Shalala: Institute of Medicine Report to Usher in "Golden Age of Nursing"

    • October 11, 2010

Change is in the air.

That was the message behind a landmark report released last Tuesday that calls for a radical transformation of the nursing profession to better meet the changing and complex needs of Americans in the 21st century.

Unveiled at a standing-room-only news briefing in Washington, D.C., the book-length report was released as speakers and audience members alike hailed its promise of new possibilities for nurses and the patients they serve. More than 2,000 nurses, health professionals and other stakeholders logged on to watch a webcast of the briefing, many gathering in large groups to view it.

The report will usher in a “golden age of nursing” in which nurse leaders take their rightful place alongside other leaders in health care, declared Donna E. Shalala, Ph.D., F.A.A.N., chair of the Committee on the Robert Wood Johnson Foundation (RWJF) Initiative on the Future of Nursing, at the Institute of Medicine (IOM). As chair of the committee, Shalala—the former head of the U.S. Health and Human Services Department who now serves as president of the University of Miami in Florida—helped draft the report.

Risa Lavizzo-Mourey, M.D., M.B.A., RWJF president and chief executive officer, echoed the sentiment, calling the report a “tipping point” for nurses and characterizing the recommendations as “courageous and consequential.”

“This is a huge milestone in America’s long and sometimes troubled journey to improve health care…,” she said. “But it also marks a difference in what nursing used to be and what I believe it’s going to be. And I believe that difference is going to be like night and day.”

The report is the culmination of a two-year effort by the IOM, supported by RWJF, to find solutions to the continuing challenges facing the nursing profession and to build upon nursing-based solutions to improve quality and transform the way Americans receive health care.

Nurse leaders lauded the report for its content as well as the context in which it arrived.

“This report is more evolutionary than revolutionary,” said the committee’s vice chair, Linda Burnes Bolton, Dr.P.H., M.P.H., M.S.N., vice president for nursing and the chief nursing officer and director of nursing research at Cedars-Sinai Medical Center in Los Angeles. Although some of the recommendations have appeared in earlier reports on the future of nursing, the current climate will enable the recommended changes to take root, she said. This time, she added in an interview, change is “within our grasp.”

Jennie Chin Hansen, R.N., M.S.N., F.A.A.N., a committee member who is chief executive officer of the American Geriatrics Society in New York, agreed. “This is a historic day for nursing.” The existing and projected shortages of qualified health care providers, including physicians and nurses, compel action on the report’s recommendations, she said, especially since they come at a time when there will be greater need for more complex care. The demand will only intensify as millions more people enter the health care system under the recently enacted Affordable Care Act, which represents the most profound opportunity for change in five decades, she added.

“There’s a convergence of forces,” Burnes Bolton agreed. “The demand side is really making it possible to think beyond the possibilities.”

Report Serves as Blueprint for Nurses, Health Professionals and Other Stakeholders

To complete the report, Shalala chaired an interdisciplinary study committee that reviewed scientific literature on the nursing profession and held a series of public forums about challenges to nursing. The product—The Future of Nursing: Leading Change, Advancing Health—serves as a blueprint for action for health care professionals, including nurses, and other stakeholders to bring about change.

In addition to Shalala, Burnes Bolton and Chin Hansen, 15 experts from a wide variety of disciplines also served on the committee. Susan Hassmiller, Ph.D., R.N., F.A.A.N., RWJF’s senior adviser for nursing, directed the project and will direct its next phase which will be to oversee implementation of the recommendations.

The report’s first recommendations relate to the removal of barriers that prevent nurses from practicing to the full extent of their training and abilities. Evidence shows that nurses are as capable as physicians when it comes to providing certain primary care, anesthetic and obstetric services, committee members said.

Yet “scope-of-practice” laws often deprive nurses of the ability to provide these services, noted committee member Michael Bleich, Ph.D., M.P.H., R.N., F.A.A.N., who is the Carol A. Lindeman distinguished professor and dean of the School of Nursing at Oregon Health and Science University in Portland, Ore. To illustrate the absurdity of some laws, he told a story about his experiences in Kansas City—a city claimed by two states with differing “scope-of-practice” laws. Nurse practitioners on one side of the city could care for patients without supervision from physicians and those on the other side practiced with more restrictions, he said. “Mind you, these are the same practitioners with same education and experience.” But depending on where they worked, some “were allowed and enabled and empowered to” deliver a greater variety of services.

The report also recommends changes that would foster interprofessional collaboration so that nurses are full partners with physicians and other health professionals in redesigning health care in the United States. Nurses—the largest part of the health workforce and the most trusted group of professionals in the country—must claim their power, said committee member William D. Novelli, M.A., former chief executive officer of AARP. “The one thing we know about making change, about big social change, attacking big social problems, is that leadership really counts,” he said. Nurses are leaders, he added, but they need to be given many more opportunities to serve in leadership positions.

A third area involves recommendations to improve nurse education so that nurses are able to meet changing health care needs. “We need more masters and doctorally prepared people,” Bleich said. “We need nurse researchers and scientists, we need nurse academics. We can’t get those individuals to the higher levels of education without the baccalaureate degree. It is critical therefore that we have more substantive numbers of people that have that degree so we can promote them into the workforce.”

Finally, the report calls for better data collection efforts and a stronger information infrastructure so policy-makers can have the information they need to institute fundamental change as well as the preparation of nurses to lead change.

“I’m confident we can make the changes recommended in this report, but it will take time, focus and tenacity,” Chin Hansen said.