VitalsSchool of Nursing

Top 10 Trends

of the Nursing Profession
As the largest profession in health care with more than 4 million registered nurses nationwide, the nursing profession has adapted in innovative ways to address the health care worker shortage and a shift in the health care landscape due in part to COVID-19.
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Registered Nurse Specializations Increase

Obtaining state licensure is required for nursing practice, and, while certification is not, the number of certified nurses has increased exponentially over time, according to Tiffani Wise, DNP, CNE, (Nursing ’10, ’08) regional dean for TTUHSC School of Nursing in Dallas, Texas. “Nurses graduate as generalists,” she added. “However, certifications allow you to advance expertise in specific niches of nursing that make you a better, more knowledgeable provider in whatever field you decide to pursue.”
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According to the American Nurses Credentialing Center, certification affirms advanced knowledge, skill and practice to meet the challenges of modern nursing, which is attractive to employers.

“I began my nursing career in the cardiovascular intensive care unit,” added Wise. “It was highly encouraged at my hospital to obtain certification in critical care, and I believe the majority of hospitals are looking for certified nurses or nurses working toward certification, so pursuing this option makes nurses marketable.”

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The Nurse Entrepreneur

In 2013, the Dallas Morning News reported 200 nurse-owned practices and clinics in Texas. Though there is no exact number today, the American Academy of Nurse Entrepreneurs, founded by Veronica Pike, MSN, FNP-C, (Nursing ’12, ’09) now boasts more than 3,500 members, most of whom are in Texas.
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“When I opened my practice in 2010, there were only two nurse-owned clinics in my town at the time,” said Tamara Bavousett, DNP, RN, (Nursing ’10, ’04, ’01) owner of Compass Pediatrics in Odessa, Texas. “Today, there are at least six.”

Nurse-owned outpatient clinics have become more common to increase health care access. Compass Pediatrics’ service area encompasses a region beyond Odessa, stretching from Seminole, Texas, to Fort Stockton, Texas.

While nurse practitioners do not have full practice authority in Texas, legislation has relaxed.

“Before, the physician had to be in the office with you,” Bavousett added. “Now, they don’t have to be on-site; you just have to have a physician contracted with your clinic as the supervisory authority.”

As a self-proclaimed “health care entrepreneur,” Pike says that nurse business owners are more critical than ever. “Now that I am well-versed in how to start and grow a health care business, I coach other nurse practitioners to do the same,” she added. “More nurse-led entities can only make our health care delivery better and more efficient.”

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Nurse Case Managers

According to the Centers for Disease Control and Prevention, six in 10 adults have been diagnosed with a chronic disease in the U.S., making nurse case managers vital to the health care industry. Nurse case managers can establish and facilitate long-term health care plans for these patients.
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“It has become harder and harder to navigate the health care system as it’s become more complex, and the pandemic has not helped with this,” said Jean Hood, BSN, RN, clinical department administrator for the TTUHSC School of Nursing Larry Combest Community Health & Wellness Center. “If we don’t support our patients by coordinating their care, it’s unlikely they’ll follow through with appointments crucial to maintaining their health.”

Facilitating health screenings is a key responsibility of nurse case managers. The Larry Combest Community Health & Wellness Center nurse case managers ensure their patients have routine screenings such as mammograms and colonoscopies. The center also has added social determinant screenings to its processes to optimize its holistic health care approach.

The impact and improvement of the center’s health care have been noticeable since the social determinants screenings became part of the process.

“Now, if we advise a diabetic patient to eat three meals a day plus snacks, and the social determinants screening tells us they don’t have the ability to buy food, we’re able to find options for this patient improving their overall care,” added Linda McMurry, DNP, RN, (Nursing ’10, ’04) professor in the School of Nursing and clinic executive director.

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Nursing Shortage, Tripled

“I have been a nurse for 48 years; there was a shortage then, and there’s a shortage now,” said School of Nursing Dean Michael Evans, PhD, RN. As the general population increases and ages, nurses are more in demand than ever. According to the Texas Workforce Commission, there are currently 23,000 more unfilled jobs in Texas than registered nurses seeking to fill them. By 2030, Texas expects a nursing labor shortage of more than 71,000.
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Facilities that do not keep up with workplace conditions and maintain worker empowerment will lose their nursing workforce, Evans added. “In 1983, there was a study commission by the American Academy of Nursing that stated there was a nursing shortage in every hospital in the nation with the exception of 49 facilities,” Evans said. At those facilities, rather than a shortage, there was a waiting list of nurses who wanted to work there, so the study was commissioned to explore reasons for the magnetism of these hospitals. Thus, the American Nurses Credentialing Center Magnet Recognition Program was born.

