Has the Future of Nursing Report Made a Difference?

Action Coalition logoBy Shawn Kennedy, AJN editor-in-chief

Last week, I went to Washington, DC, for a meeting convened to hear whether implementation of recommendations from the Institute of Medicine’s (now renamed the National Academy of Medicine, NAM) 2010 report, The Future of Nursing: Leading Change, Advancing Health, had indeed made a difference for nurses and the nursing profession.

The Robert Wood Johnson Foundation (RWJF), which sponsored the report, had also provided support to AARP’s Center to Champion Nursing in America to coordinate a “campaign for action” and manage the work of 51 state action coalitions. Five years later, RWJF asked the National Academy of Medicine to review and report on its progress.

In brief, the evaluation committee said that things were improving for nursing and that nursing needs to focus on three major themes:

  • communicating and collaborating with groups beyond nursing
  • improving diversity
  • getting better data

George Thibault, president of the Josiah Macy Jr. Foundation, presented the committee’s report. He noted that—while many gains in nursing over the past five years couldn’t be attributed directly to this initiative because work in several areas by various groups had been underway—the report had “galvanized the nursing community” and that the work to implement the recommendations had been “enormously successful” thus far. He said the initiative needs to continue to do the following:

  • Build on gains in removing barriers to full nursing scope of practice. (Eight additional states now allow full prescriptive authority for nurse practitioners, bringing the total to 21 states and the District of Columbia; the Centers for Medicare and Medicaid Services has redefined “medical staff” to make NPs eligible for admitting privileges, though in practice much has remained unchanged.)
  • Increase work in interprofessional teams.
  • Push to meet a goal of 80% of RNs with a BSN by 2020—but “don’t create barriers to enter nursing”; create pathways and support completion initiatives for those with AD education. (He noted that enrollment in both baccalaureate and completion programs has increased significantly since 2010.)
  • Create and fund transition-to-practice programs for new RNs and APRNs, and “get better evidence of their value to the nurse, the institution, and quality outcomes.”
  • Continue to promote both PhD and DNP doctoral education (especially the PhD, in order to meet a pressing need for future faculty)—but also examine the best use of these two roles. (Since 2010, enrollment in PhD programs increased by 15%, and more than doubled in DNP programs.)
  • Make increasing diversity in the nursing workforce a priority.

‘Culture of health.’ After the progress report, discussion shifted to how nursing, through state action coalitions, can contribute to creating healthier communities and promote a “culture of health,” the achievement of which is a driving force behind RWJF’s philanthropic mission. RWJF president and CEO Risa Lavizzo-Mourey talked about nurses’ key role in improving health for all. There were several presentations about organizations and individuals who have had success in community health efforts.

As a former acute care RN, I hope my colleagues in hospitals don’t feel left out. Yes, the focus is on keeping all people healthy and out of the hospital (that is everyone’s goal, yes?), but hospitals are changing, too, in order to become more engaged and responsive to the community. They are doing assessments of the communities they serve to see what the health needs are and what programs are needed.

Nurses need to be a part of this, not just in managing the programs, but in planning them. For example, does the community require early intervention outreach for families at risk, or are transitional care programs needed for a largely older population with chronic illness? One certainty is that there’s plenty for all nurses to do.

