Contemporary Nursing

Contemporary nursing is the evolving role of the nurse in treating patients in a technologically
advanced setting. In contemporary nursing, not only do nurses assume roles formerly ascribed to
doctors, they are held legally accountable as well.
Health care is challenging dramatically due to advancement of medical sciences and technology,
the abundance of clinical research and the higher demands of consumers. These changes
represent significant challenge to the nursing profession and nursing education in terms to
maintain quality of services and preparing nurse for future.
Effective system for regulation, education, research and management are keys to strengthening
the contribution of nursing services in order to achieve the required improvement in health
outcomes (WHO,2002).
The health care system continues to change as social and economic factors create a state of
constant evolution. Professional nurses respond by creating innovative alternatives to traditional
nursing practice to meet these new challenges. As nurses proactively define solutions to today’s
health care dilemmas, multiple career opportunities emerge.

Factors influencing Contemporary Nursing Practice

 Economics
 Changing family structure
 Legislation
 Science and technology
 Information and telecommunication
 Demographics changes
 Consumer demand
 Burden of non-communicable disease

Contemporary Nursing Roles

Traditional duties and responsibilities:
 Care provider
 Educator
 Counselor
 Client advocate
 Change agent
 Researcher
 Leader and manager
 Communicator

1. Caregiver
  Basic to the nursing profession.
 The nurse assesses client resources, strength and weakness, coping behaviors and the
environment to optimize the problem solving and self-care abilities of patient and
family.
 Provides physical and psychological assistance while preserving the dignity of the
client
 Care could be full, partial, or supportive-educative

2. Teacher
 The nurse teaches clients about their health and health care procedures that would
restore or maintain their health.
 Assesses the client’s learning needs and readiness to learn, set learning goals, enact
teaching strategies, and measures learning
 As teachers, nurses can teach subordinates to whom they delegate care.

3. Client Advocate
 Promoting what is best for the client, ensuring that the client’s right remains
important responsibilities of the professional nurses
 May convey the needs and wishes of the client to other health care providers
 Helps clients in exercising their rights and help them speak for themselves

4. Change Agent
 Identify patient and health care delivery problems, assess their motivation and
capacity for change.
 Determine alternatives and explore possible outcomes of the alternatives
 Assess cost effective resources in infinite health related situations.
 Assist clients to make modifications in their behavior for the sake of their health
 Make changes in the health care delivery system, such as clinical care if it is not
helpful to client.

5. Counsellor
 Emphasizes on health promotion and health maintenance rather than on management
of disease condition.
 Help clients to recognize and cope with stressful psychological or social problems.
 Provides emotional, intellectual and psychological support
 Encourage clients to look at alternatives, recognize their choices and develop a sense
of control in a rapidly changing health care environment.

6. Leader
 Influence others to work together to accomplish a specific goal. For example, a head
nurse can work with other new graduates to show them how to safely and effectively
administer blood transfusions safely and efficiently.
 Can work at the level of client, family, groups of clients, community and nation.

7. Manager
 The nurse manages nursing care of individuals, families, and communities
  Establishes operating goals and objectives
 Manages a budget.
 Concerns self with staffing and productivity
 Hires personnel
 Evaluates performance
 Delegates effectively

8. Researcher
 Becomes a principal investigator
 Use of research to improve client care
 Nurses should be familiar with the research and it’s each process
 Works as a member of a research team

9. Communicator
 Communicates with clients and other team members, nurses can identify problems
and communicate these to others members of health team to provide holistic care to
the patient.

