A s 1995 progresses, the waves of change continue to beat mercilessly against the piers of the health care industry. We watch anxiously as the pilings of bureaucratic structures weaken. The relentless battering erodes the foundations of familiar institutions. Some have already fallen. Other waves, those of affiliation and merger, obscure our familiar vista of how we think health care should appear. The traditional hierarchy, our safe harbor, is being washed away. We feel ourselves floundering in these vast waves, powerless and angry, attempting to grasp at something familiar. Much of what is familiar to nurses is disappearing under the waves.
Nurses who have always looked to hospitals for essential experience, if not life long employment, are seeing these institutions struggle to survive. The potential for career development continues to shift away from the acute care settings into long-term, community, and home care. Nurses, educated and experienced in the nursing process, diagnosis and care plan development now are confronting models, often less well defined, which demand a systematic and simultaneous integration of both clinical and financial variables. The financial components involved in changing from episodic care into a capitated model are not only highly technical, but also urgent and increasingly inevitable. The national trend in utilization of unlicensed assistant personnel continues to increase in all practice settings, with little indication of abatement in the future. As we study the unpredictable and often erratic changes in health care during the past year, we may be tempted to react emotionally. A shared image of danger, whether actual or imagined, offers a powerful anchor to those who yearn for safety.
Powerful or not, evocative or not, the image is not wholly accurate. In its imperfection, it presents a potential threat. The analogy of the waves of change is useful in helping us understand our initial reaction of anxiety, powerlessness and fear when confronting major social and economic changes. This is a critical first step. But the analogy must offer something else to be complete. If we only see ourselves clinging to the rocks, struggling for a foothold or desperately battling insurmountable waves, then our image threatens to undermine not only our larger understanding of the issues, but also our role in shaping them.
Gerontologicalnurses, perhaps without conscious awareness, have important knowledge and experience with the waves of change. We must use our experience to help refine the analogy and with a clearer image, offer direction to those who feel overwhelmed.
Our ability to do this has been demonstrated repeatedly. Over ten years ago, as prospective payment moved patients out of acute care into alternative care settings - the sicker and quicker phenomenon - gerontological nurses were there to help restructure and redefine how care was provided to those patients. Gerontological nurses, particularly those in long-term care, have long standing, relevant expertise in training and coordinating care by paraprofessional staff. Gerontological nurses maintain highly developed assessment skills, mastery of teaching older adults, and practical knowledge of the tools and techniques required to function optimally within an interdisciplinary team. These skills are all required in existing and emerging capitated models. If we plan to master the waves of change, we can and must begin with all that we already know and do so well.
If we look more closely at the image, we will see something more. Along that uncertain shore or distant promontory, there are individuals laboring. They are gerontological nurses. Look again at the thundering waves and see the lighthouse they are building. Their work continues everyday, in every place health care is provided in mis country, in the world. Their success is by no means guaranteed or even acknowledged. Yet these nurses look neither for assurances nor for applause. They know that the future, whatever it may be, will be better served by the directing beam their lighthouse will project. The safe passage of innumerable people through the rough waves of change will be made safer, easier, because of the bright light offered by gerontological nurses.
May we always see the bright beacon, above the waves of change.