“Ma'am, ma'am, how are you feeling?”
The nurse — wearing pale blue surgical scrubs, ID tag hanging from a chest pocket — had materialized as if by magic at the woman's side seconds after she fainted. The congregation at the Papillion church had gasped as the woman staggered and then collapsed. The nurse's ministrations — and those of a doctor who also rushed to the woman's side — calmed not only the patient but the worried churchgoers as well.
The episode was a vivid example of nurses' role in delivering health care.
“Nine out of every 10 letters or calls we receive are not about an MRI or other test, but about the care and regard shown by the nursing staff,” said Teri Tipton, vice president of patient care and chief nursing officer at Methodist Hospital.
Knowledgeable, capable and caring, nurses consistently rank in public surveys as the first or second most-trusted profession in the country. Yet retaining that personal touch is among challenges the profession faces as it copes with rapidly expanding technological advances, more elderly patients with multiple problems, and the financial and caseload implications of federal health care legislation.
Jane Carmody, vice president and chief nursing officer for Alegent Health, said nurses will be at the table for any discussion of the future of health care.
“They make up the largest segment of the health care work force. They understand the processes of care,” she said.
Despite a significant increase in the number of nurses who graduated during the last decade, even more will be needed in the years ahead. Demographics are partly responsible.
Every day, 10,000 baby boomers turn 65, Tipton said. Older patients generally require more care. Carmody said they don't have just one medical problem but two or three things wrong. Older adults often receive treatment in numerous settings — hospital, nursing home, physician's office — and then return home, where they frequently need complex care that only nurses can provide, she said.
Tipton said that means “we have to be on our game when it comes to understanding and serving the special needs of the older patient.”
Nursing has become a “vast profession,” said Timoree Klinger, executive director of the Nebraska Nurses Association in Lincoln, which has about 700 members who must at least be RNs.
The profession — once primarily made up of staff nurses who provided emergency or ongoing care in hospitals — has evolved into one that encompasses clinic nurses, nurse practitioners, practicing nurse midwives and nurse anesthetists, to name just a few specialty fields, Klinger said.
“Nursing went from being a support profession to some acting as primary caregivers now. ...There are fewer doctors in rural areas especially, expenses are climbing, and the nursing profession can provide health care services more economically,” she said.
Mandy Riedell, who graduated in April with a bachelor's degree in nursing from Clarkson College, will start her career in a Kansas City, Mo., hospital but eventually plans to become a family nurse practitioner or nurse educator.
Omaha's Clarkson College, one of nearly 20 nursing education programs in Nebraska and western Iowa, offers RN programs and advanced-degree programs such as nurse anesthesia and master of science in nursing.
Riedell, 22, comes from a family of nurses — her mother, grandmother and two aunts — so it's not surprising she chose the profession. Still, the nursing she will practice differs dramatically from that of previous generations.
“You wonder, ‘How did you get by?' without all of today's technology,” she said. “But it (nursing) has even changed a lot since I started school.”
Carmody said the purpose of the additional education and training available to nurses is to better serve patients.
“The exciting thing about advanced-practice nurses is that their roles are evolving. They are partnering with physicians to improve the quality of care and get care where it is needed,” Carmody said.
Tipton said the myriad nursing options available haven't created a shortage of staff nurses but do contribute to turnover.
A hospital might hire a nurse who excels at the job and then goes on to become a nurse anesthetist after a couple of years, she said.
“Hopefully, they come back to our organization,” Tipton said.
“We always have open positions. There are candidates available, but finding the person with just the right combination of education, experience and background might be difficult.”
Staff nursing isn't the only area where shortages are a concern. It has become more difficult to hire nurse educators to train students — because of the expanding number of nursing programs, because many teachers are nearing retirement age and because schools now want teachers who have a Ph.D.
The problem exists here, but it's worse on the coasts, Tipton said. “We need to address that in Nebraska.”
Other challenging unknowns include federal health care legislation, the constitutionality of which is under consideration by the U.S. Supreme Court.
Tipton said that if more people have insurance, there will be more people accessing care at all levels. However, payments to hospitals and other health care providers could decline, she said, so nurses will have to be mindful of financial performance and how to reduce waste and increase efficiencies.
“Twenty years ago nurses didn't have to have accounting or finance classes,” she said.
Carmody said Florence Nightingale — whose birthday May 12 marks the end of this year's National Nursing Week — is much more than the founder of modern nursing.
“She transformed health care,” Carmody said. “Nurses today are doing the same thing. They will be a key part to how it (federal policy) ends up.”
Pat Waters is a freelance writer who lives in Papillion. She writes occasionally for LiveWell the Magazine.