The Changing Health Care Scenario

The health care delivery system is rapidly changing as society’s health need and expectations
have changes. The world’s elderly population has increased rapidly and will continue to grow
rapidly in future. Their health care needs are complex and demand significant investments, both
professional and financial by health care industry.
In the past, most nurses considered acute care hospitals the main practice setting available upon
graduation. Few other career choices were available. Public health nursing was one of the
exceptions, providing variety in the nursing job market. As health care moves from inpatient
treatment to outpatient and home care, and acute care shifts to health promotion and disease
prevention, our culture seeks alternative options to meet this growing need. The shift in health
care settings creates a variety of choices for nurses exploring career opportunities.
Societal and legislative factors are significant in the changes of health care. Because of
population changes, the need for health care for specific- age groups and for persons within
specific geographical localities is alerting the effectiveness of the traditional means of providing
health care and is necessitating far-reaching changes in overall health care delivery system.
Technologic advances have occurred in greater numbers during the past several decades than in
all other time periods of human civilization. Such technological and scientific advancements are
themselves precipitating rapid change as well as rapid obsolescence.
Nurses today have more liberty to explore and even create job opportunities. Nurses may
continue to select the hospital acute care setting into less traditional nursing roles. As
professionals, they should exercise their influence to develop and support new nursing roles.
In the past, describing the role of the RN was simple because there were few opportunities for
variation. Today exploring job opportunities for RNs is more complicated because nurses can
practice in literally hundreds of diverse settings with a broad variety of clients. The proliferation
of career opportunities for nurses is growing. Although nursing roles have expanded, the
traditional functions of nurse remain intact.

Some Advanced Nursing Roles

As trends continue toward shortened hospital stays and increased utilization of outpatient health
care services, the need for nursing care in home and community setting has increased
tremendously. Because nursing services are being provided outside as well as within the hospital,
nurses have a choice in practicing in a variety of health care setting: acute medical centers,
ambulatory care settings, clinics, outpatient department, home health care agencies, independent
or group centers and managed care agencies.
 Nurse practitioner
 Clinical nurse specialist
 Nurse midwifery practitioner
 Certified registered nurse anesthetist
 RN- first assistant
 Nurse case managers
 Nurse entrepreneurs- nurse led clinics
 Forensic nurse
 Hospice nurse
 Flight nurse ‘triage nurse
 Tele nurse
 Nurse legal consultant
 Nurse scientist
 Nurse administrator

Future of Nursing: Challenges

Due to demographic changes, it seems clear that the direction of travel is to get many more
nurses out into the community, so that there will be a lot of opportunities and possibly new roles
for nurses outside of an acute hospital setting.
The use of technology will become more ubiquitous, and hopefully there will be more nurses
involves in research.
The future for clinical research nursing is really exciting. We are continuing to grow the number
of studies and opportunities for patients to engage in research. The variety of work makes it
attractive to a diverse range of nurses who we are able to grow and develop. Our population will
continue to get older, and people will require skilled, dedicated professional to meet their health
needs.
Nursing will have a key role in promoting health and keeping people well as well as supporting
them during times of illness. We will be leading teams and working in many different settings,
using technologies we currently can’t imagine. Nursing will change again in the next 50 years,
but the fundamentals will be the same. And despite all the challenges it will be a great
profession. Different dimensions will be added to nursing in future which are as following.
1. Expanding Technology
There are many emerging technologies that will change the practice of nursing in the
coming decade. Seven are discussed here;

 Genetics and Genomics:

Benefits: the majority of disease risk, health conditions and the therapies used to treat
those conditions have genetic and/or genomic element influenced by environmental,
lifestyle, and other factors therefore impacting the entire nursing profession.
Challenges: many nurses currently in practice know little about genetics and genomics
and lack the competence needed to effectively counsel and teach patients in this regard.

 Less invasive and more accurate tools for diagnostics and treatment and more
accurate tools for diagnosis and treatment:

Benefits: Non-invasive and minimally invasive tools for diagnostics and treatment
generally result in lower patient risk and cost.
Challenges: the rate at which noninvasive and minimally invasive tools are being
introduced makes ongoing competency regarding their use as a challenge for nurses.

 3-D Printing:

Benefits: bioprinters, using a “bio-link” made of living cell mixtures can build a 3D
structure of cells, layer by layer, to form human tissue and eventually human organs for
replacement.
Challenges: healthcare is just beginning to explore the limits of this technology. There
are limits to the materials which can be used for printing and materials science is a
laggard in 3D printing (Nusca,2012).

