitoring System Reducing Fall Rates – ex. AvaSys Telesitter
video-observation system to improve safety and lower staffing costs.

24. 1c. – Updating current & rapid advances in medical knowledge and
technology.
Health Technology (Betencourt, 2018)
 5. Scheduling and Staffing Technology – Joe Novello (37-year-old Creator
and CEO) of NurseGrid
 6. The future of mobile devices – “The future of Healthcare: 2022 Hospital
Vision Study” (Betencourt, 2018)
 7. The 3D printing – e.g. Ian McHale, a senior at the US Steinert High
School created a blueprint for producing finger splints.
 = Prosthetics and implants can be 3D printed. Dutch surgeons replaced
the entire top of a 22 year–old woman’s skull with a customized printed
implant made from plastic.
 = Organovo Bioprinting functional human tissue. Successfully bioprinted
liver tissues already in 2014.

25. 1c. – Updating current & rapid advances in medical knowledge and
technology.
Telehealth/Telemedicine in Philippines
 Telemedicine is a multiplatform technology, which uses videoconferencing
facility, high-definition cameras, computers, among others, to remotely
consult with doctors or diagnose patients. High quality operation footage
and consultations rely on high-capacity research and education networks
like PREGINET.
 In the Philippines, doctors and medical practitioners can now diagnose
and examine patients in far-flung communities, geographically isolated
regions, or underserved areas via telemedicine, an interactive technology,
which runs through the Philippine Research, Education and Government
Information Network (PREGINET).
Nursing Implications: Nursing Ethics and Review of Patient’s Privacy and
Confidentiality

26. 1c. – Updating current & rapid advances in medical knowledge and
technology.
Research in Telehealth
- Recent studies in the emergency care setting,
utilization of telemedicine during patient triage has
demonstrated reduction in patient wait time and
improvement in patient satisfaction.
- Implementation of telemedicine in urgent care
settings may make triage faster and more efficient
and lead to similar improvements in wait time and
patient satisfaction (Aungst, 2018).

27. 1d. - Shortage of nurses, and aging nurse
workforce
 According to data from the Philippine Overseas Employment
Agency (POEA), 92,277 nurses have left the country to work
abroad since 2012. That's almost 19,000 nurses leaving every
year.
 This month, alarmed by the brain drain, The Philippines
Department of Budget and Management’s 2018 National
Expenditure Program, said there are over 20,101 vacant
positions for government health workers, mostly nurses.

28. 1d. - Shortage of nurses, and aging nurse
workforce
Factors:
- do not receive the benefits enjoyed by regular employees, such as 13th
month pay and hazard pay.
- Contractual worker for many years
- Low minimum wage for professional standard
Tony Burke, vice president of the OMNI College of Nursing stated:
“Filipinos, anywhere they go, they make it and they’re successful. Filipino
nurses and Indian nurses both have really good training and experience, but
adapting is the biggest difference,” Burke said.

29. 1d. - Shortage of nurses, and aging nurse
workforce
 The nursing shortage takes place on a global scale. Australia, the UK, and
the US receive the largest number of migrant nurses. Australia received
11,757 nurses from other countries between 1995 and 2000 (Kline, 2003).
 The Philippines is the largest exporter of nurses in the world supplying
25% of all overseas nurses .
 An average, there are about 30,000 Filipino nurses traveling to the U.S.
each year.
- Source: Matsuno, Ayaka (May 6, 2010). "Nurse Migration: Asian Perspective". docstoc.com.

30. 1d. - Shortage of nurses, and aging nurse workforce
Impact of Nurse Migration
 the most educated and skilled nurses
are the first to go abroad.
 According to a study led by former
Philippine Secretary of Health Jaime
Galvez-Tan, close to 80 percent of all
government doctors have become
nurses or are in nursing schools.
 There are roughly 9,000 doctors-
turned-nurses and 5,000 of all these
medical practitioners are now
working abroad.
Matsuno, Ayaka (May 6, 2010). "Nurse Migration: Asian
Perspective". docstoc.com.

