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.