Blog by: Melanie T. Gura, RN, MSN, CNS, CCDS, FHRS, FAHA, AACC

Since nursing is the largest percentage of the nations’ healthcare labor force and will play a critical role in helping realize the objectives of the 2010 Affordable Care Act, the Robert Wood Johnson Foundation and the Institute of Medicine (IOM) launched a two-year initiative in 2008, to review the need and transformation of the nursing profession. They released the IOM report on the Future of Nursing: Leading Change, Advancing Health,[1] which calls for new and expanded roles for nurses in a redesigned healthcare system.

Nurses, who have varying levels of education and competencies, practice in a variety of settings. The committee considered these variables as well as its effort to envision the future of the nursing profession. Four key messages were developed: 1) Nurses should practice to the full extent of their education and training; 2) Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression; 3) Nurses should be full partners, with physicians and other healthcare professionals, in redesigning healthcare in the United States; and 4) Effective workforce planning and policy making require better data collection and an improved information infrastructure.

The committee proposed eight recommendations and outline initiatives to the Congress, State Legislatures, Center for Medicare and Medicaid Services, Office of Personnel Management, the Federal Trade Commission and the Antitrust Division of the Department of Justice, private and public funders, healthcare organizations, nursing education programs and nursing associations:

1. “Remove scope-of-practice barriers: Advanced practice nurses should be able to practice to the full extent of their education.[1]
2. Expand opportunities for nurses to lead and diffuse collaborative improvement efforts: Private and public funders, healthcare organizations, nursing education programs and nursing associations should expand opportunities for nurses to lead and manage collaborative efforts with physicians and other members of the healthcare team to conduct research and to redesign and improve practice environments and health systems. These entities should also provide opportunities for nurses to diffuse successful practices.[1]
3. Implement nurse residency programs: State boards of nursing, accrediting bodies, the federal government, and healthcare organizations should take actions to support nurses’ completion of a transition-to-practice (nurse residency) after they have completed a prelicensure or advanced practice degree program or when they are transitioning into new clinical practice areas.[1]
4. Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020: Academic nurse leaders across all schools of nursing should work together to increase the proportion of nurses with a baccalaureate degree from 50 to 80 percent by 2020. These leaders should partner with education accrediting bodies, private and public funders, and employers to ensure funding, monitor progress, and increase the diversity of students to create a workforce prepared to meet the demands of diverse populations across the lifespan.[1]
5. Double the number of nurses with a doctorate by 2020: Schools of nursing, with the support from private and public funders, academic administrators and university trustees, and accrediting bodies, should double the number of nurses with a doctorate by 2020 to add to the cadre of nursing faculty and researchers, with attention to increasing diversity.[1]
6. Ensure that nurses engage in lifelong learning: Accrediting bodies, schools of nursing, healthcare organizations, and continuing competency educators from multiple health professions should collaborate to ensure that nurses and nursing students and faculty continue their education and engage in lifelong learning to gain the competencies needed to provide care for diverse populations across the lifespan.[1]
7. Prepare and enable nurses to lead change to advance health: Nurses, nursing education programs, and nursing associations should prepare the nursing workforce to assume leadership positions across all levels, while public, private, and government healthcare decision makers should ensure that leadership positions are available to and filled by nurses.[1]
8. Build an infrastructure for the collection and analysis of inter-professional healthcare workforce data: The National Health Care Workforce Commission, with oversight from the Government Accountability Office and the Health Resources and Services Administration, should lead a collaborative effort to improve research and the collection and analysis of data on healthcare workforce requirements. The Workforce Commission and the Health Resources and Services Administration should collaborate with state licensing boards, state nursing workforce centers, and the Department of Labor in this effort to ensure that the data are timely and publicly accessible."[1]

Reference
1. The Future of Nursing: Leading Change, Advancing Health October 2010: www.iom.edu/nursing

Melanie Gura, RN, MSN, CNS, FHRS, FAHA is the Director of Pacemaker & Arrhythmia Services at Northeast Ohio Cardiovascular Specialists in Akron, Ohio.

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