New Report Calls for Rethinking the Nursing Profession

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The Future of NursingTransforming the nursing profession is a critical component in achieving the nation's vision of an effective, affordable, accessible healthcare system, says a new report from the Institute of Medicine (IOM).

Nurses' roles, responsibilities and education must change significantly to meet the increased demand for care that will be created by healthcare reform, and to advance improvements in the health system, the report suggests. "Nurses are critical to carrying out the core goals of quality care," says IOM president Harvey Fineberg.

The report, "The Future of Nursing: Leading Change, Advancing Health," contains recommendations from the Robert Wood Johnson Foundation Initiative on the Future of Nursing, which was launched by the foundation and the IOM in 2008.

The committee's report highlights four key messages:

  • Nurses should practice to the full extent of their education and training.
  • Nurses should achieve higher levels of education and training.
  • Nurses should be full partners with physicians and other health professionals in redesigning healthcare in the United States.
  • Effective workforce planning and policymaking require better data collection.

"This important report recognizes the crucial role that nurses will continue to play as the nation implements healthcare reform and millions of new patients gain access to the healthcare system," AFT president Randi Weingarten says.

"The report is a huge milestone in the nation's journey to improve healthcare," says Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation. The conclusions of this report are courageous and sharply drawn, as well as controversial and consequential, she adds. "It marks the difference between what nursing used to be and what it is going to be," says Lavizzo-Mourey. "The difference is like night and day. The bottom line is that we can do it—with cooperation and collaboration."

The report notes that states, federal agencies and healthcare organizations should remove scope-of-practice barriers that hinder nurses from practicing to the full extent of their education and training. These barriers are particularly problematic for advanced-practice registered nurses. With millions more patients expected to have access to coverage through healthcare reform, the healthcare system needs to tap the capabilities of advanced-practice nurses to meet the increased demand for primary care, the committee says.

Weingarten notes that "nurses, who make up the largest segment of the healthcare workforce, should be allowed to expand the scope of their practice to the full extent of their education and training—and we applaud the report’s support for that goal."

Nurses can bridge the gap caused by the shortage of primary care doctors, says committee member Dr. John Rowe. "There are certain primary care services that physicians and nurses can provide with similar efficacy. It is an idea whose time has come," says Rowe, a professor at Columbia University's Mailman School of Public Health in New York City.

To handle greater responsibilities and the increasing complexity of healthcare, nurses should achieve higher levels of education and training, the report says. The goal is to have 80 percent of nurses earn bachelor's degrees in the next decade, says committee chair Donna Shalala, president of the University of Miami. "This is a call to action for re-creating nursing in America."

Michael Bleich, dean of the school of nursing at the Oregon Health and Science University in Portland, notes that the committee is not recommending eliminating the many paths to nursing, but rather creating a more educated workforce. "We need more nurse academics, and you can't get nurses to higher levels of education without a bachelor's degree," says Bleich.

The report also notes that healthcare organizations, including nursing associations and nursing schools, should look for ways to give nurses more opportunities to gain leadership skills. Nurses in turn need to recognize their responsibility and capability to contribute on management teams, boards, and other groups shaping healthcare, the report says.

"Nurses have the power and the force to step up and take a greater [leadership] role," says William Novelli, committee member and former CEO of AARP.

AFT and its AFT Healthcare division will be working with Congress and state legislatures over the next several months to make the necessary changes so that Americans have the access to quality healthcare that the new law envisioned, Weingarten says.

The Initiative on the Future of Nursing will hold a national conference Nov. 30 through Dec. 1 to discuss ways to begin putting the report's recommendations into practice. [Adrienne Coles, Institute of Medicine, AFT press release]

October 7, 2010