New Campaign Aims to Overhaul Nursing Profession to Improve Patient Care

The Robert Wood Johnson Foundation is leading a new campaign to implement recommendations from the Institute of Medicine's groundbreaking report on the future of nursing.

    • December 19, 2010

The Robert Wood Johnson Foundation (RWJF) has kicked off a massive and multifaceted campaign to overhaul the nursing profession so that it can better meet the crushing demand for better, more affordable and more accessible health care in the 21st century.

The Foundation launched the campaign at a national summit in Washington, D.C., where more than 500 top health leaders came together to strategize about ways to implement recommendations from a groundbreaking report released on October 5 by the Institute of Medicine (IOM). The Future of Nursing: Leading Change, Advancing Health calls for a radical transformation of nursing education and practice, and nurses’ role in health care and in society. More than 100 groups viewed the National Summit on Advancing Health through Nursing via webcast at regional meetings around the country.

In her opening speech, RWJF President and Chief Executive Officer Risa Lavizzo-Mourey, M.D., M.B.A., said November 30, the first day of the summit, would go down in the annals of the history of health care as “the first day of the future of nursing.”

“This is the day we all came together to fill the final void, the critical piece, in America’s health care puzzle,” she continued. “It’s the day when we convened in Washington … and on the web to transform—not to reform, but to transform—health and health care as we know it. To change it from what it can be to what it must be.”

Donald M. Berwick, M.D., M.P.P., administrator of the federal Centers for Medicare & Medicaid Services, agreed. “I don’t think there has been a time in my professional career in which the role of nursing, the contribution of leadership potential, has ever been more crucial or possible,” he said at the event. “ … Nursing’s time is here.”

At the summit, campaign organizers unveiled plans to spark reform in five key areas: preparing and enabling nurses to lead change; improving nurse education; removing barriers to practice; creating an infrastructure for interprofessional health care workforce data collection; and fostering interprofessional collaboration.

One of the central themes of the summit centered not around nurses, but on consumers.

“The context has to be about improving health care quality,” said Donna Shalala, Ph.D., F.A.A.N, the former head of the U.S. Department of Health and Human Services and chair of the committee on the RWJF Initiative on the Future of Nursing, at the IOM, which drafted the report. “This is all about the patients. No one knows this better than nurses.”

Newly formed Regional Action Coalitions (RACs) will be key to the implementation plan. These coalitions are working in coordination with pilot programs in California, Michigan, Mississippi, New Jersey and New York to initiate implementation measures that can be emulated in other states. They are pushing for nursing-related advances at the local, state and national levels.

Another wave of 10 to 15 RACs will be announced in February, according to Susan B. Hassmiller, Ph.D., R.N., F.A.A.N., RWJF’s senior adviser for nursing and director of the Future of Nursing: Campaign for Action.

Campaign officials are working with AARP to organize a nonpartisan coalition of partners dedicated to implementing the report’s recommendations. And they have created a strategic advisory committee headed by Sheila Burke, a nurse herself, who served as chief of staff to former Senate Majority Leader Bob Dole of Kansas.

The campaign has also launched a Web site that features evidence supporting the report’s recommendations and offers strategies and resources for partner organizations.

The report was released less than two months ago, but supporters are “already asking for collaborations to be formed, connecting with each other, communicating information and making sure the evidence is out there,” Hassmiller said.

Early signs of interest and engagement are encouraging, she noted. On the day the report was released, the IOM Web site broadcasting the event crashed from overuse. In October alone, there were some 43,000 visitors to the site, making it the most visited page on the entire IOM site after its home page and the table of contents. The report has also broken an IOM sales record. “This is an issue we must all care about if we are to truly transform the health care system,” she said.

The IOM report’s “recommendations impact all people, not just nurses—and so the responsibility for implementation lies in all of us in a given community,” agreed David Knowlton, M.A., president of the New Jersey Health Care Quality Institute and co-chair of the New Jersey RAC. “For New Jersey, we know that when a diverse group of stakeholders come together around an issue that is important to all, change happens. We intend to use this same strategy as we seek to integrate the recommendations” in New Jersey.

Despite Barriers, Proponents Say Time is Right to Push for Change

Still, there are considerable barriers to overhauling the nursing profession, Lavizzo-Mourey said. Organizers are preparing to address resistance to some of the report’s more controversial recommendations, especially those involving scope of practice.

The recommendation to give nurses greater authority to practice to the full extent of their training and ability is “the most combustible part of this report,” said John W. Rowe, M.D., a professor at the Mailman School of Public Health at Columbia University and a member of the RWJF study committee. The recommendations are indeed already generating pushback from physician groups.

Encouraging communication across health sectors may also present a challenge, Lavizzo-Mourey noted, because health professionals from disparate fields aren’t necessarily accustomed to working together. Fundraising will be difficult, too, Shalala added: “People are so tight with resources right now. That will be the biggest challenge.”

Despite the obstacles, Lavizzo-Mourey said the climate is ripe for action. Health care costs are rising and demand for services is growing as the population ages, creating an economic imperative for system change. At the same time, the new health reform law creates opportunities to make changes to the nursing profession and the health care system.

"The time is now,” she said, a sentiment that was echoed throughout the two-day summit.

During the summit, participants from government, business, public health, academia and other sectors received an overview of the report’s recommendations and the plan for implementation; met in groups to discuss strategies and steps to implement the recommendations; networked around specific themes of the report; and learned about strategies for creating large-scale social change.

The summit was held just a few blocks from the former apartment of the late Clara Barton, who founded the American Red Cross after tending soldiers on the battlefields of the Civil War.

Summoning the spirit of the legendary nurse leader, Lavizzo-Mourey referred to a famous quote in which she said: I have an almost complete disregard of precedent, and a faith in the possibility of something better. It irritates me to be told how things have always been done. I defy the tyranny of precedent. I go for anything new that might improve the past.” That, Lavizzo-Mourey said, “is what I’m asking you to do here today.”

View a webcast of the National Summit on Advancing Health through Nursing. Click on any of the five separate sections to view: welcome from IOM and RWJF leadership; panel overview and explanation of IOM Committee recommendations; overview of summit objectives and logistics; keynote address by Donald Berwick; and overview of the implementation plan and implementation architecture.