 Robotics:

Benefits: robotics can provide improved diagnostic abilities; a less invasive and more
comfortable experience for the patient; and the ability to do smaller and more precise
interventions (Newell, n.d). in addition, robots can be used as adjunct care providers for
some physical and mental health care provision.
Challenges: more research is needed on comparative effectiveness of robotics and human
care providers. Many healthcare providers have expressed concern about the lack of
emotion In robots, suggesting that this is the element that will never replace human
caregivers.

 Biometrics:

Benefits: biometrics increase the security of confidential healthcare information and

eliminate the costs of managing lost passwords.
 Challenges: the measurements of biometric markers may occur in less than ideal
situations in healthcare settings and in a rapidly changing workforce, cost may become an
issue.

 Electronic Health Records:

Benefits: healthcare providers have access to critical patient information from multiple
providers, literally 24 hours a day, 7 days a week, allowing for better coordinated care.
Challenges: implementation costs, getting computers to talk to each other and debates
about who “owns” the data in the HER continue to challenge its required implementation.

 Computerized Physician/ Provider Order Entry and Clinical Decision Support:

Benefits: CPOE and clinical decision support fundamentally change the ordering process
resulting in lower costs, reduced medical errors, and more interventions based on
evidence and best practices.
Challenges: the introduction of CPOE and clinical decision support requires providers to
alter their practice. Resistance is common due to the time spent on order entry.
Implementation and training costs are often significant.

2. Computer Assistance
The computer revolutionized the nursing profession. Clinical and technological
advancements led to a nursing specialty called nursing informatics; the application of
computer and information science to promote and support the practice of nursing and the
delivery of nursing care. In addition to the routine use of computer- assisted technology
such as email, computers have many other applications in nursing.

 Nursing Administration:
Computers are used in the administrative areas of nursing for basic tasks that once
were done on paper. Staffing and scheduling systems are used to construct daily,
weekly or monthly schedules. Many scheduling systems also collect data on
individual employees such as the amount of sick time used or vacation hours
accumulated. Staffing and scheduling systems often provide a variety of reports to the
administrative nurse. Budgeting and financial tracking are another way in which
computers are used in nursing administration.

 Education:
Computers are valuable for patient and nursing education. Hospitals often use
computer programs to teach patients about chronic disease management or to provide
educational handouts. Preprinted documents such as discharge or preoperative
instructions can also be stored in the computer and printed as necessary. Nurses use
computers for a variety of continuing education programs as part of the re-licensure
process and can also complete educational programs on the computer to obtain
advanced degrees.
  Clinical Use:
Clinical application of computers in nursing are numerous. Physician prescribe
medications and treatments on the computer, and the nurse can either transcribe those
orders onto paper tools or print the paper documents for use in patient care. Staff
nurses can order medications or supplies on the computer, look up drug interactions
pr research medical condition. Many nurses use hand-held computers such as
personal digital assistants to communicate with physicians about patients in their care.

 Electronic Medical Records

Nurses use computers for documentation with an electronic health record or
electronic medical record. When an organization uses an EMR, all documentation
related to patient care, diagnostic testing, specialty referrals or any other aspect of
patient care or management are done on the computer. The computers can be
stationed at the bedside, used on mobile carts and might be in the form of a portable
electronic tablet that the nurse carries in lieu of the clipboard with paper documents.

3. New Threats to Health

Some future form of illness will require a multiprofessional approach. Many health
problems will result from the environment, poor waste disposal, ecological imbalances.
State of loneliness and population density may cause new varieties of
psychological/biological to stresses. Person may work in a more socially isolated
environment resulting from sophisticated technology. This form of care, properly
managed, will require clinical training at the doctoral level to produce the best outcomes.

4. Private Practices
The care of patients in hospitals of the future will be different. Only the acutely ill who
require all of the advantages of the hospital will be hospitalized. To keep pace with
technology, nurses will have to perform far beyond the level of technology. In all
likelihood nurses will be able to manage only one patient or very few patients under these
conditions. The closeness and constancy of interaction will change perceptions of the
capability of nurses because nursing care may be the prime need for hospitalization.
Nurses owned healthcare organizations also can satisfactorily and effectively deliver
health care services to the public. Nurse practitioners will provide a broad range of
diagnostic and treatment services to individuals and families.

