Big Challenges, Even Bigger Opportunities for Nurses in Today's Healthcare Arena


How healthcare is delivered in the United States continues to rapidly and dramatically evolve, with legislative, budgetary, and demographic realities all coming into play. The nurse’s role has changed, too.

Susan Hassmiller, PhD, RN, FAAN

Susan Hassmiller, PhD, RN, FAAN

Susan Hassmiller, PhD, RN, FAAN

How healthcare is delivered in the United States continues to rapidly and dramatically evolve, with legislative, budgetary, and demographic realities all coming into play. The nurse’s role has changed, too, as education requirements needed to practice successfully in this new arena have increased, and opportunities have expanded for nurses to assume executive and leadership roles. The nursing field also needs to contribute to the nationwide movement to build a Culture of Health to improve the health and well-being of everyone in America.

To garner some expert insight on these developments, Oncology Nursing News sat down with Susan Hassmiller, PhD, RN, FAAN, director of the Future of Nursing: Campaign for Action and senior advisor for nursing at the Robert Wood Johnson Foundation (RWJF) in Princeton, New Jersey.

Hassmiller explained that RWJF has devoted enormous resources to developing the capacity of the nursing workforce to help meet the demands of this new healthcare environment. In 2010, the Institute of Medicine (IOM) released a landmark report, The Future of Nursing: Leading Change, Advancing Health.1 The campaign which Hassmiller directs has since been working in partnership with the AARP at the national and state levels to move the IOM report’s 43 recommendations forward and prepare nurses for these new and vital roles.

A follow-on report, Advancing Progress on the Institute of Medicine Report—The Future of Nursing, was released in December 2015. This report outlines specific areas to accelerate implementation of the IOM recommendations 5 years since the IOM’s initial report: (1) Removing Barriers to Practice and Care; (2) Transforming Education; (3) Collaborating and Leading; (4) Promoting Diversity; (5) Improving Data. 2

Oncology Nursing News: What would you say are the most critical challenges facing the nursing profession today?

Hassmiller: If I had to put it in a sentence, I would say our greatest challenge would be to stay relevant. Care is transforming and shifting as we’re sitting here. There are large organizations looking to become even larger through mergers and acquisitions.

Nurses have to ensure that they are relevant, not only inside acute care facilities, which used to be our bread and butter. With healthcare transformation, more and more jobs are outside of acute care facilities, such as ambulatory care, public health settings, and office-based nurse practitioners. Nurses need to help build a Culture of Health by being well versed in prevention and wellness to keep people healthy in the first place. Nurses have to be willing to be great team players with the ability to provide care across the continuum, and this means having the right credentials, as more and more organizations are demanding that their nurses have a baccalaureate degree.

While we don’t currently have a national nursing shortage, regional shortages exist, and there are areas of the country where nurses cannot get a job—these are primarily associate-degree nurses, which underscores the need for more baccalaureate-degree nurses.

Another challenge, and it’s one we’ve always had, is to recruit nurses who are representative of the patients we treat, both in terms of gender mix and diversity. We also need to prepare more nurses to take on leadership roles.

Of all the challenges facing the nursing profession today, does any one in particular stand out?

I’ve been thinking about this topic for some time, and it’s a concern really for all healthcare providers; that is, being so technology-based—so dependent on their computer—that they’re not reaching out and caring for people as much as they used to. It’s a point underscored in a recent column that appeared in the New York Times by Teresa Brown, a registered nurse, “When Hospital Paperwork Crowds Out Hospital Care.”

I use a case example of my husband who was in a bad bicycle accident over the summer; he’s fine, but throughout his hospital experience, he pointed out to me how physicians and nurses were hiding behind their computers to make sure all the boxes were checked off. We’ve got to remember to keep caring, because that is why people trust us so much.

How would you assess the impact of the Affordable Care Act on nursing practice?

The Affordable Care Act (ACA)—healthcare transformation, generally—has ushered in many mergers and new laws, and with that, new job roles and responsibilities. Again, how that affects nursing is that we have to be sure to stay relevant as the ground is shifting beneath us. Nurses need to be there at the table, talking about the value of their role across the whole delivery of patient care spectrum. They can think broadly about the health and health care systems and bring their ideas for improving care to leadership tables. They also bring the patient’s perspective: they spend the most time with patients, and they are repeatedly ranked by Gallup as the most trusted health professional. This is a big emphasis of the Future of Nursing Campaign—ensuring that nurses have a voice.

