The future of nursing and health care: Through the looking glass 2030.

Abstract

The future of nursing and health care: Through the looking glass 2030 Dr. Loretta Ford in her Editorial last month (Ford, 2010) talked about creating a vision for the future. As we celebrate the 25th anniversary of the American Academy of Nurse Practitioners, we see that vision materializing over the next 25 years. Whatever awaits us in the next two decades in health care in the United States will involve a change in the way we conceptualize health, health care, and the roles of nurses, in particular nurse practitioners (NPs). Gazing into the crystal ball, we see a future bright with promise for Americans, all of whom will finally have access to health care. Health care will be a right, not the privilege of those lucky enough to be able to afford premiums out-of-pocket or through their employers. Those who have been covered by government programs—such as the elderly, dependent children, persons with disabilities, and pregnant women—will continue to receive care regardless of their employment status, that of their parents, guardians, or spouses, or their ability to pay out-of-pocket. We predict that the future will include single-party-payer health care so that our health care dollars will be spent as wisely as possible and we will not continue to spend more than one-third of our health care dollars on overhead costs (Centers for Medicare & Medicaid Services, 2009). Health care for all has long been the dream of many nurses and we predict it will finally become a reality in our lifetime. Nurses will still constitute the largest single group of heathcare professionals on the front lines and will have a profound impact on the quality and effectiveness of health care. They will be major players in the new healthcare system, both as leaders and as providers of care across all levels of care settings. They will be the ‘‘glue’’ of the healthcare system and remain the caregivers closest to the patient and assume a lead role in the effective use of information technology in the quality and efficiency of healthcare services. Nursing-sensitive care performance measures (National Quality Forum [NQF], 2009), endorsed by the Joint Commission for Transforming Health Care (2010), will be in place in all settings. Nursing informatics will be an essential role in new technology innovation (Health Information and Management System Society [HIMSS], 2009). ‘‘The future of nursing depends on a profession that will continue to perform an instrumental role in patient safety, change management, quality improvement, and usability of systems as evidenced by quality outcomes, enhanced workflow, and user acceptance.’’ (Robert Wood Johnson Foundation, 2009, p. 5). Nurses will play a leading role in improving health outcomes. Patients and families will have access to the best evidence-based health information, with health education services in tailored patientappropriate learning environments and formats. Patient education of utmost quality will enable patients and their families to manage their own health care. Nurses will be leaders in developing resources and addressing patient health literacy. All Americans will have a true, up-to-date, reliable personal electronic health record (EHR) that will be used by clinicians across disciplines in the provision of care. Providers will electronically access critical healthcare information in the event of a catastrophic healthcare emergency. Emergency room personnel will electronically access essential healthcare data on critically ill or injured patients. Communities will share data among providers to facilitate the efficient provision of care (Fried, 2008). All Americans will have a ‘‘smarter’’ healthcare home so that fragmentation and duplication of care will be minimized. The heart of this health care home will be a primary care provider who will coordinate care with the patient. Nurse practitioners and primary care physicians will be the primary care providers, the majority of these being NPs, already the largest group of primary care providers in the country. We will finally have achieved consensus on credentialing and establishing regulation for advanced practice nurses (Stanley, Werner, & Apple, 2009). We believe that the primary care provider will be a part of a team or network of providers, with interoperability of EHRs. Patients will carry their personal health records (PHRs) in their own portable electronic devices or retrieve the records through the Internet so that access to appropriate care will be as seamless as possible, regardless of location. Patients will own their records, rather than healthcare institutions or providers controlling these records, restricting access, and requiring that patients sign consent or release forms. Thus, patients will be able to grant selective access to healthcare professionals who need the information to partner with them in their care. Most patients will be well informed about their health issues and concerns through the health portals and other Web services such as the Mayo Clinic, Cleveland Clinic, and National Institutes of Health sites. Empowered by knowledge, the power in patient–provider relationships will shift to a partnership and more patient-centered care.