Oct 6, 2011, 12:00 PM, Posted by Peter Lazes
By Peter Lazes, PhD
Director, Healthcare Transformation Project and Director, Program for Economic Transitions
As was clearly stated in the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health1, there is an urgency to transform our current health care system and education system for nurses in order to improve the coordination of care, provide better chronic care management, and control the cost of care for individuals and communities. Increasing the number of BSN-prepared nurses to 80% of RNs is an important component of the current recommendations which will help achieve the aforementioned goals. Yet, there are a number of factors tied to the shifting focus of the health care industry that may impede the full implementation of this recommendation.
As the IOM report argues, the ways in which nurses were educated and practiced during the 20th century are no longer adequate for dealing with the realities of health care in the 21st century. In order to equip 80% of RNs with baccalaureate degrees, health care professionals and nursing school administrators need to acknowledge that non-acute care work is an increasingly critical component of current health care reform legislation and of changes in our reimbursement system. Unless there is a clear emphasis in nursing school curricula on the shift from hospital-based care to community care and from a fee-for-service reimbursement system to a capitation or global payment model, there may be little incentive for nurses to pursue an additional nursing degree. “Why bother? I already have the skills that I need” might be a logical response from a nurse who is currently employed by a hospital. While acute care nurses will still be needed, a growing number of nurses will be required to staff the new jobs that are being created in primary care practices, in hospital clinics, and in medical homes. Nurses must be prepared for a spectrum of job opportunities that will require a novel set of skills but will also present creative and impactful ways to influence patient care.