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Editorial

On the Road Again to Nursing's Future

Kennedy, Maureen Shawn MA, RN, FAAN

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AJN, American Journal of Nursing: July 2021 - Volume 121 - Issue 7 - p 7-8
doi: 10.1097/01.NAJ.0000758408.66564.be
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Abstract

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Figure:
Maureen Shawn Kennedy

While 2020-2021 has been deemed the (extended) Year of the Nurse and the Midwife by the World Health Organization (WHO), it might also be considered the Year of Reports on Nursing. I've been hard pressed to keep track of the many reports issued on nursing's role in future health care delivery. Most reports were in planning stages prior to the COVID-19 pandemic while others were prompted by the upheaval the pandemic caused. Either way, these reports have all sought to revisit health care and nurses' roles in light of the many health system failings the pandemic revealed. In chronological order, we've had:

State of the World's Nursing 2020 (April 2020). Released at the beginning of the pandemic by the WHO, the International Council of Nurses (ICN), and the Nursing Now campaign, this report provided a first-ever global view of the profession and challenges that need to be addressed to meet the United Nations Sustainable Development Goals by 2030. (See www.who.int/publications/i/item/9789240003279.)

Preparing Nursing Faculty, and Addressing the Shortage of Nurse Faculty and Clinical Preceptors (December 2020). In the National Advisory Council on Nursing Education and Practice's 17th report to the Secretary of Health and Human Services and Congress, the Council acknowledged the “severe and long-standing shortage of nurse faculty and clinical preceptors” and called for funding to improve training of faculty and preceptors, develop nurse faculty residency programs, and create a national center for nursing education. (See www.hrsa.gov/sites/default/files/hrsa/advisory-committees/nursing/reports/nacnep-17report-2021.pdf.)

Transforming Together: Implications and Opportunities from the COVID-19 Pandemic for Nursing Education, Practice, and Regulation (January 2021). This report, published by the Tri-Council for Nursing, noted six now familiar issues as critical to the future of nursing: equity and health equity, ethics, innovation, interprofessional emergency planning and response, mental health and well-being, and nursing workforce. The report noted specific areas for moving forward and which organizations might lead in each area. (See https://img1.wsimg.com/blobby/go/3d8c2b58-0c32-4b54-adbd-efe8f931b2df/downloads/Tri-Council-COVID-19-Report-5-2021.pdf.)

Nurses for Health Equity: Guidelines for Tackling the Social Determinants of Health (April 2021). Released by the World Innovation Summit for Health, a global organization that aims to find innovative solutions to urgent problems, this report “focuses on what can practically be done by nurses to reduce inequalities in health” and offers international examples of successful models. (See www.wish.org.qa/wp-content/uploads/2021/05/Nurses-for-Health-Equity-report.pdf.)

The Essentials: Core Competencies for Professional Nursing Education (April 2021). This updated report from the American Association of Colleges of Nursing detailed a transformation to competency-based education to provide “more consistency among graduates; clarity in expectations for program outcomes; preparing graduates with a greater understanding of the discipline of nursing; and a smoother transition from one education program to another as well as from one career path to another.” (See www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Roadmap-to-New-Essentials.pdf.)

During Nurses Week in May, two reports were released:

Nurses: A Voice to Lead—A Vision for Future Healthcare (May 2021). Released by the ICN, this report reiterated many of the recommendations from the State of the World's Nursing 2020 report, notably that a global investment in nursing is “central to the design of health systems that focus on public health, prevention and primary care,” to achieve the Sustainable Development Goals. It also offered specific examples of how many national nursing organizations are working to improve nursing and health care within their countries—models others can replicate. (See www.icn.ch/system/files/documents/2021-05/ICN%20Toolkit_2021_ENG_Final.pdf.)

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity (May 2021). This much anticipated consensus report from the National Academy of Medicine (NAM) addressed nursing's role in reducing disparities and advancing health equity for all. Its recommendations include strengthening and financing nursing education and practice to address social determinants of health; building a more diverse workforce that can practice at all levels to the full extent of its education and training; increasing the supply of and support for nurses, especially in public health and schools; and improving workplaces to improve nurses' well-being. (See https://nam.edu/publications/the-future-of-nursing-2020-2030.)

Of note, Future of Nursing 2020-2030 committee member William Sage, MD, JD, issued a supplemental statement, “Meeting America Where We Are” (Appendix E), noting his disappointment that the report isn't “more attentive to recommendations affecting the basic RN workforce.” He also noted that “hospitals are barely acknowledged,” although they consume the greatest amount of health care dollars and are the major employer of nurses. He calls for a fundamental shift in hospital management and financing, especially in physician-oriented payment models that pay physicians for their work but do not pay nurses for their work, and to restructure financial payment schemes so nursing's value is evident in strategic planning, budgeting, and operations.

My take: the recommendations of all of the reports would greatly move nursing forward to improve health care, but the devil is in the details. The path to the future needs more than nursing's vision; it requires buy-in from regulatory and financial sectors and a road map to help navigate the way forward for nurses in all settings. Hopefully, the strategies developed at the recent Campaign for Action summit will provide that map. Maybe then we can get there from here.

(To listen to a conversation with NAM Future of Nursing 2020-2030 committee member Regina Cunningham, chief executive officer of the Hospital of the University of Pennsylvania and adjunct professor and assistant dean for clinical practice at the University of Pennsylvania School of Nursing, go to https://journals.lww.com/ajnonline/pages/podcastepisodes.aspx?podcastid=3.)

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