By Alexandra Wilson Pecci

A rising awareness of ethical issues, a push for better representation in the boardroom, and initiatives to raise education levels among RNs will be top-of-mind topics for nurse leaders next year.

The Ebola virus. Nurse staffing battles. ED violence.

Unlike any year in recent memory, 2014 was a turbulent one for the nursing profession. But it was also an exciting one, and 2015 promises more of the same. I touched base with a couple of nursing leaders to get their take on some of the top issues that are in store for the profession.

1. Ethics

ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, called 2015 "our year of ethics" during a media call last month about a U.S. Navy nurse who faces possible disciplinary action for refusing to continue force feeding detainees at Guantanamo Bay Detention Camp.

The ANA will be releasing a revised version of its code of ethics early in the year, and with it, a number of webinars, educational materials, and special activities, such as an Ethics Symposium in June, Cipriano says.

"It's very clear that nurses confront ethical issues every day regardless of where they practice," says Cynda Hylton Rushton, PhD, RN, FAAN, the Bunting Professor of Clinical Ethics at the Johns Hopkins School of Nursing and Berman Institute of Bioethics, a lead organizer of the National Nursing Ethics Summit, held at Johns Hopkins University in August.

That summit resulted in the just-released Blueprint for 21st Century Nursing Ethics: Report of the National Nursing Summit."My hope for the summit was to use it as a vehicle to raise awareness about the centrality of ethics in nursing practice and really to engage all of the community on how we can actually strengthen that aspect of our profession together," Rushton says.

2. Nurses in the Boardroom

Getting 10,000 nurses on corporate and non-profit health-related boards of directors by the year 2020 is the goal of the new Nurses on Boards Coalition, comprised of 21 national nursing associations and led by the Robert Wood Johnson Foundation and AARP.

"Nurses know what needs to be done to make care safe, accessible and cost effective. They also know how to help consumers stay healthy in the first place," says Susan B. Hassmiller, PhD, RN, FAAN, Senior Adviser for Nursing, Robert Wood Johnson Foundation, and Co-Director, Future of Nursing: Campaign for Action.

Data from 2011 shows that only 6% of board members are nurses. "Nurses can have a great impact on every single one of the nine areas where our nation lags behind its peers in the [Institute of Medicine's] Shorter Lives, Poorer Healthreport. So, what do they need to do? Lead!" Hassmiller says. "I am encouraging all nurses, no matter where they are or at what level they work, to get involved in committees, boards, and professional organizations."

3. Building a 'Culture of Health'

Hassmiller points out that in that IOM report, the United States ranked last or near-last when compared with 16 other affluent nations on nine key indicators:

*Infant mortality and low birth weight

*Injuries and homicides

*Teenage pregnancies and sexually transmitted infections

*Prevalence of HIV and AIDS

*Drug-related deaths

*Heart disease

*Chronic lung disease

*Disability

"Nurses, especially, understand wellness and prevention, so I believe we have a special role to play in building a culture of health," she says. But it's not only patient health that nurses need to focus on; it's also their own.

"How do we create an environment where nurses can be more resilient and navigate these situations with a little less cost to their own wellbeing and health?" asks Rushton.

That includes everything from compassion fatigue, to exposure to hazardous drugs, to making sure nurses are properly trained and have the right equipment to both care for patients and keep themselves safe during potentially dangerous situations, such as when caring for Ebola patients.

4. Growing Momentum for Nurse Education

The Institute of Medicine's goal of having at least 80% of the nursing workforce hold bachelor's degrees by the year 2020 is not only familiar; it's possibly out of reach, unless the percentages start rising more quickly.

One way to increase momentum toward the goal of higher education levels for nurses is to start building a strong business case for it, and a study released in October aimed to do just that. Researchers estimate that increasing the proportion of BSN-prepared nurses caring for each patient to 80% or more would reduce annual readmissions by roughly 248 days, reducing costs by more than $5.6 million annually.

"The business case for at least 80% of all nurses having a BSN by 2020, as the Future of Nursing IOM report recommends, is solid," Hassmiller says, pointing to that study.

"That case is even stronger once other factors are considered: the crushing faculty shortage; the need for many more primary care nurse practitioners; and the growth in community-based care, driven by consumers' preferences and the Affordable Care Act. To fill these needs, nurses must have advanced degrees, so first attaining a BSN is imperative to move up the education ladder."

5. More Interdisciplinary Collaboration

From patient-centered care to creating an ethical healthcare landscape, interdisciplinary collaboration has never been more crucial to the success of the health system. "We all have a stake in working together," Rushton says. To this end, Hassmiller says that the Robert Wood Johnson Foundation is concluding ten of its leadership programs that are uni-disciplinary in order to instead build team-building programs with stakeholders from multiple healthcare sectors.

"Nurses are called to lead, yes, but they are also called to work with others from multiple disciplines and sectors so that care might be as seamless and safe as possible. We know that bad things happen when teams do not work effectively," she says.

One recent and terrifying example: The first Ebola case in Dallas, which proved that EHRs are no substitute for nurse-physician communication.