Six Questions for Sue

Susan Hassmiller, PhD, RN, FAAN, the Robert Wood Johnson Foundation's senior adviser for nursing, discusses challenges and opportunities for nurses in 2012.

    • January 29, 2012

1) What’s your assessment of the status of nurses in the United States today? Has there been progress in terms of the roles nurses play in our health care system, and the influence nurses have?

Certainly, in the century since Florence Nightingale passed, we’ve made a lot of strides. Nurses used to not be able to take people’s blood pressure, for example. Today, of course, we can. But we have a very long way to go. How much you can do depends, in part, on where you work. Some environments and workplace cultures are much more open to utilizing nurses’ skills than others. Magnet hospitals, for example, put great emphasis on shared governance, evidence-based practice and nursing leadership at all levels of the institutions.

Depending on the laws of their state, some nurse practitioners are able to practice to the top of their education and training. In other instances there are not only state laws prohibiting nurses from fully implementing their role, but also institutional and cultural barriers. School nurses, for example, should be able to do much more than they currently do with health education, disease management and direct care, but some school systems are restrictive in what they allow nurses to do. Finally, when it comes to overall health and health care decision making in this country, including overseeing systems of care and board governance, nurses are significantly behind other professionals.

That’s what the Institute of Medicine (IOM) Future of Nursing Report is about. Our mission is to transform health care and improve patient outcomes by more effectively utilizing nurses, whether it is with caring directly for people or serving in boardrooms.

When the IOM committee was in session, members would come back from high-level policy meetings in their own states or on Capitol Hill and say: There was no nurse present. Nurses represent only 6 percent of positions on hospital boards, for instance. So that’s where the leadership chapter came from. But we are making some progress. Look at Mary Wakefield, the first nurse in history to head the Health Resources and Services Administration (HRSA), an agency that oversees care to the most vulnerable of this country. And wouldn’t it be great if Marilyn Tavenner, who is also a nurse, were confirmed as the new head of the Centers for Medicare & Medicaid Services?

2) It has been more than a year since the Institute of Medicine (IOM) released its Future of Nursing report. Did you anticipate the kind of continuing impact that it has had?

When I was busy overseeing the construction of the report, I was intensely focused on making it the best it could be and ensuring that we had sufficient evidence to support every single recommendation. I was hopeful that there would be support for the completed report, but I did not fully envision all that has happened since its release.

After the report was published, it was like the floodgates opened for nurses. They felt that this was a report they could stand behind and wanted to be involved with. At that time, I only had approval [from the Robert Wood Johnson Foundation (RWJF)] for an IOM report implementation project, which is different from a big campaign like the one we are now running. We had to quickly come up with a mechanism to involve the many interested parties.

I was already working with the RWJF-funded Center to Champion Nursing in America (CCNA) at AARP, and we had state teams in place. We realized that state teams comprised entirely of nurses wouldn’t work, but we did build on those teams. We insisted, though, right from the start that teams had to consist of many stakeholders other than nurses. We started with five states and now have extraordinary teams in three dozen states all across the country. And we’re calling on the Centers for Medicare & Medicaid Services and on HRSA, business leaders, accreditors and many others to join us. I anticipate that we will have teams in all 50 states working with us within the next few months.

3) What are the priorities for the Future of Nursing: Campaign for Action in 2012?

In the first year, our priority was to get the word out about the report and start engaging people about the need to more effectively utilize nurses—to get engagement and involvement from nurses and non-nurses alike. We formed state Action Coalitions and we brought in national partners. We would tell people about the campaign, and then tell them again and again. It was about educating people.

Now, we’re heading into the second year and we’re still focused on education, but we have really shifted to outcomes as well. Now it’s about helping state Action Coalitions come up with their own state plans for what they are going to do and helping them achieve their goals. We are linking them to each other (through CCNA webinars, regional meetings, one-on-one mentoring, etc.) so they can share information and lessons learned. We’re encouraging Action Coalitions as well as allied organizations to advance the recommendation that matters most to them. We can’t tell them what their priorities are. But we can provide technical assistance to try to help them and CCNA is doing an outstanding job of providing this technical assistance.

