The Future of Nursing is Arriving

    • November 8, 2012

For years, health care experts have envisioned a future in which nurses would be able to achieve their full potential—as students, as practitioners, and as leaders—and in doing so, improve the nation’s health and health care.

That future is not in a galaxy far, far away. In some ways, in some places, it’s already here, thanks to a national campaign working to implement recommendations from a landmark nursing report issued two years ago by the Institute of Medicine (IOM).

“The larger world view about the future role of nurses is taking root,” said Susan Reinhard, PhD, RN, FAAN, senior vice president of the AARP Public Policy Institute and chief strategist for the Center to Champion Nursing in America. “Nurses are stepping up to help lead this transformation in health and health care for people of all ages, and that’s incredibly exciting to see.”

The future of the nursing profession is on the horizon in Vermont, where the governor has created a commission to ensure that nurses are able to serve as full partners in the state’s health care system. It’s becoming a reality in Texas and Wisconsin, where new initiatives are making it easier for more nurses to pursue higher education. And it’s arriving in New York, where nurse advocates are coming together to curb a shortage of nurse faculty, and in New Jersey, where nursing champions are working to place nurses on government boards. In Indiana, New Hampshire, and Rhode Island, meanwhile, new programs are promoting interprofessional education that includes nursing and medical students.

The future of nursing is evident on the national scene as well.

Leading education and nursing organizations issued a joint call for a better-educated, more diverse nursing workforce in September. The statement came as a major boost for academic progression in nursing, which aims to help nursing students in associate degree programs move more easily into baccalaureate and graduate-level programs.  Creating “seamless transitions” between academic programs will help create a more highly educated nursing workforce, which will improve patient care and help fill faculty and advanced practice nursing roles.

The Future of Nursing: Campaign for Action, an initiative of AARP and the Robert Wood Johnson Foundation (RWJF), is working to transform health care through nursing. One of the many ways it is doing that is by working with leaders in 49 states to develop a strategy to increase nurse education levels using existing community colleges and university systems more efficiently. Another way is by revising employer policies to support academic progression.

Meanwhile, leading nurse organizations have come together to launch a $4.3 million initiative, funded by RWJF, to advance state and regional strategies to create a more highly educated workforce. Under the initiative, Academic Progression in Nursing, nine states showing particular promise in that endeavor were recently awarded two-year, $300,000 grants.

Change is also coming to the federal government and the business world.

The retail giant Target is engaging its staff nurses in leadership positions. The Leapfrog Group is using a hospital’s working environments for nurses—or its Magnet status—as an indicator of its nursing service and leadership. And Aetna, a major health insurance company, continues to promote and support nurse development and advancement through a variety of initiatives under the leadership of Susan Kosman, RN, BSN, MS, Aetna’s first chief nursing officer.

“This landmark report highlights the important role that nurses can and should play in transforming health care delivery,” Kosman said. “At Aetna, we have nurses who are leading and collaborating to develop new models of care, leading large clinical operations and providing expertise in many other areas.”

In the public sector, the Health Resources and Services Administration recently announced it will open a new national center to enhance interprofessional education and collaboration among health care providers across the nation. The center will be housed at the University of Minnesota Academic Health Center. Learn more about it here.

The Department of Veterans Affairs, meanwhile, has outlined a plan to implement the IOM report recommendations throughout its vast health care system.  The Federal Trade Commission is challenging limits to regulations that restrict the practice of advanced practice registered nurses (APRNs) in eight states.  And the Centers for Medicare and Medicaid Services now supports the use of team-based and collaborative care for patients and recently launched its first-ever initiative to pay for graduate nurse education (GNE).

Under the GNE initiative, Medicare is funding five hospitals over four years to expand the capacity to educate APRN students. If the project is deemed a success, funding could become permanent and the program implemented on a national scale. “This announcement marks a historic moment of investment in the crucial and growing role of nurses in our health care system,” RWJF President and CEO Risa Lavizzo-Mourey, MD, said in a statement. 

Four Overarching Priorities

The Campaign has four overarching priorities: strengthening nurse education, training and diversity; supporting nurse leaders; eliminating barriers that restrict the ability of nurses to provide care; and promoting interprofessional collaboration among health care professionals. Its goals are steeped in evidence found in the IOM report, which argues that:

•           a more highly educated and more diverse nursing workforce is needed to manage increasing numbers  of diverse patients with multiple health conditions in a more complex health care system;

•           more nurse leaders are needed to share their unique—but often overlooked—insights into ways to direct and manage health system change, promote prevention and contain costs;

•           nurses need to be able to practice to the full extent of their education and training to expand access to primary care at a time of shortage; and

•           nurses and other health care professionals need to collaborate more to improve the quality and coordination of care.

The Campaign for Action launched shortly after the release of the IOM report. Since its founding, it has created an organizational structure; raised awareness about the report and its recommendations; established field efforts at the national and state levels; forged partnerships with a diverse array of organizations; and opened dialogues with groups that have some concerns about certain aspects of the report.

The Campaign has made great progress in these areas over the last two years, said John Rowe, MD, a professor of the Mailman School of Public Health at Columbia University and a member of the RWJF study committee that drafted the report. “Most commissioned reports just get put on the shelf,” he said. “Not this one. The energy and momentum behind the Campaign to implement its recommendations are tremendous.”

The Campaign has indeed made headway.  It is working with an advisory council of leading nursing organizations; an advisory committee of leaders in business, health care and education; and a “diversity steering committee” comprised of leaders of organizations that advocate on behalf of groups underrepresented in nursing.

It has spread the word about the report far and wide, helping to make it one of the most widely read reports in the history of the IOM. And it has created a vast field network spanning the entire country, with grassroots groups now working in 49 states to turn the report’s recommendations into reality.

Meanwhile, it has reached out to both allies and adversaries. The Campaign is supported by a coalition of some 50 organizations representing leading nursing, health care and consumer groups as well as health insurers such as Aetna and CIGNA, businesses like Target and Verizon, charities such as Disabled American Veterans and the March of Dimes, and advocacy groups like the American Association of People with Disabilities and the American Federation of Teachers.

“This Campaign is truly a national campaign, with stakeholders from beyond the nursing profession,” Reinhard said. “That’s significant. We’re now in phase three of the Campaign. We’re really working at the nuts-and-bolts level now and putting our arms to the wheel. We’re saying, ‘Let’s move! Let’s move!’”

Still, the Campaign faces hurdles as it tries to raise funds in the wake of a recession. “Implementing these recommendations, especially those that relate to developing a more highly educated nursing workforce, is going to cost money,” Rowe said. “It’s not yet clear where that money will come from.” And while the Campaign has eased concerns among some groups about certain aspects of the report, there continue to be some pockets of resistance, he added.

Actualizing the report’s vision is a monumental undertaking that involves overcoming many hurdles, Reinhard agreed: “If it were easy, it would have been done.” Still, she and others are pleased with the Campaign’s progress so far and optimistic about its future. No longer mere words on paper, the IOM future of nursing report is beginning to become a reality on the ground, they say.

“From the outset, we said that we did not want this report to sit on the shelf and collect dust,” Susan Hassmiller, PhD, RN, FAAN, director of the Campaign for Action and senior adviser for nursing at RWJF, said in a recent blog post. “It is a living, breathing document that is helping to transform health care through nursing. We look forward to even more progress in the months and years ahead.