All Together Now : AJN The American Journal of Nursing

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All Together Now

Kennedy, Maureen Shawn MA, RN, FAAN

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AJN, American Journal of Nursing 115(2):p 7, February 2015. | DOI: 10.1097/01.NAJ.0000460661.19296.d5
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Maureen Shawn Kennedy

In 2010, the Institute of Medicine (IOM) released its report, The Future of Nursing: Leading Change, Advancing Health, and its recommendations have been backed by an aggressive implementation campaign. The Campaign for Action, launched by the Robert Wood Johnson Foundation (RWJF) and AARP, has formed coalitions in every state to move this work forward. Along with Nursing Outlook, the official journal of the American Academy of Nursing, AJN is pleased to bring you reports on the initiative's progress, starting with this issue.

During the past five years, the report and its recommendations have received a lot of publicity. Advanced practice RNs (APRNs)—NPs, nurse anesthetists, clinical nurse specialists, and nurse midwives—have surely been attentive, as they are directly affected by legislative changes governing their practices.

But the report isn't only about APRNs. As Susan Hassmiller, who spearheads the initiative, told me, the campaign “is working to ensure that all nurses practice to the top of their education and training, whether they are staff nurses, nursing educators, or advanced practice nurses,… [and] to ensure that nurses have a voice in all health care decision-making matters… and to help them prepare for leadership roles.” Since the report calls for a considerable transformation of the profession and how we practice, one might expect most nurses to at least be aware of it.

Yet this doesn't seem to be the case. Recently I asked a wide cross-section of nurse colleagues—working in settings ranging from community hospitals to large academic medical centers, community health organizations, and nursing schools—whether they think most RNs at the point of care are familiar with the report.

Most respondents echoed this answer: “What I hear from staff nurses… is that the IOM report is about APRN practice and has little relevance. There is some variation on this, especially if particular nurses sit on committees where there is more thorough discussion on all of the recommendations…. Some may link the push toward BSN education as coming from the IOM report and have mixed feelings about that. Personally, I feel that the IOM report itself was strong on the needs of all nurses, but strategies have focused on APRNs—maybe necessary, but regrettable.”

Nurse administrators at both Magnet and non-Magnet facilities said they've been addressing the report's recommendations through committees and shared governance councils, and have incorporated them into strategic goals. One respondent noted, “Unless nursing leadership within care settings has worked to raise awareness about the IOM report and its recommendations among direct care nurses, their awareness is likely more limited.”

Until now, the sweeping changes brought about by the Affordable Care Act and the dire need to increase primary care access have tended to put NPs in the spotlight; but this work is about all nurses. Nurses in acute care settings must be able to practice to the full scope of their licensure if their patients are to receive optimal patient-centered care. AJN has published many articles documenting what is possible when nurses are given the support and resources to practice professional nursing in a system that recognizes its value. Nurse-led initiatives and protocols have been shown to reduce hospital-acquired infections, falls, and medication errors; prevent complications; and increase patient comfort and safety, among other gains.

It's up to each of us to pay attention to what shapes our profession and our roles—and to push for our right to practice to the full extent of our capabilities. We all need to engage with how our practices evolve. As one respondent cautioned, “Nurses are being left out as new care providers emerge (case managers, patient navigators, health interventionists, and others). I see all of these groups chipping away at activities that nurses are well-equipped to do: helping patients manage their own health and navigate the systems that will keep them healthy, promoting health [and] preventing disease, providing illness care, and supporting final life and dying transitions.”

So read the IOM report—it's free at And visit the Campaign for Action's Web site ( to join the coalition in your state. Become the go-to nurse about the Future of Nursing in your workplace, and engage your colleagues. Together, we can create the future we want to see.

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