To become a magnet hospital, you must exceed expectations in multiple factors of magnetism. Factors such as the quality of nurse leadership, solid structure and processes, empowerment of staff, professional conduct, quality improvement, and quality of employee care are all considered for a hospital to achieve magnet status.

TTUHSC School of Nursing is also responding to the shortage. “When I first started here 10 years ago, the total number of students enrolled in the school was 1,300,” Evans said. “Right now, we have 2,000. We’ve grown considerably and in a smart, methodical way that produces high-quality nurses in a higher quantity than ever before.”

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Self-Care is Health Care

Over the past year, 83% of nurses report a negative impact on their mental health75% of nurse leaders report the emotional well-being of their staff as their No. 1 challenge, according to a survey by Vivian Health, a job marketplace platform for health care professionals.
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  • Three-fourths of nurse leaders report the emotional well-being of their staff as their No. 1 challenge, according to the American Organization for Nursing Leadership.
  • Sixty-five percent of nurse leaders say that the current level of staff burnout is not sustainable, according to the New Mexico Organization of Nurse Leaders.
  • Forty-one percent of nurse leaders report concern at the levels of anger and anxiety they are seeing among staff, according to the Association of California Nurse Leaders.
  • Sixty-six percent of acute and critical care nurses have considered leaving nursing after their experience in the pandemic, according to the American Association of Critical-Care Nurses.
  • Sixty-three percent of nurses do not believe the health care system makes a priority of their mental health and well-being, according to Trusted Health, a health care staffing agency.

These are staggering statistics. Add to this the fact that traveling nurses are making three times what an advanced practice nurse earns, according to Kelli White, MSN, FNP-BC, a nurse practitioner in Abilene, Texas, it’s become apparent that nurses’ well-being needs prioritization.

“We’re seeing some major positions opening up at our bedsides and especially in COVID-19 units,” said Ronda Mintz-Binder, DNP, CNE, associate professor in the TTUHSC School of Nursing Doctorate in Nursing Practice and RN to BSN programs. “The shortage causes the nurses that are still there to work more shifts, incentivized by more money, but then they burnout quickly from the strain.”

Experience is a factor, too. Mintz-Binder said the more experienced nurses handle stress and strain better than new nurses starting in a pandemic. “The experienced nurses have developed coping strategies and have seen a lot of things in their career, but the newer nurses start out with a shock to their systems,” she added.

As a nurse scientist, Mintz-Binder has a collaborative relationship with Methodist Mansfield Medical Center — an off-campus instructional site for TTUHSC — where she has witnessed a prioritization of well-being for nursing staff.

As part of her research, Mintz-Binder provided nursing staff with lavender inhalers and taught them relaxation techniques such as breathing and coloring. The nurses were allowed options for their relaxation break as long as they committed to doing something every shift for eight weeks. Study results revealed an increase in resiliency and work satisfaction among the nursing staff, so the hospital implemented a protocol for mental wellness while on shift.

“They have a tranquility room for nurses to take a 10- to 15-minute mental health break,” she said. “They give their phone to another nurse who covers their patients for their break time, and it has really made a difference in their working environment and quality of productivity.”

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Online Education

Enrollment in the TTUHSC School of Nursing Doctor of Nursing Practice and Master of Science in Nursing programs have increased over the past four years from 46 and 726 students in the 2016-2017 academic year to 126 and 806 in 2020-2021, respectively. According to the American Association of Colleges of Nursing’s annual survey in 2020, 445 RN to BSN programs — 64% of polled participants — are now offered entirely online.
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“Since I’ve been at TTUHSC School of Nursing, we have offered distance education programs,” said Emily Merrill, PhD, (Nursing ’94) associate dean for TTUHSC School of Nursing. “Over time, I’ve seen students and faculty acclimate to it and use it to create some amazing educational programs.”

