A massive, multifaceted campaign to transform health care through nursing is off to a promising start, new data show.
In its first three years, the Future of Nursing: Campaign for Action has made steady progress in areas relating to nurse education, practice, interprofessional collaboration, data collection, and diversity, according to a series of “dashboard” indicators that were released last month.
“We are moving in the right direction, and we expect progress to accelerate in the years ahead,” said Campaign Director Susan B. Hassmiller, PhD, RN, FAAN, senior adviser for nursing at the Robert Wood Johnson Foundation (RWJF). “Our biggest accomplishment, though, cannot be measured in numbers. Since the Campaign began in late 2010, there has been a continuing cultural shift in attitudes about nurses and nursing and the critical role nurses play in health and health care.”
RWJF Senior Program Officer Nancy Fishman, MPH, agreed. “Because of the Campaign, there’s more awareness about the importance of preparing the nursing workforce to address our nation’s most pressing health care challenges: access, quality, and cost.”
The Campaign, which is led by RWJF and AARP, has created Action Coalitions in all 50 states and the District of Columbia that are comprised of nurses, other health providers, consumers, educators, businesses, and others. It was launched in response to a groundbreaking report by the Institute of Medicine (IOM) that called for a transformation of the nursing profession to improve health and health care.
That transformation is beginning to take place, according to the dashboard—a set of graphic illustrations that measure progress in key areas. The Campaign has also released a set of “supplemental indicators” that provide more detailed information about Campaign progress.
Between the fall of 2010 and the fall of 2012, the number of nurses enrolled in doctoral programs rose 43 percent, from 11,645 to16,685. Much of the growth came in DNP—or doctorate of nursing practice—programs; the number of students enrolled in these practice-oriented programs jumped from 7,304 in 2010 to 11,575 in 2012. Enrollment in research-oriented PhD programs has also grown; in 2012, 5,110 students were enrolled in these programs, up from 4,611 in 2010.
The data reflect significant progress toward the IOM report’s recommendation to double the number of nurses with doctorates—the kind of nurses who are needed to fill faculty vacancies, conduct scientific research, and provide highly skilled nursing care to a patient population living longer but sicker, with a greater number of chronic conditions that require complex care. An RWJF-supported program, the Future of Nursing Scholars, will also help to boost the number of nurse leaders prepared with research-oriented doctorates, Hassmiller said.
The percentage of employed nurses with baccalaureate degrees is also on the rise, reflecting progress toward another key IOM report recommendation: that 80 percent of the nation’s nurses hold bachelor’s degrees or higher by 2020. In 2010, 49 percent of the nation’s nurses held bachelor’s degrees in the science of nursing (BSNs); in 2013, 51 percent did—a 4 percent increase.
“The percentage increase may seem small, but it reflects real growth,” Fishman said. The nursing workforce is 3 million strong, she noted, so every additional percentage point represents 30,000 more nurses with bachelor’s degrees.
Moreover, more nurses are enrolling in baccalaureate programs, according to the American Association of Colleges of Nursing, and the number of graduates in RN-to-BSN programs is ballooning—signs that the percentage of employed BSN-prepared nurses will continue to rise, Hassmiller said.
Change ‘Takes Time’
Still, the IOM report’s “80 by 2020” goal remains far off, and change will not come overnight, Fishman said. “Moving these numbers takes time.”
That’s true of other Campaign objectives as well, according to Joanne Spetz, PhD, professor at the Institute for Health Policy Studies and associate director for research strategy at the Center for the Health Professions at the University of California, San Francisco. “Each of the IOM recommendations has a fair amount of challenge associated with it. Everything the IOM report recommended was absolutely spot on, but if the goals were easy to meet, then they would have been met already.”
The IOM recommendation related to scope-of-practice, for example, faces opposition from some organized physician groups and is subject to the whims of state-level politics. But it is moving forward nonetheless.
Since 2010, seven states—Minnesota, Connecticut, Kentucky, Nevada, Rhode Island, North Dakota, and Vermont—removed statutory barriers that prevented nurse practitioners (NPs) from providing care to the full extent of their education and training.
Other states have passed laws that build momentum toward full practice authority for NPs. Texas, for example, removed a restriction requiring on-site physician supervision of nurse-led retail health clinics. And Utah allowed NPs to be reimbursed by Medicaid for the services they provide to beneficiaries in the state.
“More and more states are modernizing laws every year as a result of the Campaign and its efforts to raise awareness about the importance of removing barriers to practice and care,” said Winifred Quinn, PhD, director of advocacy and consumer affairs at the Center to Champion Nursing in America (CCNA), an initiative of AARP, the AARP Foundation, and RWJF. These kinds of advances, she said, will help increase consumer access to care. CCNA coordinates the Campaign for Action.
Diversifying the nursing workforce is another key goal of the Campaign, and progress is being made in this area, too. The number of minorities in the nursing workforce is gradually rising, as is the share of the nursing workforce that they represent, according to the Campaign’s supplemental indicators on diversity.
In 2010, about 24 percent of the nation’s RNs identified as minorities; that percentage inched up to 25 percent in 2012. Data collection is improving in this area too. In 2011, 34 states collected data about the race and ethnicity of their nursing workforces; in 2012, that number jumped to 44.
The IOM report also calls for more interprofessional education and collaboration among health professions students, and the dashboard notes progress there, too. In the 2011-2012 academic school year, two of the nation’s top nursing schools that also have graduate health professional schools required at least one interprofessional clinical course or activity. In the 2012-2013 academic year, two more schools required interprofessional courses or activities.
Thirteen states, meanwhile, increased the number of data items they collect on the nurse workforce between 2010 and 2013, which helps build the national infrastructure for collection and analysis of interprofessional health care workforce data. Comprehensive data are needed to enable policy- and decision-makers to ensure that the nation has an adequate supply of nurses.
Nurse leadership is another key goal of the IOM report, but progress in this area is difficult to measure, Spetz said. As of 2011, 6 percent of the nation’s hospital boards had nurse members, and new data won’t be released until later this year or next. “The leadership indicator is a sticky wicket,” Spetz said. “There are a lot of ways nurses can and are taking on leadership roles, and we’re not necessarily going to see the totality of that in a single indicator.”