Even as more ambulatory care moves out into the community setting, what we’ve been seeing nationally is the continued need for acute care services. It’s especially going to be that way on the inpatient side, when you talk , or the need for a high level of emergency care. Inpatient professionals had been thinking in the past that everything labeled “inpatient” was going to go outside of the hospital. But what most of my colleagues see coming is a deeper intensity of acute care service.

Look at our aging population of patients, and there’s also been a big push for health and wellness on the preventive care side. Those factors are going to take more than a decade to have an impact on the acute care setting. You’ve got a growing elderly population, with who are going to need treatment. The less-acute cases can be treated outside of the walls of the hospital, but there’s also going to be a continued need, as the population ages, for a higher level of acute care on the inside.

Several years ago, the healthcare industry had a collective expectation that large numbers of nurses were all going to leave the workforce and retire. Due to issues in the economy, they didn’t [retire] in the numbers expected. But with the economic recovery, many health systems are seeing more and more retirements now, so they’re making some creative roles for those nurses to try and keep them on board. Helping to prepare newer nurses and keeping the experienced ones on in roles where, perhaps, they don’t have to do a lot of labor-intensive bedside care.

Q: Why has the thinking changed?

Q: Is the industry properly prepared for this?

Many organizations and health systems are recognizing these needs now from a values proposition, ensuring the appropriate care is in the right setting at the right time, with the right caregivers in place. Many of those services have been moving to the outpatient world and into the community. But we’re recognizing what the demands of those needing acute care will be in the next few years.

Q: Is there an effort being made to encourage nurses — ones who might be considering retirement — to keep them longer?

Q: How is the need for more inpatient care going to change soon?

Q: What about the need for nurses, specifically? Is there a danger of a shortage?

Q: What can be done to encourage nurses to take jobs in rural settings?

Q: Are nursing-degree requirements a fluid situation?

Q: Are there more specific areas where nurses are in a shortage?

On a couple of levels. Related to your previous question, from the Institutes of Medicine report that came out in 2010, it was determined at that time that the degree necessary for the nurses of the future would be their baccalaureate. But this is one of the factors that have made filling rural jobs difficult. This is where creative academic-practice partnerships come in, with two-year associate’s degree nursing schools and universities partnering with medical practices. This helps to guarantee that while nurses might be graduating from a two-year program, they’re also continuing on with their education, and doing so within the setting of a practice, so that they will achieve their baccalaureate degree. There’s also a need for APNs, particularly in the community setting. Many organizations are actively recruiting APNs. Rural areas are even struggling to fill openings for physicians, but they’re able to hire APNs to fill those roles in primary care. APNs are allowed more practicing privileges, depending on each state’s individual governing board, in terms of writing prescriptions or conducting medical tests.

Nationally, there’s an extreme shortage of nurses in critical care, emergency and ORs. Many healthcare systems are struggling to find enough experienced nurses to fill these roles. Recruiting newer nurses is something they can do, but it takes a significant amount of time to train those nurses and get them up to speed within their specialty.