I’ve been very involved with the American Red Cross and for them, what mattered was that nurses responding to disasters be allowed to use all their skills. Malpractice issues got in the way, however. We were losing volunteers to other organizations when nurses discovered they could not practice to the top of their education and training. So the Red Cross took the report and identified the recommendation that is relevant to disaster planning and changed their policy.

Many other organizations went through their own prioritization process, choosing other priorities. We did at the Robert Wood Johnson Foundation as well and chose as our own priorities: leadership; education progression; and interprofessional collaboration.

4) How can nurses around the country support implementation of the IOM report’s recommendations?

First, by knowing that it exists. When people come up to me—faculty or deans or chief nursing officers—and they say things like, “Staff nurses or students don’t know about the report,” I say: “That’s your responsibility! You’re the dean! You need to make sure your faculty are integrating the report, its principles, its philosophies, and its recommendations into your classes.” I say the same to chief nursing officers: “You’re the CNO. You need to build it into your governance structures and really convey to all nurses the relevance of the recommendations for them.”

Nurses and others need to implement the report’s recommendations wherever and however they can, and get involved in the campaign to transform health care. Everybody needs to know about the report and translate it for others. Recently I was at dinner with a diverse group of people from my neighborhood, and somebody mentioned that it took forever to get in to see their doctor for a very simple issue, and it immediately gave me an opportunity to talk about the value of nurse practitioners. This report and Future of Nursing: Campaign for Action are about making care better in this country for everyone. We are talking about cost, quality and access. I would love for everyone reading my words right now to join the Campaign.

5) Please talk about the role the Robert Wood Johnson Foundation will play in advancing nurses and nursing this year.

We’ll continue all of our nursing leadership programs this year, like the Executive Nurse Fellows (ENF) program, the New Jersey Nursing Initiative, and the Nurse Faculty Scholars (NFS) program. We’re doing everything we can to connect all of our nursing programs with one another so there is power in numbers and resources. I am encouraging all RWJF scholars, fellows and grantees to be ambassadors for this report and for the kind of change we need to improve health and health care for all. Many have already jumped into leadership positions in their states, because they see the IOM report as a chance to apply the leadership skills they learned through their RWJF programs. Six state Action Coalitions are led by ENFs, and many Action Coalitions have engaged representatives from ENF, NFS, Partners Investing in Nursing’s Future (PIN) and Health Policy Fellows. The Future of Nursing: Campaign for Action is a fabulous coming together of grantees, fellows, scholars and alums. It is leadership in action!

At RWJF, we’re also going to launch a few new programs this year, on nurse education progression, community- and public health-based nursing, interprofessional collaboration, and more. We’re also exploring ways to get some monetary resources to the state Action Coalitions. And we’re counting on other funding agencies such as foundations and the government to help.

6) How will you measure success for the IOM nursing report, and for nurses and nursing, in 2012?

I love it when the IOM announces every month that we’re number one on the "hit parade." We keep breaking records for the number of visitors to the report on the IOM website and the number who are printing and/or buying the report. Now the IOM has given me a direct challenge to continue that kind of impact into 2012 and I promised we would. We’ve got to keep up the visibility and we’ve got to continue encouraging stakeholders other than nurses to come forward and support the report and the Campaign. Nurses will carry the day, but it will take a really diverse cohort of stakeholders to get all the recommendations met. We want to be the place for new voices and diverse partnerships.

We’re going to have a publicly displayed dashboard by the end of the summer that will measure indicators like education progression, scope of practice, and nursing leadership. It will measure the outcomes at given points of time on the indicators that mean the most to this Campaign. For the sake of people who need care everywhere, we must make a difference!