To identify solutions of nursing care that will not only address many of the issues facing the profession but also transform the way Americans receive health care, the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF) have launched a new Initiative on the Future of Nursing. As part of the initiative, IOM has convened a committee of experts to identify the potential for increasing access, improving quality and reducing costs through the involvement of nursing leaders and widespread use of nursing care solutions.
The study committee will review innovative models of nursing care and education; its goal is a transformational report on the future of nursing, with solutions that nursing can provide to improve the quality of patient care while controlling costs.
“We believe our nation cannot adequately address the challenges facing our health care system without also addressing the challenges facing the nursing profession,” said Risa Lavizzo-Mourey, M.D., M.B.A., President and CEO of RWJF. “For health reform to succeed, and for patients to receive better care at a cost we can afford, we must change the way health care is delivered. And nursing is at the heart of patient care.”
The Initiative’s study committee will be led by Donna E. Shalala, Ph.D., former Secretary, U.S. Department of Health and Human Services, and current president of the University of Miami. Linda Burnes Bolton, Dr.P.H., R.N., FAAN, vice president for nursing, chief nursing officer, and director of nursing research at Cedars-Sinai Medical Center, will serve as the committee's vice-chair. They are joined on the committee by other distinguished researchers, health professionals, and leaders from academia, industry and non-profit organizations. The committee held its inaugural meeting today in Washington, D.C., and will continue to meet several times over the next 10 months.
“Nurses are a linchpin for health reform and will be vital to implementing systemic changes in the delivery of care,” said IOM President Harvey V. Fineberg, M.D., Ph.D. “Donna Shalala’s experience in health leadership at the nation’s highest levels, and her understanding of the complexity of the health delivery system and the issues facing nurses and other health professionals, make her exceptionally qualified to lead this effort.”
Nursing care models offer important insights on improving patient care, explained Lavizzo-Mourey. Health care settings that employ more nurses have been shown to have fewer medical errors, lower rates of hospital acquired infections, shorter hospital stays and lower patient mortality. Nurses are uniquely trained to provide case management of patients with chronic diseases, helping them avoid high-cost acute care. Nurses-led efforts in health promotion and screening for early detection are at the heart of preventive care and wellness that can reduce the burden of illness. In conjunction with physicians and other health providers, advance practice nurses can provide primary care services to patients.
But nursing faces a number of challenges that threaten to limit the promise of those nurse-led solutions. Chief among them is the current and projected shortage of nurses; estimated to escalate to a half-million full time nurses by the year 2025, caused by nurses retiring and an increase in the number of older Americans with greater health care needs. The shortage is compounded by a lack of educational capacity to train the next generation of nurses, and educational programs that need revision to better match advances in clinical practice and greater emphasis on quality and safety.
“This Initiative couldn’t be more timely,” emphasized Shalala. “Our nation is engaged at all levels—whether at individual hospitals or among federal policy-makers—in trying to improve access and quality of care. To successfully transform the way health care is structured and delivered in our country, it is absolutely essential to actively engage nurses for their leadership, expertise and proven solutions. Nurses and their concerns must be part of our national discussion about health reform, and viewed as a key to the solution.”
Sponsored by RWJF, and conducted by the IOM, the Initiative study committee aims to present its findings in the fall of 2010. To inform its deliberations, the committee will hold three town hall meetings to gather information. The committee’s recommendations will be the basis of a report on nursing that will define a clear agenda and blueprint for action, including changes in public and institutional policies at the federal, state and local levels.
Burnes Bolton added that nurses are uniquely positioned to inform this effort since they are on the front lines of patient care each and every day. "At 2.5 million strong, nurses comprise the largest segment of the health care workforce,” she said. "Nurses close, extensive interaction with patients makes them ideally qualified to help contribute to solutions that result in better care at lower cost."
The committee may examine and produce recommendations related to the following issues, with the goal of identifying vital roles for nurses in designing and implementing a more effective and efficient health care system.
- Reconceptualizing the role of nurses within the context of the entire workforce, the shortage, societal issues and current and future technology;
- Expanding nursing faculty, increasing the capacity of nursing schools and redesigning nursing education to assure that it can produce an adequate number of well prepared nurses able to meet current and future health care demands;
- Examining innovative solutions related to care delivery and health professional education by focusing on nursing and the delivery of nursing services; and
- Attracting and retaining well prepared nurses in multiple care settings, including acute, ambulatory, primary care, long term care, community and public health.
In addition to Shalala and Bolton, the committee members are:
- Michael Bleich, R.N., Ph.D., M.P.H., FAAN, dean, Oregon Health & Science University School of Nursing
- Troyen A. Brennan, M.D., J.D., M.P.H., executive vice president and chief medical officer, CVS Caremark Corporation
- Robert E. Campbell, M.B.A., retired vice chairman, board of directors, Johnson & Johnson, and former chairman, Robert Wood Johnson Foundation Board of Trustees
- Catherine Dower, J.D., associate director for research, Center for the Health Professions, University of California, San Francisco
- Rosa Gonzalez-Guarda, Ph.D., M.S.N., M.P.H., R.N., assistant professor, University of Miami School of Nursing and Health Studies
- David Goodman, M.D., M.S., professor of pediatrics and of health policy, The Dartmouth Institute for Health Policy and Clinical Practice; director, Center for Health Policy Research; and co-principal investigator, Dartmouth Atlas of Health Care
- Jennie Chin Hansen, R.N., M.S., FAAN, president, AARP
- C. Martin Harris, M.D., M.B.A., chief information officer, Cleveland Clinic
- Anjli Aurora Hinman, C.N.M., M.S.N., M.P.H., Woodruff Fellow, Emory University; 2008 Graduate, Family-Nurse Midwifery Program; and alumni chair, Health Students Taking Action Together, Inc.
- Bill Novelli, M.A., distinguished professor, McDonough School of Business, Georgetown University
- Yolanda Partida, M.S.W., D.P.A., director, Hablamos Juntos and assistant adjunct professor, Center for Medical & Education Research in California, University of California, San Francisco, Fresno
- Robert D. Reischauer, Ph.D., president, The Urban Institute
- John W. Rowe, M.D., professor, Department of Health Policy and Management, Mailman School of Public Health, Columbia University
- Bruce C. Vladeck, Ph.D., senior adviser, Nexera Consulting
Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.
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