31. 1d. - Shortage of nurses, and aging nurse
workforce
 Reasons of Decline of Nurses
 Imminent retirement of a generation of nurses (even stretching retirement
in much older age)
 40% of working RNs over the age of 50 by 2010 and nearing retirement
(Buerhaus, 2008)
 demand of nurses exceeded supply of 400,000 RNs 2020 lead to nursing
shortage rise at 500,000 by 2025 as demand of nurses increase 2% – 3%
a year (Buerhaus, Potter, Staiger, & Auerbach, 2008).
- Buerhaus, P., Potter, V., Staiger, D. O., & Auerbach, D. I. (2008). The future of the nursing workforce in the United States: Data, trends
and implications. Sudbury, MA: Jones and Bartlett. Available at http://www.jbpub.com/catalog/9780763756840/

32. 1d. - Shortage of nurses, and aging nurse
workforce
CHALLENGES IN NURSING MANAGEMENT
1. Generation Gap of Nursing Workforce
Title: Can I relate? A review and guide for nurse managers in leading generations.
An article review to enable nurse managers develop an understanding of the five-generation health workers
by defining the characteristics, general behaviors, strategies for the nurse managers to employ each
generational groups.
These groups are: Traditionalists (born between 1922 and 1945), baby boomers (born between 1946 and
1964), Generation X (born between 1965 and 1979), millennials (born between 1980 and 1995), and
Generation Z (born after 1995).
Outcome of the study was that; There are strengths in each generation. Key differences can be harnessed to
build stronger teams through comprehensive communication strategies, customized reward systems, and
workplace flexibility (Christensen, Wilson, & Edelman, 2018).
IMPLICATIONS: Managers can use Its intergenerational differences, the nurse managers can develop
harmonious environment that bridges generational differences and promotes workforce unity.

33. 1d. - Shortage of nurses, and aging nurse
workforce
CHALLENGES IN NURSING MANAGEMENT
Title: Values of generation Y nurses compared to generation X and baby boomers - A cross-sectional study
This conducted study answer its query with the assumption that there is an effect on the attitudes and
behavior of values between the 3-generations:
generation Y/mellineal (1981 - 1995) and generations X (1966 - 1980) and the baby boomers (1956 - 1965).
Results: The values of self-centredness, stimulation, and hedonism are of high importance to generation Y in
both self-assessment and outside consideration, tradition, conformity, and safety are considered less
important (Huber & Schubert, 2018).
IMPLICATIONS: In the sense of a transformational understanding of leadership, operative and strategic
nursing management must consider generation-specific differences in dealing with nursing staff.

34. Transforming Healthcare System in this 21st
century
 Article: Reimagine Health Care Leadership, Challenges and Opportunities
in the 21st Century
 Effective nursing leadership in a healthcare organization correlates with
staff job satisfaction, retention, turnover and quality of care.
 Nursing leadership development must be supported by appropriate level
of educational preparedness, and requisite set of competencies and skills
(Lee, Daugherty, & Hamelin, 2018).

35. Online Nursing Education
 The resource capacity in nursing programs has a direct impact on student
admissions and number of graduates who enter the nursing workforce.
 Online delivery of nursing education is identified as a solution to
expand nursing program capacity.
Source:
Russell BH. (2015). The who, what, and how of evaluation within online nursing education: state of the science. J Nurs
Educ,.54(1):13-21. doi: 10.3928/01484834-20141228-02.

36. Virtual Learning Environment
 Many higher education institutions use virtual learning environments
(VLEs) that has potential value and appropriateness
 Using VLEs for purposes beyond teaching and learning functions,
 providing a method of collecting data that has minimal costs,
 requires few resources,
 offers maximum flexibility,
 has apt technical support and engages participants.
Source:
Grech A, and Cassar M. (2018). Can virtual learning environments be used as research platforms? Nurse Res. doi:
10.7748/nr.2018.e1568.

37. Changes in Models of Care
 new healthcare models to meet the healthcare demands of the 21st
century.
 New models of care have emerged in recent years that could lead to
changes in healthcare delivery and the health professions workforce.
 assuming expanded roles for a broad range of patients in ambulatory care
and community-based settings
 Educational Redesign of Undergraduate Nursing Curricula
 Expansion of Nursing Research

38. Nurse Deployment Program
 Deployment programs are geared towards providing
Human Resource for Health (HRH) to areas of needs
– unserved and underserved for more effective and
efficient health service delivery.

