Critical Care and the Future of Nursing

In the rapidly changing environment of critical care, nurses have embraced the concept of lifelong learning and maintaining currency in practice. Critical care provides a rich opportunity to develop research questions, and the research skills embedded in a doctoral education are highly valued by critical care nurses. With this learning, nurses have stepped up to lead at the bedside and within health care organizations, and have actively sought participation in national policy decisions.

The IOM report noted that today’s complex environments of care, coupled with increasing acuity and vulnerability of patients, require highly skilled and well educated nurses. This is particularly true in acute and critical care. AACN has a long history of providing leadership in ongoing educational opportunities. Indeed, AACN’s dedication to supporting nurses in providing quality care to patients and families is reflected in the name of the annual conference, the National Teaching Institute and Critical Care Exposition (NTI).²  Every May, members gather together to share, to learn, and to rejuvenate their practice. Embedded in NTI is the Advanced Practice Institute, which focuses particularly on development of leadership and clinical expertise of advanced practice nurses. The enthusiasm and excitement at NTI demonstrate the level of commitment of critical care nurses to improving practice and to continued education.

Certification is another venue for demonstrating ongoing excellence in specialty practice. Certification validates knowledge, skills, and abilities beyond the scope of registered nurse licensure, and critical care certification is an honored tradition. CCRN, PCCN, CCNS, and ACNPC certifications make visible one’s competence in nursing practice, and increasing the numbers of certified nurses provides demonstrated benefits to patients and health care organizations.

Although continuing professional education and certification are important, academic preparation is vital to nurses making their fullest contribution to critical care in the future. The current educational level of bedside nurses and advanced practice nurses needs to be raised to enable nurses to keep pace with the demands of an increasingly complex health care system.

The IOM report advocates increased levels of education for all nurses by 2020, including a goal that 80% of nurses hold baccalaureate degrees, and that the number of doctorally prepared nurses double from the current 1%. Critical care nurses in particular need advanced education. Improvements in acute and critical care depend on well educated nurses who can identify problematic areas of care, generate new evidence for nursing practice, and incorporate evidence-based best practice to improve patient outcomes. A cadre of nurses with advanced degrees (including master’s and doctoral) will be essential to moving critical care forward. Mechanisms to streamline nursing education are needed. Articulated programs and valuing prior education are essential to move practicing nurses seamlessly through baccalaureate and graduate education.

The IOM report calls for nurses to be full partners in redesigning health care, including policy making. AACN has a long history of leadership in critical care that serves as a strong foundation for the future. For the past decade AACN has been part of the Critical Care Societies Collaborative.

This collaboration among the 4 major critical care professional and scientific societies brings AACN together with the American College of Chest Physicians, the American Thoracic Society, and the Society of Critical Care Medicine to present a strong and coherent voice for critical care. For example, in 2009 the Collaborative published an open letter to President Barack Obama advocating improvements in end-of-life care in acute and critical care settings as part of health care reform.³  Speaking as one, the Collaborative is a powerful voice for critical care practice.

Importantly, the IOM report highlights the fact that nurses need allies and advocates in addressing issues that prevent nursing from fully blossoming. Legislation must change to enable critical care nurses, including advanced practice nurses, to make optimal contributions. The IOM report notes that what advanced practice nurses are able to do after graduation varies widely based on the politics of geographic regions rather than on their abilities, education, or training. State by state variation in the scope of practice for advanced practice nurses creates difficulties that must be addressed.

Whereas nurses are instrumental in advancing these changes, the active support of interdisciplinary colleagues who value collaborative practice is also essential. Several key allies are already in place, including the IOM Committee and the members of the Critical Care Societies Collaborative. The IOM Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, led by Dr Donna Shalala, brought together highly respected role models to advocate for the nursing profession. The IOM is an important institution, founded within the National Academy of Sciences in 1970 to provide “independent, objective, evidence-based advice to policy makers, health professionals, the private sector, and the public.”⁴  Because of their independence, the IOM Committee could objectively report barriers to nursing education and practice, and make honest recommendations that transcend the current situation and discourage disciplinary territoriality. Our partners in the Critical Care Societies Collaborative can lend support to these important initiatives. Every nurse should cultivate interdisciplinary alliances that support the contributions of nursing.

So what are the next steps? Critical care nurses will gather this month at the AACN National Teaching Institute to celebrate their history, update their skills, renew relationships, and look to the future. The future of critical care nursing will be built on the firm foundation of our past: collaborative relationships with physicians and other health care professionals, a commitment to furthering nursing education and certification, and a passion for research and practice that will improve outcomes for our patients. Together with our partners we will create the future of critical care nursing.