5. Collegiality among Health Professions

Peers with trust and confidence in themselves and each other are the building blocks for
collegiality- the relationship of cooperative care giving hand on effective communication
and mutual respect. Collegiality levels the playing fields between physicians and RNs
and creates a healthy environment that fosters the best patient care. collegial interactions
are an important component of job satisfaction. When true job satisfaction is the norm,
employment ceases to be a job and becomes a calling. All clinical professions will find it
increasingly necessary to function as multidisciplinary unit. The movement toward
doctoral preparation for all will result in large overlap of knowledge content within them.
It may be that ultimately there will be mergers of professions and the reduction in
 number. The chief influence will be the state of scientific and clinical knowledge at the
time these may occur.

6. Change in Role Image

Nursing has the stigma of inertia; part of this inertia results from the role socialization
process. Many nurses have not undergone the role professionalizing processes of the
university-based professions. Nurses’ role socialization occurs, for the most part in
isolation from others in relatively restricted educational and clinical setting. Because of
the paucity of fundamental sciences, their preparation is more tasks oriented, with
emphasis on psychomotor skills rather than thoughtful analysis of the clinical scene.
Heavily entrenched ‘ward routines’ and procedure book ideology helps to condition them
to almost automatic behavior with little variation at any time. Role empathy, or taking the
role of other with all the insight is required, is a means of assisting easy communication
within the profession. It is essentially, a form of social fit in which all the role dimensions
are clear and each nurse can adjust with some degree of freedom instead of stereotyped
preconceptions. Nurses also need to use professional organizations to influence society,
instead as of a platform for a divisible debate.
Only professions that maintain high public trust can expect to wield strong social
influence in the affairs of health. This influence is not a condition granted in perpetuity
by society but must be earned continually and achieved by unstinting the effort by those
who make the profession a career. The image of nurses as a superb public resource would
be potentiated and recognized as a professional knowledge system able to keep current
with the burgeoning of scientific knowledge and human needs.

7. Unification of Education and Practice

Nurses in service roles and educators must work together to improve the educational
nursing environment. improvements may result in a higher percentage of nurses
extending their education. Besides a low number of candidates for higher degrees as
compared to all other clinical and scientific disciplines, nurses tend to further their
education at a later period in life. The bulk of persons earning their doctoral degrees in
most other professions and disciplines generally do so by their late twenties. They launch
their careers when they are older age of attainment, as situation that is not conducive to
building relationship strength. Clinical research that is a means of enriching practice
remains at a low level. The reuniting of education and practice is a powerful means of
enhancing the strength of the profession.

8. Self-governance
Self-governance is another means of consolidating professional pride, self-imagery, and
clinical visibility. Nurse faculty member generally function under self-governance
structures. Nurses who are in service agencies can use self-governance staff organizations
as an organizational device to consolidate the strength of nursing management with that
of the clinical vigor of the nursing staff. The rights, responsibilities and obligations of this
pathway should enable nurses to serve their patients through the standard emanating form
a unified effort. Participation in this endeavor can result in new vistas of self-direction
and augment the professional growth of each nurse.
 9. Lateral Mobility for Nurses
Another advantage of the clinical doctorate is that it permits the possibility of nurses
earning combined doctorates in the manner of M.D/Ph.D. programs. the combination of
scientific doctorate with the professional one results in use of wide range of content to
develop interesting research problems and to participate with an enlarged contribution to
multidisciplinary research. The image of nurses as a contributor to the scientific domain
would be strongly enhanced.

Trends that will affect the Future of Nursing

 Changing populations demographics and increasing ethnic and cultural diversity of
nursing.
 The technological explosion, particularly information and technology
 Globalization of world’s economy and society.
 Educated consumer, alternative therapies and genomics, and palliative care.
 Shift to population-based care and the increasing complexity of patient care.
 The cost of health care and the challenge of managed care
 The impact of health policy and regulation
 Nursing shortage
 Significant advances in nursing science and research.

References
• Pandey.K. and Bhandari.B. Texbook of Nursing Trends and issues.1 st ed. Nepal:
Samiksya Publication Pvt. Ltd:2073.
• https:// nursekey.com/contemporary-nursing-roles-and-career-oppurtunities/