39. Human Resource for Health (HRH)

40. Human Resource for Health (HRH)

42. THANK YOU

43. References
 Aungst, L. A. (2018). Can telemedicine improve triage and patient satisfaction in urgent care settings? Journal of the American Association of Nurse
Practitioners, 1. https://doi.org/10.1097/JXX.0000000000000117

 Babaran, C. (2016). PH healthcare facilities shift gears to telemedicine through PREGINET. Retrieved November 17, 2018, from
http://pregi.net/uncategorized/ph-healthcare-facilities-shift-gears-to-telemedicine-through-preginet/

 Betencourt, E. (2018). The Future of Nursing Technology Is Exciting. Retrieved November 17, 2018, from http://blog.diversitynursing.com/blog/the-
future-of-nursing-technology-is-exciting

 Caring for our senior citizen. (2017). Retrieved November 17, 2018, from https://www.pressreader.com/philippines/manila-
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
 Christensen, S. S., Wilson, B. L., & Edelman, L. S. (2018). Can I relate? A review and guide for nurse managers in leading generations. Journal of Nursing
Management, 26(6), 689–695. https://doi.org/10.1111/jonm.12601

 Commission in Population. (2018). Philippines moving toward aging population: Retrieved November 17, 2018, from https://news.abs-
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
 Company-Sancho, M. C., Estupiñán-Ramírez, M., Sánchez-Janáriz, H., & Tristancho-Ajamil, R. (2017). The connection between nursing diagnosis and
the use of healthcare resources. Enfermería Clínica, 27(4), 214–221. https://doi.org/10.1016/j.enfcli.2017.04.002

 Dieleman, J. L., Squires, E., Bui, A. L., Campbell, M., Chapin, A., Hamavid, H., … Murray, C. J. L. (2017). Factors Associated With Increases in US Health
Care Spending, 1996-2013. JAMA, 318(17), 1668. https://doi.org/10.1001/jama.2017.15927
 Hackman JR. (2010). Leading teams. In: Hickman GR, ed. Leading Organizations. 2nd ed. Los Angeles, CA: Sage Publications.

44. References
 Henriksen, J. (2016). An alternative approach to nurse manager leadership. Nursing Management (Springhouse),
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 Huber, P., & Schubert, H.-J. (2018). Generationsspezifische Unterschiede in den Werthaltungen von Gesundheits-
und Krankenpfleger / -innen – Eine Querschnittstudie. Pflege, 31(4), 203–211. https://doi.org/10.1024/1012-
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 Ilinca, S., & Calciolari, S. (2014). The patterns of health care utilization by elderly Europeans: frailty and its
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 Institute of Medicine (2001). Crossing the quality chasm: a new health system for the 21st century. Washington, DC:
National Academies Press.
 Kline, Donna S. (2003). Push and Pull Factors in International Nurse Migration. Journal of Nursing Scholarship, 35(2).
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Safety and Quality: An Evidence-Based Handbook for Nurses. Agency for Healthcare Research and Quality (US).
Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21328732
 Lee, E., Daugherty, J., & Hamelin, T. (2018). Reimagine Health Care Leadership, Challenges and Opportunities in the
21st Century. Journal of PeriAnesthesia Nursing. https://doi.org/10.1016/j.jopan.2017.11.007
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 Perez, A. (1999, Jul-Dec). Building an active, disability-free society for all. Human Rights Forum, 9(1).
 Perez, J. B. (2018). Total health expenditures grew by 8 percent in 2017. Retrieved November 17, 2018, from
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45. References
 Philippines is nursing a crisis. (2018). Retrieved November 17, 2018, from
http://www.asianpacificpost.com/article/8108-philippines-nursing-crisis.html
 Population ageing in Europe Facts, implications and policies Research and Innovation. (n.d.).
Retrieved from https://ec.europa.eu/research/social-
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 Rising Health Care Costs What Factors are Driving Increases? (n.d.). Retrieved from
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healthcare-costs-philippines/
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