The ACA also really depends on people who can think on their feet and be great team players. Although it’s great to have a niche level of expertise, nurses have to understand where their patients have come from and where they’re going to provide the best and most holistic care these days.

Many more people have insurance under the ACA, but nurses especially can have a big impact in informing the public about the importance of prevention: how to stay out of the hospital and to get their immunizations and cancer screenings, like mammograms and Pap tests.

Can you talk a little about scope of practice and why this is important for the nursing profession and the healthcare system as a whole?

The Future of Nursing Campaign for Action is working very hard on ensuring that every state in the country has modernized their laws around scope of practice. We believe that all nurses should practice to the top of their education and training so that patients have access to timely care. When a state does not have a modernized scope of practice law, it costs the system a lot more to provide the care, because physicians have to be paid to supervise the nurse practitioners. When nurses practice to the full extent of their training, it works best for consumers and the healthcare system. A lot of new nurse practitioners have been trained and educated in the past few years, and people do understand that nurse practitioners add value. It’s a very attractive profession to be in, providing primary and specialty care services, and nurse practitioners will be in demand in the years to come.

What are the benefits of nurse residency programs?

Research and evidence show that nurse residency programs matter and are very beneficial. Often, nurses will graduate from nursing school without all of the clinical practice experiences they need to hit the ground running. The problem arises, however, with who’s going to pay for these residency programs, and many facilities point to budgetary concerns; however, we do know that people who graduate from residency programs are more likely to stay, so this helps with retention.

For nurses who don’t have the opportunity be in a residency program, those who practice in a rural area for example, it’s so important to have a mentor and avail themselves of continuing education and professional development opportunities. When I started out in nursing, although I was working in an acute care setting, I also volunteered in a community health clinic.

With the population living longer, often with chronic conditions like heart disease and cancer, it is also really critical that nurses understand how to meet the needs of geriatric patients, and this includes giving the best oncology care possible.

How can nurses who practice in nonacademic settings become more involved in research?

I love it when nurses want to get involved in research projects. I don’t think you need a PhD to be a researcher. Nurses are part of research teams conducting clinical trials, but really any community or staff nurse can do research; all you need is an inquiring mind and a supportive supervisor. At a basic level, research involves simply having a question about how something could be better. You don’t have to be part of a large NCI clinical trial. You can get together with colleagues on your floor or among your peers in nursing professional groups. There are foundations like the American Nurses Foundation and RWJF, as well as community foundations, which will consider smaller research projects, as long as they are aligned with the foundation’s overall goals. For example, an organization may be focused on addressing cancer disparities and how to ensure that minorities are getting proper oncologic care.

What strategies would you suggest to nurses avoid professional burnout?

It breaks my heart when I hear that nurses are so incredibly stressed out that they leave the profession. We can’t afford to lose great people. First and foremost, nurses have to take care of themselves. We have to make sure that we eat right, that we exercise and take care of our bodies and our own mental health.

Then, we need to have mentors. I’m preaching this all over the country: everybody should be a mentor and have a mentee, no matter how young or old you are. We need to take care of each other. I was just on a mentoring call last night with someone I’m mentoring from Oregon, and we talked about all of the things that he is taking on. What are the priorities? Where could he, according to his own talents, give the most value? What would bring most value back to him? What are the tradeoffs?

If you feel like you’ve taken on too much at work, speak up. This isn’t whining. Make it evidence-based: “I can only be my best, if I give up ‘x’.” Don’t be afraid of delegating.

Looking ahead, how do you envision the future of nursing?

The 2016 Gallup Poll once again found nursing to be the most trusted profession. Nursing remains an extremely attractive career option. We’re there when children are born; we’re in the schools; and we’re there when people get sick and are facing life-threatening illness. We’re the translators, and we should be the translators—we need to stay in that care role. It’s very scary when a patient gets a cancer diagnosis, and we put ourselves in their shoes. That’s what earns us the most trusted rating every year, because we care.

Former US Department of Health and Human Services Secretary Donna Shalala, who led the IOM report working group, calls this “the golden age of nursing.” It’s a great career if you’re action-oriented and have solutions for healthcare. In fact, what attracted me to nursing is that I have an action-oriented heart. Nursing allowed me to care, to find solutions, and to give back.

We also have so many people coming back as second-career nurses because of the rewards. It’s a great time to be a nurse.


  • Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press; 2010.
  • Institute of Medicine. Assessing Progress on the Institute of Medicine Report: The Future of Nursing. Washington, DC: National Academies Press; 2015.

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