One Take on the Top 10 Issues Facing Nursing

By Shawn Kennedy, MA, RN, AJN editor-in-chief

So I’ve been in Dallas at the Sigma Theta Tau International (STTI) biennial meeting. The venue is the Gaylord Texan, a large, climate-controlled resort under a glass dome—as you leave your building and walk “outside,” you’re really not. Don’t believe the flowing stream or flowers or gardens (all real) along the walkways, or the Longhorn steer (fake) behind a fence that stands outside my building—you’re still inside. And to make it even more surreal, there are Christmas holiday decorations everywhere, including a gingerbread house the size of a small hotel room. It will be strange to step back in time to Halloween when I get back home.

A daunting list. There are a few thousand people here for the meeting, way too many sessions to choose from (20 different topics for each concurrent session period), plus rows of posters and exhibit booths. And of course, great networking. One lively session I attended was standing room only—and that’s after any floor space had been occupied by people sitting cross-legged. It was a discussion of the top 10 issues facing nursing, led by STTI’s publications director Renee Wilmeth (she’s not a nurse, which probably makes her less biased). The issues were compiled from responses provided by 30 nursing leaders, and were presented in question form:

  1. Is evidence-based practice (EBP) helpful or harmful? (Amazing how many interpretations there were of EBP, some of them—as I know from our EBP series—quite incorrect.)
  2. What is the long-term impact of technology on nursing?
  3. Can we all agree that a bachelor’s degree should be the minimum level for entry into practice? (General agreement here, despite concerns regarding the adequacy of financial support for achieving this goal.)
  4. DNP vs PhD: separate but equal? (Not much discussion—I think no one wanted to really get into this.)
  5. How do nurses get a seat at the policy table?
  6. How do nurses cope with the growing ethical demands of practice? (This generated the most discussion, especially around whether society should provide unlimited costly care to those whose personal choices contribute to their health problems.)
  7. How do we fix the workplace culture of nursing?
  8. What role do nurse leaders play in the profession?
  9. What are we doing about the widening workforce age gap?
  10. How do we make the profession as diverse as the population for whom it cares?

Your turn: would you agree that these are the ‘top 10’ issues? What’s missing? What’s here that shouldn’t be?

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2016-11-21T13:11:34+00:00 October 31st, 2011|students|11 Comments
Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.


  1. Top 10 (New) AJN Posts of 2011 « Off the Charts December 20, 2011 at 11:51 am

    […] It Depends What Business You’re In,” by Julianna Paradisi, artist/nurse/blogger, and “One Take on the Top 10 Issues Facing Nursing,” by Shawn […]

  2. Top 10 (New) AJN Posts of 2011 « Off the Charts December 20, 2011 at 11:50 am

    […] It Depends What Business You’re In,” by Julianna Paradisi, artist/nurse/blogger, and “One Take on the Top 10 Issues Facing Nursing,” by Shawn Kennedy Rate this: Share this:TwitterStumbleUponDiggFacebookLinkedInLike this:LikeBe the […]

  3. Vickie November 15, 2011 at 1:42 pm

    In the nearly 20 years of practicing as a nurse, wages have either stayed the same or decreased. Benefits have decreased. Responsiblities have increased. We are telling ourselves that we need more and more advanced degrees…will nursing then be valued? If we don’t value experienced nurses of all degree programs, why would any other discipline. When will we get a clue; lobby and apply pressure as a unified professional practice?

  4. Barbara Berg November 15, 2011 at 1:21 pm

    Missing! Patient Centered Care. The majority of floor nurses work in hospitals, home health, and hospice. Every time a hospital along with governing agencies seets out new guidelines and goals the administrators of the hospital develop the strategies and the tactical responsibilities lye on RN’s. RN’s have two roles: Independent, oversight and general care of the patient coupled with countless and repetative paperwork generated either technology or the old fashion way (leaving the nurse to basicaly document by exception because their isn’t time to document appropriately)–The second role is dependent, carrying out Physician orders

  5. JAR November 7, 2011 at 12:45 pm

    If we all had BSN’s many of these problems would take care of themselves—we are not all on the same page therefore, hospitals have to put us on the same page in the form of another policy that targets the least prepared. I look forward to the day when the profession understands the disservice it is doing to itself and patients by allowing such a spectrum of educational backgrounds.

  6. Alisha Miranda November 2, 2011 at 12:42 pm

    Bit of a constructive article that impacts the field of nursing. Though I’d be interested in seeing others who can respond with a more positive article, say Top 10 Advantages in Nursing – or the like. We’d be open to discussion about going more in depth in these issues as well if you’re interested. Either way, glad we stumbled upon this post!

  7. Jackie Larson November 2, 2011 at 9:35 am

    That’s a big concern, Kaye. It’s something we see a lot. Generally, the right policies are already in place, but they are not being practiced. Units and department become silos – creating different, unofficial policies they use as workarounds because the actual policies are not enforced, not understood, and therefore ineffective. I agree with you – the answer is usually not to add policies, it’s to educate teams and make common practice of the policies already in place.

    Jackie Larson – Avantas

  8. kayejmillerrn November 1, 2011 at 8:50 pm

    Policy, policy, policy. When administation wishes for something to occur or not to occur a policy is made. We have policied ourselves into corners with no escape. We are fighting our own created demons.

    Kaye Miller, RN

  9. Shawn Kennedy October 31, 2011 at 3:29 pm

    And one more thing that came up – a great quip from one attendee:

    “If you don’t have a seat at the table, you’re probably on the menu.”

  10. Jackie Larson October 31, 2011 at 3:19 pm

    Great list! #5 is a huge concern. Nursing needs a seat at the table. We find that one of the best ways to help nursing earn their seat is by leveraging BI tools. The language of the C-suite is Metrics. Being able to use data to prove your point will help you win the support you need to drive improvements in care and morale, which, in turn, lead to improved financial results.

  11. Medora S. McGinnis (@MedoraRN) October 31, 2011 at 1:20 pm

    Wow, what an amazing conversation that must have been. I think with both number 4 and 5, the undertone these days is that no one wants to talk about it – we’ve been talking about our RN entry levels for a while now (about 50 years?), and the differences (if any) between PhD and DNP might just be something folks don’t want to approach in a public workshop environment.

    One thing that has been extremely popular with up-and-coming nursing students is social media – how to use effectively, professionally, and appropriately, and if we should. Last week we held our National Student Nurses’ Association Midyear Convention in Memphis, holding several conversations and workshops on this very idea. We heard some interesting responses from our members, including the idea of avoiding social media all together; it’s interesting, though, that there are some clear benefits (such as professional networking and exposure) that can come from its “appropriate” use. I would add it to the list, for sure – the list of top 10 issues facing nursing… and student nurses.

    Thank you for sharing this conversation with us!

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