Joyce Pulcini is director of the master’s programs and of community and global initiatives at the George Washington University School of Nursing in Washington, DC. She also is the contributing editor for AJN’s Policy and Politics column.
IOM speakers and panel focus on a major report’s increasingly visible real world effects—while emphasizing diversity and the roles of every type of nurse at every level.
On December 11, I attended the Institute of Medicine (IOM) event celebrating the three-year anniversary of the The Future of Nursing: Leading Change, Advancing Health report, released in 2010. The event at the National Academy of Sciences in Washington, DC, highlighted the impact of the report so far and discussed the continued work of the Future of Nursing: Campaign for Action in terms of priorities for the nursing profession.
- Harvey V. Fineberg, president of the IOM and panel moderator, started with the fact that the The Future of Nursing: Leading Change, Advancing Health report had generated more than 1.3 million hits since it was first launched in 2010 and that this was one of the most successful of all of the IOM reports. The goal was that this report not sit on the shelf like many past reports but that it be used to improve the health care system. All speakers agreed that this goal was being realized.
- Donna Shalala, president of the University of Miami and chair of the IOM Committee on the Robert Wood Johnson Foundation (RWJF) Initiative on the Future of Nursing, said that the response to the report demonstrated that it was “nurses’ time.” She emphasized that all parts of society need to be represented in the health care workforce and that all levels of nursing should play a role in improving the quality of health care. In discussing scope of practice roles for advanced practice nurses, she pointed out that the state of New Hampshire has had full scope of practice for nurses for more than 20 years and that no major safety or quality problems have been reported there.
- Susan Hassmiller, senior advisor for nursing at the RWJF, discussed the fact that this report was highly rigorous and only used evidence-based studies to validate the findings. She noted that since the report was published, 15 states had introduced new legislation on the scope of practice for nurses. She also said that 51 action coalitions had been activated as a result of the report and that all were working on the so called 80/20 recommendation to increase the proportion of nurses with BSN degree to 80% by 2020. She also emphasized that diversity is the key in this recommendation.
- Lynda Burnes-Bolton, vice chair of the Committee on the RWJF Initiative on the Future of Nursing and vice president and chief nursing officer at Cedars-Sinai Health System in California, said that lower cost outcomes are the goal and talked about the success of this effort in her home state.
- Carmen Alvarez, a George Washington University postdoctoral fellow, family nurse practitioner, and certified nurse midwife who practices in Virginia clearly described clearly some of the challenges for APRNs as they try to care for patients. She provided poignant examples of situations in which precious time was lost acquiring physician signatures and the inconvenience to patients that resulted.
- David Vlahov, dean of the University of California, San Francisco School of Nursing, emphasized the report’s recommendation that the number of doctorally prepared nurses should double by 2020. He talked about the need to take down the “silos” that exist in university health career programs and subsequently in the health care setting itself. Finally he emphasized the changing demographics in society, with greater diversity and the aging of the population, and the imperative for the health care fields, especially nursing, to address these changes.
- Darrell Kirch, president of the Association of American Medical Colleges, spoke about the tensions between the disciplines and the need to speak about interdependent practice vs. independent practice. He said that the professions must address the following statistics: 10,000 Americans are turning 65 each day and one-sixth of physicians are turning 65 this year. The solution is to work together to meet the health care needs of the population, as there will be more than enough work to go around as patient care move out of the hospital and into the home and the community.
The panel addressed the four key recommendations of the IOM report:
- Nurses should be able to practice to full extent of their education and training.
- Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
- Nurses should be full partners with physicians and others in redesigning U.S. health care.
- Effective workforce planning and policy making require better data collection and an information infrastructure.
Barriers and drivers were noted by the panelists, and the key themes of inclusiveness, diversity, and interdisciplinary health care and education for nurses and all health care professionals were addressed.