• The future is both predictable and uncertain.

• Current and predicted trends can be seen in factors such as population, demographics, social forces, economics, technology, and business.

• Nurses can work proactively to build a new and better future.

• Gatekeeper – Refers to a primary care physician who regulates the patient’s entry into the health care system for HMOs. The gatekeeper is at risk for a portion of the person’s health care costs.
• Multistate regulation of licensure – A process to facilitate practice of medicine or nursing across state lines without application for multiple state practice licenses

• The current emphasis is on acute conditions that short-term hospital stays, and insurance coverage for entry into the system.
• The heath care system has little to offer persons with limited financial resources, and yet 4.5 million Americans have no health care coverage.
• There has been a shift in the location of care from the acute care institution to the community.
• The future emphasis will be on wellness rather than illness.
• What does the future hold?
• A continued shift to community settings and an increasing variety of services begin offered.
• Quick and efficient access to comprehensive health services.
• Satellite centers and mobile health units that provide access for hard-to-serve populations, with Advanced Practice Nurses designing and administering such centers.
• Local, regional and national boundaries for the provision of health care will blur.

• The American Health Care System is combining business practice with managed care guidelines. Managed care efforts will continue to grow.
• Increased regulation and oversight can be expected for all health care services.
• The typical health care consumer will be increasingly informed and demanding.
• Quality of life issues will take center stage, such as cloning, gene manipulation, euthanasia and anti-aging treatments.
• Alternative offerings such as herbal remedies, therapeutic touch and massage will become a part of mainstream practices.
• Emotional, mental and physical management will increasingly be approached holistically.
• Trends Influencing Future Health Care in the United States include:
• Demographics
• Social forces
• Economics
• Technology

Physicians

• It is predicted that medical schools will produce 33% fewer specialists in order to maintain current physician-to-population ratios.
• Medical schools are decreasing enrollment and limiting the number of residency positions.
• These cuts are contrary to projected trends and seemed to be aimed at protecting earning power by ensuring a specific ratio of physicians to clients. This may however benefit the nursing practice as it continues to expand and advance.

Nurses

• A nursing shortage looms on the horizon with schools of nursing showing a steady drop in enrollment.
• The complexity of nursing is also increasing, as are nursing roles, responsibilities, and accountability. These will all demand greater education.
• The need for nurses prepared and certified for advanced practice will expand as nurse-managed clinics, nurse-run outreach centers, and tele-nursing practices grow.
• Providing community-based health care to clients across state lines is part of the new health care system termed – multistate regulation of nursing practice.
• Utah became the first state to pass a law allowing its nurses to practice across state lines without obtaining additional licenses.
• As of 3-3-2000 North Carolina, Maryland, Nebraska, Arkansas, South Dakota, Texas, Utah & Wisconsin have enacted the Nurse Licensure Compact. It has also passed the House in Mississippi is currently on the Senate Calendar. For the most recent updates visit this link http://www.ncsbn.org/files/mutual.asp
• One drawback to this initiative is the tracking of the rules and regulations in different states. Nurses need to know what they can and cannot do under the regulations of the state or states in which they practice.
• Increased cultural competence will be needed. Nurses will treat a more culturally diverse, aging population with increasing numbers of chronic conditions.
• Nurses will be increasingly involved in case management and helping the consumer to evaluate, choose and access needed health care services.
• Autonomy, responsibility and accountability will continue to grow for nursing.
• Literacy for computers and computer skills will be needed and will make work easier for nurses.
• Internet offers instant access to information.
• Technological advances will allow monitoring, diagnostic testing and complex procedures in the home.
• Nursing education will use community-based setting as their primary site for clinical practice and colleges will have branches in other countries.
• Teachers will be student-centered.
• Part-time nursing programs as well as evening/weekend programs will increase.
• Curriculums will be learner-friendly and process-oriented rather than content-directed (finally!).
• Learning will be part of an ongoing career, rather than a static occurrence.
• Technology has created mechanisms that make long distance learning and computer classrooms a reality.

The profile of the nurse of the future

• Community-based
• Versatile
• Computer competent
• Resource expert
• Culturally competent
• Bilingual or multilingual
• Critical thinker
• Outcome-oriented
• Skilled case manager
• Communications expert
• Autonomous and independent
• Coordinator
• Collaborator

• Wellness and the development of human potential will be the focus of health care.
• Consumers will actively participate in health care decisions.
• Access to quality health care will become available to all & demands from consumers will be ever-increasing.
• Care will be equitably extended to minorities, women, children, the old, the poor, the homeless, to the immigrant, the migrant farm worker, the refugee, the disabled, the chronically ill and the mentally ill.
• Worldwide health problems are expected to lessen in severity.
• Wellness for all and the development of every individual’s human potential.

The majority of materials presented here are direct quotes from the following reference:

Ayers, RN, MN, Ph.D, Martha. 1999. Community-Based Nursing Care: Making the

Transition. New York: Mosby. ISBN 0-8151-1339-0

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