Courage, Questions, and the Future of Nursing
Bonnie Clipper’s August editorial in Nurse Leader, “A Call to Step Up: Courage, Innovation, and the Future of Nursing,” opens with a diagnosis most nursing leaders will recognize: workforce shortages, rising acuity, financial pressure, and accelerating technology, all converging at once. Dr. Clipper, founder of the Virtual Nursing Academy, suggests that current nursing care models were designed for a different era, where the workforce and patient volumes were more stable and predictable.
Dr. Clipper’s central point is that incremental fixes to an outdated care structure are not enough to meet the demands of today’s healthcare system. Today, innovation is necessary. The important distinction, though, is that technology does not automatically equal innovation. Instead, innovation happens when leaders use it to intentionally redesign how work gets done, which may require asking difficult questions about roles, tasks, and expertise.
Ultimately, redesign takes courage and commitment and urges nursing leaders to be the ones driving the change rather than being the recipients of it.
Open Questions
In the editorial, Dr. Clipper poses a set of difficult questions:
- Does this require a nurse?
- What work must be done at the bedside?
- What work can be done virtually?
- How do we differentiate between tasks and expertise?
- How do we use technology to amplify nursing practice rather than fragment it?
These questions intentionally remain unanswered; to first assert that nursing has to author its own future, and then hand over a prewritten answer key would be to undercut its own premise. Instead, these questions are meant to be sat with and thought over.
After years of working alongside nursing teams, first in virtual observation and then in virtual nursing, we have worked through these exact questions across a range of real hospital programs. Here’s what that has taught us.
Build a Foundation, Not a Safety Net
“Does this require a nurse?” is a question that doesn’t get asked nearly enough. The more familiar framing runs the opposite direction, with nursing treated as the safety net, the role that absorbs whatever else falls through. Environmental services (EVS) is short-staffed, so a nurse cleans the room. The EKG tech is tied up, so nursing has to run the 12-lead. A patient care tech calls off, so the nurse picks up bathing, toileting, and blood sugars, on top of everything else. Over time, that pattern becomes an unspoken rule: nursing will catch whatever falls through the cracks.
Flipping the question changes what gets built. Asking “does this require a nurse” means constructing an actual foundation underneath nursing, one that catches the work that doesn’t need a nurse’s license to be done, instead of leaving nurses to catch it by default. A fair amount of hospital work turns out not to require a nurse at all, and that’s actually a good thing. If everything on a nursing unit truly required a nurse to do it, an already stretched, understaffed workforce would have no real way out. The fact that so much of it doesn’t require a nurse means there’s real room for other roles, other technology, and other solutions to carry that work instead.
In terms of technology like virtual nursing, beginning with ADT (admissions, discharges, and transfers) is a useful starting point. These are some of the easiest tasks to move off a bedside nurse’s plate, since a virtual nurse can carry them just as capably. It’s a solid place to start, and one that can apply to nearly any inpatient unit.
It’s also not meant to be the finish line. Once that first layer of foundation is in place and ADT is reliably handled virtually, more of what currently lands on bedside nurses by default becomes a fair question to ask about, one task at a time.
Separating Tasks From Expertise
Dr. Clipper’s next question, “how do we differentiate between tasks and expertise,” calls for a similar shift in how it gets asked. It’s not enough to ask who can do a task, but rather to ask who should do it.
For example, discharge education: a bedside nurse juggling five patients can technically walk someone through discharge instructions. But a patient newly diagnosed with diabetes ideally needs more than that: dedicated, focused time with someone like a diabetes educator who has the specialized training to appropriately cover it. Not who can, but who should.
The same logic works in both directions, just aimed at different kinds of work. In one direction, it’s a question of whether a nurse’s training goes deep enough for the task at hand, such as with diabetes education, wound evaluations, and psychiatric evaluations- work that calls for more specific expertise than general bedside training covers.
In the other direction, it’s the reverse question: whether a nurse is more qualified than the task actually requires. Patient observation is a good example. An RN can physically monitor a single patient, but that task doesn’t call for an RN’s full scope of training, and a virtual observer, trained specifically for observation, can cover several patients at once, thereby freeing up the bedside nurse.
Making Room For Amplification
Dr. Clipper’s final question is the one that ties everything else together: how do we use technology to amplify nursing practice rather than fragment it? It’s tempting to treat innovation as a checklist problem, tally up everything moved off a bedside nurse’s plate and call it answered. But amplification is a bigger question than subtraction. Moving ADT off a bedside nurse’s plate, or asking whether a task calls for more or less training than a nurse has, matters for a bigger reason than the tally of what gets removed. It’s about creating enough space to ask what nursing actually means right now, and what it should keep meaning as everything around it changes.
Most nursing teams don’t have room to ask that question today. When a shift is spent managing whatever’s fallen through the cracks elsewhere, there’s no space left to think about what nursing could look like at its best, only what it takes to get through the day.
Amplification asks a different set of questions, not whether something can be automated or moved virtual, but what nursing actually is at its core, what deserves to stay exactly as it’s always been, and what matters most to protect as everything else shifts around it. Human connection at the bedside sits at the center of that list. Done well, gains in efficiency can create more room for connection, not less.
Leading This Together
Dr. Clipper is pushing the field to act in this moment, insisting that these questions be asked out loud, acted on, and, most importantly, owned.
As she says, innovation is no longer an option. Quick fixes, bolted-on technology, and top-down mandates are suboptimal and unlikely to elicit the true care transformation that is desperately needed. Instead, it takes the courage to rethink care delivery from the ground up, keeping what’s good, discarding what isn’t, and making real structural change instead of adjustments around the edges.
This is a moment for nursing leaders to seize. It calls for courage, but it also comes with real opportunity.