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  • Consider how nursing is changing and how that affects the stress levels of nurses.

  • Consider how diversity (ethnic culture, tenure, age, and so on) in nursing is positive for the profession.

  • Consider what it means to be a “professional” nurse.

  • Explore how different nursing roles lead to different burnout rates.

  • Explore how to avoid boundary crossings.

  • Consider how to manage stress while on the job.

Nursing is the nation’s largest healthcare profession (Health Resources and Services Administration [HRSA], 2010). According to a report from HRSA, 2.6 million of all registered nurses, or 84.8%, are actively employed in nursing. The majority of nurses, 62.2%, work in a hospital setting, according to the 2010 Institute of Medicine (IOM) report on the future of nursing.


Nursing care is the core business in hospitals because people seldom are hospitalized unless they need nursing care and observation. If healthcare continues to change as is being predicted, the percentage of nurses working in the inpatient hospital setting will decline as the nation begins to shift from an acute-care focus to prevention and better chronic-disease management. The only patients who will remain in the hospital will be complex patients and those patients who are no longer acute but do not have a safe place for transfer.

Nurses will continue to be needed for those patients whose complex medical needs require hospitalization. The overall need for nurses is not expected to decline due to a “graying of the population” and the increase of patients with chronic disease. The focus on population health will expand the use of nurses in the outpatient, transitional, and home settings. Many of the changes to come are unknown and may produce anxiety and an underlying stress for nurses.

The Institute of Medicine (IOM) report on the future of nursing describes the major roles and responsibilities of nurses in the following major areas: direct patient care to teach and counsel patients; coordinate care and advocate for patients; and research and evaluate more effective ways of caring for patients (IOM, 2010). Even though one of the major responsibilities of nursing is direct patient care, nurses spend 80% of their time on documentation, medication administration, and communication with other providers. This leaves less than 20% of their time specifically for providing other types of direct care (IOM, 2010).

With implementation of the Affordable Care Act (ACA) in 2010, the United States has an opportunity to move to a higher-quality, safer, more affordable healthcare system by transforming the way healthcare is currently provided. The ACA is the biggest change in healthcare since the creation of Medicare and Medicaid in 1965. The nursing profession has the potential to play a major role in changes by virtue ...

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