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The Initiative on the Future of Nursing

Shalala, Donna E. PhD; Bolton, Linda Burnes DrPH, RN, FAAN

AJN, American Journal of Nursing: September 2009 - Volume 109 - Issue 9 - p 7
doi: 10.1097/01.NAJ.0000360287.07808.e1

Nurses are transforming American health care.

Donna E. Shalala is the former secretary of the U.S. Department of Health and Human Services and the president of the University of Miami and chairperson of the Robert Wood Johnson Foundation (RWJF) Initiative on the Future of Nursing at the Institute of Medicine. Linda Burnes Bolton is the chief nursing officer at Cedars–Sinai Medical Center, Los Angeles, and the vice chairperson of the RWJF Initiative on the Future of Nursing. The authors acknowledge the contribution of Gina Ivey, communications director at the RWJF Initiative on the Future of Nursing, in the writing of this article.

Few health care reform efforts will affect patients as directly as determining how nurses can best work toward ensuring high-quality, affordable care for all Americans. As the chairperson and vice chairperson of the Initiative on the Future of Nursing, a new effort created by the Robert Wood Johnson Foundation and the Institute of Medicine, we are seeking innovative ideas that address important nursing issues, such as the nurse shortage and regulatory and reimbursement barriers to nursing, and which can help transform the way Americans receive care.

Without question, we're joining a very crowded field in the health care reform debate. Participants include health care providers, insurers, policymakers, and consumers. This long-running debate is impassioned and opinionated, with many participants firmly convinced they know the best way to fix our desperately broken system. The initiative provides a means for nurses to join this effort. It will convene three regional town hall–type meetings, and several technical or policy-oriented workshops, to gather information. The initiative's committee will then prepare a consensus report, and the initiative's sponsors will hold a national conference on the issues raised.

As the largest group of health care professionals, nurses hold the key to effective health care system change. We know that efforts to address the challenges facing the system will be in vain without their expertise and leadership. So much of what nurses do directly addresses health care reform goals: better-quality care for more people at a lower cost. Nurses have been shown to reduce the rates of medical error, death, and hospital-acquired infection, and they contribute to shorter hospital stays for patients. Nurses are trained to provide case management in patients with chronic diseases, helping them avoid high-cost acute care. And nurse-led efforts in health promotion and screening for early detection are at the center of preventive care. Along with physicians and other providers, advanced practice nurses provide primary care to patients who might otherwise go without basic health care.



Unfortunately, nursing is facing a crisis that, left unaddressed, will severely hinder health care reform efforts. There simply are not enough nurses. Current estimates put the shortage at a half million by 2025, and it could worsen as the population ages and the need for long-term care and chronic disease management increases. This workforce crisis requires swift and bold action to fix ongoing problems: insufficient faculty to educate the next generation of nurses, inadequate nursing curricula that fail to address 21st-century clinical practice, and regulatory and reimbursement constraints that prevent the health care system from using nurses as effectively as possible.

The Initiative on the Future of Nursing will work over the next year to develop a blueprint for action on these issues and identify ways for nurses to contribute to the design and implementation of health reform. Our nation's leaders must not squander the opportunity to benefit from the insight and experience of nurses as they tackle the daunting task of determining who pays for and delivers health care services. The initiative recognizes that our health care system depends on the involvement and expertise of a vast number of professionals. At the same time, we must acknowledge that no matter the specific outcomes of health care reform, nurses will be on the front lines of the redesigned system, delivering care.

Let us know your thoughts on the initiative at

© 2009 Lippincott Williams & Wilkins, Inc.