Stubenrauch, James M.
The Future of Nursing: Leading Change, Advancing Health, the report issued in October 2010 by the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF), is the most viewed report in the IOM's history. Providing a detailed blueprint for transforming nursing—as well as health care overall—the report identifies four areas of concern: scope-of-practice issues, nursing education, nursing leadership and interprofessional collaboration, and the data collection that workforce planning and policymaking depend on. The means for achieving the desired changes are spelled out in a list of 43 action points.
Figure. At the Octob...Image Tools
Michael Bleich, dean of the School of Nursing at Oregon Health and Science University in Portland and one of the report's authors, spoke enthusiastically in a recent interview about the Campaign for Action, the multiyear initiative of the RWJF and AARP's Center to Champion Nursing in America (CCNA), to implement the IOM report's recommendations. Bleich has been interpreting the report for nurses in many different settings, from hospitals to correctional facilities. And although he's seen awareness of the report grow, that growth isn't uniform.
"Whenever I speak with nurses about the report," he said, "I find they're very receptive. Ultimately, though, I can open the door but they've got to walk through it. They have to see that transforming the health care system is up to them."
This sense of urgency is characteristic of the implementation effort, which resembles a political campaign. Bleich is only one of many nursing leaders who've spent the past year traveling nationwide, meeting with nurses and lobbying for the support of business leaders, government officials, educators, insurers, funders, and consumers. In one two-day period, nursing leaders from 25 states had more than 100 meetings with Congressional delegations and committees.
As the campaign enters its second year, AJN asked several nurse leaders to assess its progress.
WHAT'S BEEN ACHIEVED?
According to Susan C. Reinhard, senior vice president at the AARP Public Policy Institute and CCNA chief strategist, "The most exciting things have been the interest at the state level and the creation of action coalitions." Thirty-six states now have coalitions of stakeholders from a cross-section of health care, business, and consumer groups focused on implementing the report's recommendations; most other states are developing coalitions.
Stakeholders convened by the CCNA include 27 national nursing organizations (known as the Champion Nursing Council) and more than 40 national health care, business, and consumer groups (known as the Champion Nursing Coalition), including CIGNA, the AFL–CIO, the American Federation of Teachers, the American Cancer Society, the American Hospital Association, Target, Johnson and Johnson, and Kaiser Permanente. Nursing organizations—often a state nursing association or a workforce center—partner with at least one nonnursing organization that shares the goals of the report. Each coalition sets its own priorities and designs its own initiatives (see http://championnursing.org/coalition).
For example, one Champion Nursing Coalition member, the Leapfrog Group, a consortium of health care purchasers that oversees hospital quality, safety, and affordability, recently added Magnet recognition to the data the group publishes in its annual survey on hospital quality indicators.
Removing scope-of-practice barriers. The IOM report urged the Federal Trade Commission (FTC) to review "regulations concerning advanced practice registered nurses to identify those that have anticompetitive effects without contributing to the health and safety of the public." The aim is to amend restrictive regulations to allow nurses to care for patients in all circumstances for which they are qualified.
Winifred Quinn, the CCNA's director of legislation and field operations, said that Congressional leaders, including John D. Rockefeller IV (D-WV) and Daniel K. Inouye (D-HA), the current and former chairmen of the Senate Commerce Committee, respectively, cited the IOM report in a formal request to the FTC in support of the recommendation. The FTC has now prioritized this issue and is responding to state lawmakers' invitations to evaluate proposed legislation.
The FTC ruled that a proposed Alabama regulation would tighten already restrictive regulations on certified nurse anesthetists and that Florida and Texas bills would increase competition, free trade, and access to care by allowing NPs to provide primary care without physician supervision. The FTC rulings can be influential but aren't binding: the proposed Alabama regulations were tabled, and neither the Florida bill nor the Texas bill passed.
Nurse leadership and interprofessional collaboration. Reinhard emphasized that the report doesn't advocate replacing physicians with nurses. "Interprofessional collaboration is very much in sync with health care reform," she said. "Broadening the discussion to include social workers, physical therapists, pharmacists—everyone on the health care team—helps people focus on the delivery of care rather than professional boundaries. She added that a team won't perform well "if you're holding back some of its members."
Susan Hassmiller, the RWJF's senior advisor for nursing, said that the RWJF is working at the national level with a group of nurse and physician leaders on improving interprofessional collaboration. "Interdependence will have broad benefits for everyone on the patient care team," she said. Reinhard added that at the state level, conversations are more personal. "I've heard very high-level physicians on panels saying quite clearly, 'We support this.'" She added, "We're not against collaboration; we're against restrictive collaboration."
Data collection and workforce planning. The impending primary care provider shortage makes a collaborative effort to improve research and data collection and analysis crucial to workforce planning. Bleich said, "Beyond the numbers is the need to ensure that nurses are prepared at the right time to enter the workforce, with the right competencies." This implies a dynamic information exchange among academic institutions, employers, and policy planners.
According to Hassmiller, the National Council of State Boards of Nursing and the Forum of State Nursing Workforce Centers recently signed a memorandum of agreement stating that the two organizations will take joint responsibility for compiling nursing workforce data from all 50 states and the District of Columbia.
WHAT YOU CAN DO
"I'm thrilled by the enthusiasm and support that have been generated so far," said Hassmiller, "but there's much more work to be done." She recommends talking about participation with local leaders and getting involved with the action coalition in your state. Go to www.thefutureofnursing.org.—James M. Stubenrauch
© 2011 Lippincott Williams & Wilkins, Inc.