1) October marked the second anniversary of the groundbreaking report by the Institute of Medicine (IOM) on the future of nursing. Did you anticipate the kind of impact it has had on the nursing profession and on our health care system?
I was certainly hoping that the IOM report, The Future of Nursing: Leading Change, Advancing Health would be used as a blueprint for change. What I did not fully realize was the magnitude or just how many people would be involved. So many organization leaders have told me they have changed their way of doing business, working collaboratively with those they never worked with before, teaching students and delivering care in different ways, because of the report. And what I am really impressed with is not only the many thousands of people in this country who are finding ways to implement the report, but the impact on nurses and health care leaders around the world. The IOM sends me information on who is downloading or buying the report, and the list reads like a participant list for a United Nations meeting.
2) The IOM report has broken records for the number of visitors on the IOM website and the number who are printing and/or buying it. Why do you think a report about the nursing profession is, and remains, so popular?
Nurses very much want to provide great care to their patients and nursing faculty want to ensure that they are teaching cutting edge, evidence-based material. This report is providing a blueprint for what both nurses and nurse faculty are looking for. It is also giving assurance to key stakeholders, including consumers, policy-makers, physicians and business owners, that nurses are serious about wanting to provide the highest quality, most accessible and cost effective care possible.
3) As you know, the Supreme Court upheld the Patient Protection and Affordable Care Act (ACA) this summer. What does that decision mean for nurses and nursing?
Nurses want to do all they can to help patients stay well, get better, or transition to a peaceful death. And with more people obtaining health insurance, there will be a greater need for all kinds of providers, including nurses. The Supreme Court decision means an influx of patients with even more complex, chronic needs into the system. We need nurses to lead at all levels and to work with other nurses, as well as others in the health and health care fields, and across all settings. For example, primary care and public health nurses need to work collaboratively to address the epidemic of chronic disease. Nurse-led teams need to work at the primary, secondary and tertiary prevention levels to help slow the speed of these chronic care needs entering into the health care system.
As the largest health care profession, nurses must be a vital part of informing and carrying out implementation of the ACA to assure increased access while improving quality and lowering cost.
Graduate nursing education is preparing more advanced practice registered nurses, who are being recognized as major contributors to transformation of the health care delivery system.
Also, the ACA accelerated delivery system reforms that focus on increased primary, preventive and care coordination (including transitional care), all of which have nursing at their core. So the ACA solidifies and strengthens nursing's central role to health care transformation.
4) What are you top priorities for implementing recommendations from the report over the next two years?
The Robert Wood Johnson Foundation (RWJF) supports the entire Campaign for Action, including whichever recommendations each state chooses to work on as its own priorities. We do this primarily through a grant to the Center to Champion Nursing in America (CCNA) at AARP, which serves as the operational headquarters for the Campaign.
RWJF will be providing additional support to three of the Campaign priority areas: academic progression, interprofessional collaboration, and leadership. We have already developed a national program that is funding nine states to demonstrate and evaluate promising practices to help more nurses get a BSN or higher degree. We have also co-funded a new national Center for Interprofessional Education and Collaborative Practice, along with the Josiah Macy Jr. Foundation, the Gordon and Betty Moore Foundation, and the John A. Hartford Foundation, as well as the Health Research and Services Administration; it will have a mission to accelerate teamwork and collaboration among nurses, doctors and other health professionals. Finally, we will continue to make investments in nursing leadership through programs such as our RWJF Nurse Faculty Scholars and RWJF Executive Nurse Fellows.
5) Are there any areas of the country where the “future of nursing” has already arrived? In other words, are there states or localities or organizations that have actualized your vision for the profession, whether in the area of practice, education or leadership?
Oh yes! The saying, “the future is here...it is just not everywhere,” does apply here. A few examples:
Academic Progression: Our new Academic Progression in Nursing grant recipients are bringing community colleges, universities, employers and other stakeholders together to build regional and statewide infrastructures for smooth and accelerated academic progression for community college students. They are making use of the latest technology, including simulation, online education, and telehealth. The Magnet program will be asking all new applicants and those reapplying how they will reach 80 percent of their nurses having a BSN or higher degree by the year 2020. Thousands of community college graduates are now making their way back to school as a result of these programs and policies.
Leadership: Nurses are being prepared as leaders at statewide leadership institutes in Wyoming and North Carolina; through Nurses on Boards programs, held twice per year in New Jersey; and by emerging young leader recognitions/40 Under 40 in Virginia and Nebraska. Kaiser Permanente in California has created a comprehensive mentorship program to address leadership needs at their organization. The Tri-Council for Nursing—which includes the American Association of Colleges of Nursing, the American Nurses Association, the American Organization of Nurse Executives, and the National League for Nursing—all have extensive leadership and mentoring programs for their members. Leapfrog is promoting nurses as leaders in the hospital safety scoring process and giving them a “call to action” to make safety a priority. The Health Plans Work Team (led by Aetna) is working with CCNA to brainstorm how they can collectively address the leadership and education progression needs of nurses.
Practice: Many states have pending legislation to ensure that all advanced practice registered nurses are able to practice to the top of their education and training. Nurse-managed clinics nationwide are serving the most vulnerable of our populations while maintaining the highest level of patient outcomes. The American Red Cross has changed its internal policy for its disaster nursing workforce to allow all nurses to work to the top of their education and training, ensuring complete access to care where and when care is needed the most. Organizations are developing materials to explain the vital role that nurse practitioners will play in a transformed health care system where primary care providers will be in great demand.
6) How can this newsletter's readers help the Future of Nursing: Campaign for Action reach its goals?
The first thing I would like everyone to do is to go to our new website at www.CampaignforAction.org and join the conversation. You can also find your state and find out how to contribute your time and expertise. We have state action coalitions in 49 states that are working on their own recommendation priorities and the leads for each of the states are listed. Please contact them and get involved.
This is such a historical time for nurses to step up to the plate and become personally involved in improving quality, cost and access for patients everywhere. It is also very important to work with those outside of nursing, including employers, business owners, doctors, policy-makers, payers, and most especially the patients themselves. Nursing, and making health care better for all, is something that should involve us all.