The Year in Review: Federal Government Takes Steps to Transform Nursing, Improve Health

    • December 18, 2011

The nationwide campaign to transform the nursing profession—and in so doing, improve health and health care—is off to a running start at the state and local levels.

The federal government is catching on quickly as well.

Members of the executive and legislative branches took a number of actions this year that support the goals of a groundbreaking report on the future of the nursing profession, which was released last year by the Institute of Medicine (IOM). Implementing the report’s recommendations, proponents say, will advance comprehensive health care change and help ensure that all Americans have access to high quality, patient-centered care.

This year, the Obama administration tapped nurses to serve in two key leadership posts; announced that certain federal health grants would support interprofessional education and collaboration and advance nurse education; allocated funds for health clinics managed by nurses and for nurse home visitation programs; and sought funding increases for nursing workforce development programs in its budget proposal, which was released at the beginning of the year.

In addition, key members of Congress took actions indicating they support and are working to implement the goals of the IOM report, The Future of Nursing: Leading Change, Advancing Health.

The steps bolster the report’s call for nurses to achieve higher levels of education and training through an improved education system; assume more positions of leadership in the health care system and beyond; work as full partners in the redesign of the nation’s health care system; and practice to the full extent of their education and training. These are key ways to help improve health and health care in the United States, the IOM report states.

Taken together, this year’s federal actions indicate that powerful members of the executive and legislative branches understand the importance of the report and are taking steps to implement its recommendations, said Winifred Quinn, MA, PhD, director of legislation and campaign operations at AARP and the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation (RWJF).

Nursing Education Programs Dodge Deep Budget Cuts

Nursing education programs, meanwhile, dodged a legislative bullet this month during House and Senate consideration of the fiscal 2012 federal budget. Earlier this year, the House leadership proposed deep cuts to nurse education programs. Such cuts would have dealt “a grave blow” to the sustainability of nursing education infrastructure and the pipeline of future nurses, said Kathleen Potempa, PhD, RN, FAAN, president of the American Association of Colleges of Nursing. But earlier this month, House and Senate budget negotiators agreed to a plan that spared nursing education programs from significant cuts.

One setback to nurse education could come if the Centers for Medicare and Medicaid Services (CMS) does not comply with a request to expand a pilot graduate nurse education program before it begins next year. “We’re hopeful that our message got through to CMS and that some of the restrictions that would hinder the success of the program are being reexamined,” Quinn said.

Proponents cheered other federal actions this year. In November, President Obama tapped Marilyn Tavenner, MHA, BSN, RN, to take over the helm of the Centers for Medicare and Medicaid Services. She is serving as acting administrator until her nomination is confirmed by the Senate. In September, Major General Patricia Horoho, CNS, RN, became the first nurse appointed to serve as surgeon general of the United States Army.

Also this year, the Health Resources and Services Administration (HRSA) announced it intends to support programs that emphasize interprofessional education and collaboration. The Nurse Education, Quality, Practice and Retention program, for example, will support grant proposals that develop interprofessional collaborative practice models. And the Advanced Nurse Education program will fund grant proposals that include technological training (such as simulation and telehealth projects) and interprofessional education.

Also this year, the Department of Health and Human Services allocated funding for nurse-managed clinics and for home visitation programs. The funds, authorized by the health reform law of 2010, will help increase access to primary care services for low-income people and support nurse-led care.

On the legislative side, key members of Congress used their positions to press federal agencies to support the goals of the IOM report.

Members of the Senate Appropriations Committee, for example, called on the Department of Health and Human Services to develop a plan to implement the report’s recommendations by early 2012. “That’s big,” Quinn said. “This is the congressional arm raising awareness about the IOM report and suggesting its recommendations are needed to ensure there are enough nurses to meet consumer needs now and in the future.”

Other powerful lawmakers asked the Federal Trade Commission (FTC) to review state laws that restrict the practice of advanced practice registered nurses. The FTC complied and issued statements that support IOM report recommendations in four states this year. “It’s a way to keep pressure on the states and to point out from another angle why the restrictive scope-of-practice laws are not really good for our country,” Quinn said. “They decrease access to care for consumers while reducing commercial competition.”

The federal actions complemented a whirlwind of activity at the state and local levels undertaken by the Future of Nursing: Campaign for Action, a nationwide effort organized by RWJF and AARP to implement the report’s recommendations.

Groups working to implement the IOM report recommendations have coalesced in nearly every state, and three dozen states have formed Action Coalitions that include nurses and other health care professionals, business executives, academic and nonprofit leaders, policy-makers and consumer advocates. Each Action Coalition has set its own goals based on the IOM report recommendations and is now working to reach those goals.

Action Coalitions are expected to be in place in nearly every state sometime next year, and proponents of the report are hopeful that decision-makers at the federal level will take more steps to transform the nursing profession. When it comes to the budget, however, Quinn expects a similar struggle because the composition of Congress will be the same and the economy does not appear to be on a fast track to recovery. “It’s a presidential election year,” she said, “but we’re expecting most everything else to be the same.”