4 Challenges Nurses Will Face in 2018

Kathy Quan RN BSN PHN - 03/22/19

As 2018 gets started, we’re barely into it and there are already a couple of top issues facing nurses this year. The first involves a new law in New York requiring RNs to obtain a BSN or higher within 10 years of graduation. The second involves a shortage of IV bags due to the primary factory in Puerto Rico suffering damage in Hurricane Maria in September 2017. The third involves the rapid spread of the flu across the country. The fourth involves the increasing need for more experienced nurses. 

1. New York Requires RNs to obtain a BSN or Higher

Nursing is no stranger to continuing education, but the New York law is the first in a while to try to force the issue of a mandatory BSN. It has long been discussed and encouraged by the Institute of Medicine and American Nurses Association have advocated since 2010 for 80% of nurses to have their BSN by 2020. The ongoing shortage of nurses has often interfered and delayed the progress towards this goal. Despite the arguments, controversy and shortages, New York has moved forward and placed a law on the books. New RNs have 10 years from the date of graduation to complete the process which can normally be completed in as little as 18-24 months. Established nurses in New York will have to comply with the BSN order as well, but the time frame is not yet settled. Other states are watching closely. A few have legislation in various levels of the process.

Studies have continued to prove that the quality of patient care and evidence-based outcomes are improved when the percentage of BSN (or higher) prepared nurses are involved in the patient’s care. Arguments continue that BSN programs don’t prepare nurses for bedside and ‘real world” nursing care as well as ADN programs do, but BSN programs develop critical thinking and leadership skills that can have greater impact on mortality and improved outcomes.

No amount of nursing education prepares nurses for everything they will encounter in their career, and in order to keep up to date with changes, many states require 20-30 hours of continuing education every license renewal period.  Advancing education towards the BSN or higher can be counted towards fulfilling this requirement. Nursing is known as a lifelong learning experience and expanding the education and knowledge base serves to make better providers.

As 2017 closed out, nurses were voted by the Gallup Poll as the Most Honest and Ethical Profession in 2017 for the 16th year in a row. This isn’t just a nice accolade, it’s because nurses rise to the challenges and provide innovative answers. Meeting the challenges in 2018 will serve as a great example of this.

2. States Suffering a Shortage of IV bags

Nurses are fabulous at improvising and one of the biggest challenges facing nurses in 2018 is the shortage of IV bags. In particular the shortage includes small IV bags used to piggy back medications, vitamins and supplements. This creates challenges for the delivery of important medication especially in treating such problems as dehydration, and malnutrition from illnesses such as the flu and the associated GI symptoms that seems to be spreading quickly. Nurses have had to stand and slowly push medications through the IV line instead of hooking up a bag piggy back style and attending to other duties while the solution runs in. This is not just time consuming; it diminishes patient care. 

The factory in Puerto Rico was badly damaged by the hurricane in September 2017 and is still not operational. The FDA is attempting to get a couple of other factories approved and online to provide backup until the Puerto Rico factory is fully functioning. This will not be an overnight solution. And illness doesn’t wait! 

3. Influenza Outbreak Across the U.S.

According to the Centers for Disease Control and Prevention (the CDC), flu season has hit the entire continental United States all at once rather than sweeping from one coast to the other as it often does. The flu vaccine has been said to be less effective in preventing flu, but perhaps is working to lessen symptoms for those who have been vaccinated. The flu is said to be more virile and debilitating this year than in past years meaning even nurses are missing more days of work.

Seasonal illness such as the flu always presents challenges to nurses especially in the ED, the ICU, and on med/surg units. Additionally, nurses working in clinics, physician offices, home care and hospice are also dealing with near epidemic levels of illness not only among their patients, but their own staff as well. The frigid cold weather in parts of the country has not helped. Flu season in 2018 is already gearing up to be one of the most challenging that nurses and health care providers have dealt with in years.

4. The Need for Experienced Nurses 

Another challenge for nurses in 2018 is that improvising and innovation stem from experience. Newer nurses have possibly not had experience in some techniques that have long since been abandoned for newer technology such as manually pushing IV meds that may take 20-30 minutes to complete. Some medications are caustic to veins, painful to infuse and downright dangerous to push too fast. This is information that may be almost foreign to newer nurses. And so, we have the challenge of training and educating quickly in order to maximize the efficiency, quality and accuracy of the care as well as keeping up with the needs. That’s not an easy task and not all venues have the capability.

Some of the medications can be given via Gtube (if the patient has one in place) or NG tube if necessary when the IV route isn’t available. Once again, a nurse who’s not familiar with the procedure such as passing an NG tube can present a barrier or a slow down to care that hasn’t been an issue for some time.

Nursing is indeed a lifelong learning experience and you’re guaranteed to see something new on a regular basis. It might not always be something entirely new and exciting, but it can be something you’ve never experienced in your career. Sometimes we have to step back and take a page from older nursing books to work around problems presented. Continuing education may not always be about learning something entirely new.  Keeping an open mind and being willing to flex and learn on a dime is essential to long and successful career in nursing. We are quickly being reminded of this in 2018.