Editor-in-chief, AJN

5 Comments

  1. shassmi@rwjf.org December 20, 2015 at 2:52 pm

    Dear Ms Jones: as a certified coach and helper to many… and a very well educated nurse we would love for you to join the Campaign and learn more about the strategies we are implementing. Not exactly sure what you mean by sugar coating the recommendations? Could benefit from hearing the solutions you might have for what you outlined. I also would love the opportunity to share with you all the ways NP practice has advanced to truly improve access and quality of care (more work to be done but we are working with CMS, Joint Commission, employers, FTC, VA and more); the way the Campaign has taken on every barrier that might impede a nurse from going back to school (finances is a hard one…you are right!) and working with employers and schools to overcome these barriers; helping to increase diversity with our diversity steering committee (all the leads from the minority nursing associations); and paying particular attention to nursing faculty through the RWJF Nurse Faculty Scholars and Future of Nursing Scholars program and helping to ensure that federal dollars continue for faculty loan repayments, in additions to the thousands of foundations who are also working on this. Replacing faculty is indeed another tough one and would love to hear any other solutions you might have on this one. Finally, I absolutely agree with you about the inconsistency in quality with all the new BSN programs cropping up. Working with the accreditation boards help. I think todays nurses are working harder than ever and deserve every ounce of help we can give them. I am glad you are in the business of helping nurses…so are we. Perhaps we can creatively come up with solutions together. Other ideas?

  2. shassmi@rwjf.org December 20, 2015 at 2:27 pm

    I am so proud of all the nurses and “nurse champions” who have been part of the Future of Nursing Campaign since the beginning. What a difference nurses have made to help build their own capacity…advancing education, building our leadership competencies, becoming more diverse, modernizing scope of practice laws, doing more to practice in teams and much more. And now we must show the people in this country that nurses are there for them as we always have! Doing all we can to keep people and communities healthier. We know how to do this no matter the job we have…even in acute care…we take into consideration everything that can help make a person healthier and share that with them. So many people need our help. What a great time to be a nurse! We truly have so much to offer. To join a state action coalition affiliated with the Future of Nursing Campaign, you can feel free to reach out to me shassmi@rwjf.org or go to campaignforaction.org. To read more about building a Culture of Health go to rwjf.org

  3. LifeCoachRN, Naomi D. Jones, RN, MS, CRNI December 19, 2015 at 2:15 am

    My problem with this article and the IOM report is that the impact of implementing these recommendations is being glossed over. What I have noted, speaking to many nurses across the country, is that some implementation has proved more devastating to the nursing profession than helpful.
    Even according to this article after 5 years we still only have 21 states allowing prescriptive privileges yet recognized no REAL change in practice for NP’s.
    The goal of 80% BSN has not addressed the “barriers” that have been created in its implementation. When the age to receive social security was raised from 65 to 67, it was phased in over several years. Nothing was put in place for nurses of a certain age who are still effectively working in the profession but would not reap the full benefit from the 2, 3, or more years of time and expense of going back to school then leading into retirement.
    Also nothing was put in place to grandfather nurses who had advanced degrees in areas like health administration and MBA’s. There are many nurses leaving the profession for these reasons (anyone counting?), thereby impacting the impending nurse shortage. It’s like we are discarding experience and education in any other realm related to our vast areas of practice.
    Consistency among BSN programs is not addressed. Schools are popping up everywhere, extemely expensive and with no or little oversight as to their accreditation and ability to graduate its participants. There also seems to be no real plan to increase diversity.
    Finally addressing the 15% increase of DNP’s and PhD’s is not making a real difference in increasing BSN faculty availability because compensation has not been addressed. Add that there is no real buy in from physicians to share the platform of administering care. I believe, as nurses, we should not be so willing to sugar coat the proposed outcomes of these recommendations but let’s use our ability to critically examine, PSDA and complete the cycle by re examining the process to see if the hypotheses are REALLY true!

  4. Steve December 17, 2015 at 6:19 pm

    My mother was a nurse for over 40 years and I heard over and over about understaffing and scope of practice issues. I start nursing school in January as a second career now that I’m close to retirement. You want to put more nurses on the job? Reduce the costs of school and capitalize on people like me that are entering nursing as a second career by recognizing learning from outside the traditional nursing courses.

  5. Mary Ann Davis December 17, 2015 at 4:07 pm

    Maybe clinics , doctors offices, can do more in follow up of patients seen. Might keep patients out of the ER. Maybe the above mentioned could do a more thorough job of patient treatment. That would keep hospital admissions down. Hospital admissions are now assessed for past medical problems because no one has time to look at those histories………that has been my experience……….

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