Maryjoan Ladden, PhD, RN, FAAN, is a senior program officer at the Robert Wood Johnson Foundation.

There is near-universal agreement among health care stakeholders and experts that the country needs to grow the number of primary care providers. If the health care system is to meet the growing demand for care that will result from the greying of the Baby Boomers and the influx of millions of newly insured Americans, we're going to need a bigger, better-prepared health care workforce.

That’s a point the 2010 Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, made very clearly with respect to nurses. That landmark report also pointed out that health care is becoming increasingly complex as our understanding of illness grows and as the tools and systems we have available to combat it change and evolve.

Maryjoan Ladden, PhD, RN, FAAN, is a senior program officer at the Robert Wood Johnson Foundation.

During a recent visit to my adopted home state of Massachusetts, I took a fresh look at a primary care practice I had previously known only from afar. I was part of the team visiting Cambridge Health Alliance–Union Square Family Health, which is one of 30 primary care practices recognized as exemplar models for workforce innovation by The Primary Care Team: Learning From Effective Ambulatory Practices (LEAP) project. This project, a new initiative of the Robert Wood Johnson Foundation and the MacColl Center at Group Health Research Institute, is studying these 30 practice sites to identify new strategies in workforce development and interprofessional collaboration. The overarching goal of LEAP is to better understand the innovative models that make primary care more efficient, effective, and satisfying to both patients and providers, and ultimately lead to improved patient outcomes.

This site visit took me back to my time as a nurse practitioner at Boston Medical Center, Harvard Vanguard Medical Associates, and Boston’s school-based health centers. This is where my passion for primary care began. As we prepare for millions more Americans to enter the health care system in the coming year, we must identify ways to expand access to primary care, improve the quality of care, and control costs. One important way is by exploring how to optimize the varied and expansive skill sets of all members of the primary care team. This idea has been examined in medical and popular media, but there has been little study of the workforce innovations employed by primary care practices to meet the increasing demands for health care.

Linda Wright Moore, MS, is a senior communications officer at the Robert Wood Johnson Foundation (RWJF).

The swirl of controversy and nonstop debate around the Patient Protection and Affordable Care Act  (ACA) is like a play that never ends: Every time you think you’re coming to the finale, another character or plot twist crops up—and the production drags on … and on.

So it goes with the ACA: Last year, the U.S. Supreme Court ruled the new law to be mostly sound, but fudged on the state mandate to expand Medicaid just enough to keep the drama twisting and turning—and to make many poor and uninsured people ineligible for government subsidies.

Meanwhile, repeated attempts to repeal the law—at least 38 to date—have contributed to a jarring statistic: 42 percent of Americans are unaware that the ACA is the law of the land. In light of the lack of knowledge that the health reform law is the law—it’s no surprise that half of the public admits to not having enough information to understand the likely impact of the ACA on themselves and their families.

Susan B. Hassmiller, PhD, RN, FAAN, is senior adviser for nursing at the Robert Wood Johnson Foundation, and director of the Future of Nursing: Campaign for Action.

On Thursday, New York Times blogger Pauline Chen, MD, took a fresh look at the disagreements over the services that advanced practice registered nurses should be authorized to provide, reporting on a primary care meeting at which a doctor dared to raise “the unmentionable” topic with his colleagues. The room, she reports, erupted into discord and chaos.

The same divide was documented in a survey reported by the New England Journal of Medicine in May.  It is a terrible shame.  What we need, now more than ever, is open and reasoned conversation within and between health care fields about the best way to provide high quality care and improve our population’s health.

These are challenging times for our health care system. Millions of Americans are about to gain insurance through the Affordable Care Act. Our population is getting older and living with more chronic illnesses. And we have an urgent need to promote prevention, improve quality, and contain costs.

There is no question that we need more physicians and more primary care physicians in particular. There is no question that physicians should treat the sickest patients and those with the most complex health problems.  But there also is no question that we need nurse practitioners to be able to practice to the full extent of their education and training.

A report funded by the Robert Wood Johnson Foundation (RWJF) and produced by the University of Michigan Center of Excellence in Public Health Workforce Studies is the first comprehensive assessment of the size, composition, educational background experience, retirement intention, job function and job satisfaction of nurses who work for state and local health departments.

Paul Kuehnert, MS, RN, CPNP, team director of Public Health at RWJF, and an alumnus of the RWJF Executive Nurse Fellows program, discusses the report’s findings.

Read more about the Robert Wood Johnson Foundation’s work on public health nursing.

Lori Melichar Gadkari, PhD, MA, is a senior program officer at the Robert Wood Johnson Foundation (RWJF), in the Research and Evaluation Unit.

Yesterday the New England Journal of Medicine published the results of a study co-funded by the Robert Wood Johnson Foundation, Johnson & Johnson, and the Gordon and Betty Moore Foundation. “Perspectives of Physicians and Nurse Practitioners on Primary Care Practice” finds that 96 percent of nurse practitioners and 76 percent of physicians agreed with the Institute of Medicine report recommendation that “nurse practitioners should be able to practice to the full extent of their education and training.” The new study is authored by Karen Donelan, ScD, EdM, Catherine M. DesRoches, DrPH, Robert S. Dittus, MD, MPH, and Peter Buerhaus, PhD, RN.

