“We need a workforce that is appropriate in size and expertise, and unrestrained in their practice,” Mary Naylor, Ph.D., R.N., F.A.A.N., said at the second committee meeting of the Initiative on the Future of Nursing, held in Washington, D.C., on September 14. The two-year project is a joint effort of the Robert Wood Johnson Foundation and the Institute of Medicine. Its goal is to examine issues facing the nursing profession, and develop recommendations to ensure that the nursing workforce can meet the demands of a reformed health care and public health system.
Naylor, the Marian S. Ware Professor in Gerontology and Director of the New Courtland Center for Transitions and Health at the University of Pennsylvania, School of Nursing, is also National Program Director of the Robert Wood Johnson Foundation-sponsored Interdisciplinary Nursing Quality Research Initiative. Compared to physician-only teams, nurse practitioners and nurse/physician teams provide better care management, patient outcomes and patient satisfaction, she said. Nurses and midwives also play a part in decreasing hospital readmissions, and nurse-led models of care lower overall health care costs.
“We have not demonstrated the reliability of the nursing workforce consistently,” and there is confusion among the public about who nurses are and what they do, Naylor noted. An inadequate pipeline of nursing faculty, complex reimbursement and payment rules, and disparities in federal law and public policy pose challenges for the nursing workforce.
Ann Hendrich, R.N., M.S.N., F.A.A.N., vice president of clinical excellence operations at Ascension Health, has extensively studied health care work environments and their effect on nurses and patient outcomes. Her Time and Motion study was funded in part by RWJF. “Many acute care nurses function at the level of a marathon runner,” she said. “Patient care activities account for 19.3 percent of nursing practice time, and only 7.2 percent of their time is spent on patient assessment and reading vital signs,” because their time is spent on documentation, administration, and care coordination.
“We need to make sure nurses are empowered and they have time to practice nursing,” Hendrich added, offering examples of nurse-led initiatives that have produced positive outcomes. She recommended a series of changes in the workplace as part of an overall change for the profession.
Nursing will have to transition from inpatient, acute care to ambulatory, chronic prevention and management, said Edward O’Neil, Ph.D., M.P.A., F.A.A.N., professor in the Departments of Family and Community Medicine, Preventative and Restorative Dental Sciences and Social and Behavioral Sciences at the University of California, San Francisco.
Organization flexibility, evidence based practice, informatics, development of leadership skills, and new expectations will be important to the transition of nursing as health care evolves, he added. The nursing workforce’s success will depend upon the profession envisioning necessary changes, education responding appropriately, and consumers accepting the changes. O’Neil also is director of the Center for Health Professions, which leads the RWJF Executive Nurse Fellows Program.
“I think nursing is responsible for holding itself back at times,” he said. “I wonder if we could… take this great wonderful asset we have in nursing and move it progressively and proactively into the future.”