Without online programs, Merrill added, nurses would struggle to advance their education and patient care skills— online education allows the opportunity to never stop learning. For this reason, in combination with trend No. 6, the TTUHSC School of Nursing offers the majority of its Doctor of Nursing Programs 100% online, barring clinical rotations.

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Doctoral Education on the Rise

The American Association of Colleges of Nursing reports an increase in Doctor of Nursing Practice programs — from 50 in 2007 to more than 350 in 2019. There are currently 357 DNP programs at nursing schools nationwide and an additional 106 in development. These programs are available in all 50 states plus Washington, DC. Texas is in the top nine states for the most programs at 51.
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“There is a great need for doctoral education,” said Emily Merrill, PhD, (Nursing ’94) associate dean for TTUHSC School of Nursing. “Due to the complexity of health care, the advances in scientific knowledge and demands for clinicians to have a high level of education in both science and nursing, it is advantageous to pursue a doctoral degree.”

According to report by The Future of Nursing: Campaign for Action, a nationwide initiative — founded by the Robert Wood Johnson Foundation, AARP Foundation and AARP — designed to harness the power of nursing to help all Americans lead longer, healthier lives, 1,282 nurses obtained doctoral degrees nationwide in 2010. In 2020, 9,158 nurses obtained doctorates.

“We’ve seen this trend for a while now, and students have been more interested in our BSN to DNP program,” said Pat Allen, EdD, RN, CNE, professor in the School of Nursing. “Ours was the first program to be approved in Texas and one of a few in the state with a telehealth course.”

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Telehealth Builds Momentum

Telehealth practice in the nursing profession initially involved nurses connecting with patients by telephone to ensure access to care. It has since evolved into clinical evaluations via online technology, monitoring patient status remotely, and telephone access is still heavily utilized to triage patients. The pandemic pushed telehealth to the forefront of clinical practice in early 2020. While telehealth visits skyrocketed globally during shutdowns, they have now stabilized at a level roughly 38 times higher than pre-COVID, making telehealth even more important to the nursing profession, according to a report from CB Insights, which is a company that provides national technological insights.
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“If you look at current health care job postings, many of them are telehealth positions,” said Joanna Guenther, PhD, associate professor in the TTUHSC School of Nursing Department of Nurse Practitioner Studies. “As adjustments were made to legislation to allow telehealth practice in the beginning of the pandemic, consumers and practitioners have adapted well.”

For a deeper look into TTUHSC’s involvement with telehealth, read “Telemedicine’s Perfect Storm” in the Winter 2021 issue of Pulse.

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Nursing Advocacy

According to, there are 100 national organizations, and 14 in Texas, dedicated to nursing advocacy.
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“I’m involved in two organizations that are very active in policy,” said School of Nursing Dean Michael Evans, PhD, RN. “Many of our organizations are based in Washington, DC, which is by design as the location gives them access to legislators and government officials.”

One of the most significant areas of advocacy close to home is mandated physician supervision of nurse practitioners. “In Texas, we are losing nurses to other states because nurse practitioners aren’t allowed open practice,” Evans added. “They do exactly what primary care physicians do and are necessary to the overall provider shortage happening in our country.”

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Moving out of the Hospital Setting

Along with the rise of nurse specialization comes the diversity of practice settings. While the National Nursing Workforce Survey reports that 55.6% of nurses still practice in the hospital, the number has decreased compared to 56% in 2013 and 62% in 2008 — reported by the Health Resources and Services Administration. Other nurse practice settings include correctional facilities, outpatient clinics, schools, home health and entrepreneurship, etc.
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One such outpatient clinic is the TTUHSC School of Nursing Larry Combest Community Health & Wellness Center. “When we started this clinic 15 years ago, we were seeing 300 patients a month with two nurses on staff,” said Linda McMurry, DNP, RN, (Nursing ’10, ’04) professor in the TTUHSC School of Nursing and clinic executive director. As of press time, the clinic averages 2,700 visits a month and employs 18 nurse practitioners and 18 registered nurses.

According to Cause IQ, there are 347 outpatient clinics and facilities, 216 community and free clinics, and 58 managed care organizations and group health practices in Texas, giving nurses multiple options.