When asked how increasing the supply of nurse practitioners would potentially affect the United States health care system, the authors found that the majority of physicians (73%) said increasing the supply of primary care nurse practitioners (PCNPs) would lead to improvements in the timeliness of care. A much smaller majority of physicians (52%) said increasing the supply of PCNPs would lead to improvements in access to care for people in the country. 

However, the new survey found significant disagreement between primary care physicians and PCNPs about whether increasing the supply of PCNPs would improve patient safety and the effectiveness of care, and whether it would reduce costs. There was also a large professional divide about proposed changes to PCNPs’ scope of practice, putting PCNPs in leadership roles, and the quality of care that PCNPs provide.

Susan B. Hassmiller, PhD, RN, FAAN, is senior adviser for nursing at the Robert Wood Johnson Foundation, and director of the Future of Nursing: Campaign for Action.

National Nurses Week begins today, May 6, and runs through Sunday, May 12, which is Florence Nightingale’s birthday. The theme for the week this year is: delivering quality and innovation in patient care.

It’s a wonderful theme, because nurses do even more than deliver high-quality patient care. Nurses conduct groundbreaking science and discovery, develop innovations that improve the quality of care, provide primary care, help patients and their families avoid and manage illness, teach at community colleges and universities, shape public policies, serve in the military, help when there are disasters, run large health organizations, and much more.

Since it opened its doors 40 years ago, the Robert Wood Johnson Foundation has recognized that, which is why it has invested more than $580 million in nursing over the last four decades. That investment continues today, with support to our programs that prepare the next generation of nurse faculty, support nurse research, promote nursing leaders, and more.

The Institute of Medicine, too, recognized nurses’ many contributions to improving health care in this country in its groundbreaking 2010 report. That is why the report called for a more highly educated nursing workforce, more support for nurse-led research, and more nurses in leadership roles of all kinds, from the front lines to the board room. The Future of Nursing: Campaign for Action is working to implement those and other recommendations from that report.

This week on this blog, you will be able to learn more about it and read about some of the innovative work that nurses around the country are doing. This is one of my favorite weeks of the year, because it provides us an opportunity to really showcase nurses’ work. Enjoy!

Catherine J. Malone, MBA, DBA(c), is a program associate working in the areas of diversity and nursing for the Robert Wood Johnson Foundation. This is the first in a series of posts looking at diversity in the health care workforce.

As a member of the Robert Wood Johnson Foundation’s (RWJF) Human Capital team leading the group’s diversity efforts and the Foundation’s Diversity Team, I would like to share some of our work in this area. I must start by noting that “diversity” means different things to different people. At RWJF we recognize and value all types of diversity and therefore have a broad definition of the term which is described in the Foundation “Diversity Statement” below:

“Diversity and inclusion are core values of the Robert Wood Johnson Foundation, reflected in our Guiding Principles. We value differences among individuals across multiple dimensions including, but not limited to, race, ethnicity, age, gender, sexual orientation, physical ability, religion and socioeconomic status. We believe that the more we include diverse perspectives and experiences in our work, the better able we are to help all Americans live healthier lives and get the care they need. In service to our mission, we pledge to promote these values in the work we do and to reflect on our progress regularly.”

Michael Painter, JD, MD, is a senior program officer at the Robert Wood Johnson Foundation (RWJF), and an alumnus of the RWJF Health Policy Fellows program. This post originally appeared on the RWJF Pioneering Ideas Blog.

Have you read “The Swerve,” the Pulitzer Prize-winning book by renowned historian Stephen Greenblatt? In it a canny Renaissance era book hunter discovers and releases knowledge in the form of a medieval, controversial poem lost to posterity. The poem had dwindled down to a single handmade, leather-bound version held behind the vine-covered, ancient walls of an Italian monastery. According to Greenblatt, the unleashing of that book changed everything that came after. That small book with the long poem on the nature of things set in motion forces that challenged the status quo and triggered dramatic, world-wide change—a swerve. The only way that knowledge survived the millennia was because monks trained in hand crafting books had carefully copied the one survivor—and saved it for centuries.

Last week, the Khan Academy, AAMC (Association of American Medical Colleges) and the Robert Wood Johnson Foundation may not have triggered quite such a momentous unleashing—but this powerful collaboration did start something very interesting with potentially significant implications for health care education.

Susan B. Hassmiller, PhD, RN, FAAN, is the Robert Wood Johnson Foundation (RWJF) Senior Adviser for Nursing and Director, Future of Nursing: Campaign for Action.

After about a year of planning, we held the Campaign for Action National Summit in Washington D.C. in late February and early March. We brought together more than 200 leaders from state Action Coalitions—nurses, other health leaders, consumers, educators, business leaders and others who are working at the state level to advance nursing and improve health care. These Action Coalition leaders are experts and activists who came to Washington to share innovative ideas for transforming health care and improving health, and to plan for the future. 

The mission of the Campaign for Action and its Action Coalitions, which are in every state and the District of Columbia, is to advance recommendations from the Institute of Medicine’s landmark report, The Future of Nursing: Leading Change, Advancing Health. Those recommendations cover a range of issues, including academic progression, nurse leadership, scope of practice, workforce data collection, diversity, and much more. Our goal, in all this work, is to ensure that nurses can contribute as equal partners in a reformed health care system in order to improve patient care.

We planned the Summit as a nontraditional conference that used a U.N.-style approach. It was designed to allow participants—who are from nursing, medicine, business, health systems, philanthropy, and academia—to learn from each other.