Many nurses are familiar with The Future of Nursing: Leading Change, Advancing Health report released October 2010 by the Committee on the Robert Wood Johnson Foundation (RWJF) Initiative on the Future of Nursing at the Institute of Medicine (IOM, 2010). If you are not, I strongly encourage you to take a look at this momentous report. A brief (4 pages), the full report (671 pages!), and other free downloadable resources are available (see Web Resources).
The Future of Nursing (FON) report emerged from a 2-year study by an impressive committee of healthcare, business, and nursing leaders. They were asked: “What roles can nursing assume to address the increasing demand for safe, high-quality, and effective health care services?” (IOM, p. xi). The passage of the Affordable Care Act in March 2010 (U.S. Department of Health and Human Service [HHS], 2012) opened primary care, prevention, and wellness care to an estimated 32 million additional Americans. This, in addition to an aging and increasingly diverse population, places greater burden on the nation's healthcare system. The need for America's 3 million nurses—the largest group of healthcare professionals—to step up to the plate has never been greater.
What's different about this report from previous tomes about nursing? First, this truly is an “action-oriented blueprint” (IOM, October 2010, p. 1) with four key messages and specific implementation recommendations (Table 1). Second, the report focuses on patients. As Susan Hassmiller, Director of the FON Campaign for Action at RWJF put it, “...this is not a report about what is going to make nurses happier... this is really a report about what is best for patients...how nurses can be effectively involved and take leadership in creating better patient care” (International Academy of Nursing Editors [INANE], 2011, p. 20). Third, the report has captured widespread attention beyond nursing, from Congress to state legislatures, from business to medicine and philanthropic entities. Fourth, groups are implementing the recommendations. The Senate Appropriations Committee directed HHS Secretary Kathleen Sibelius to develop a plan to implement the FON recommendations; the plan will be released early 2012 (INANE, 2011). The Center to Champion Nursing in America (CCNA), an initiative of AARP, the AARP Foundation, and RWJF, began a Campaign for Action Coalitions “to effect long-term sustainable change in moving the recommendations into action” (CCNA, 2012). To date, 36 state action coalitions have assembled.
Excitingly, results are emerging! Programs facilitating seamless transition from AD to BSN to MSN to doctorate are springing up. Schools also are implementing interprofessional education, “where students from various health professions learn about, from, and with each other” (World Health Organization as cited in RWJF, 2011, p. 5). You can read updates about how the FON recommendations are being implemented at the CCNA Web site.
Much of the focus surrounding the FON report has been on removing practice barriers for advanced practice registered nurses (APRNs) and working on avenues for nurses to enter practice with, or quickly achieve, higher levels of education. These are absolutely appropriate and needed.
However, I wonder what staff nurses at the point-of-care are thinking about the FON report. As a staff nurse, I've asked myself some hard questions about what it might mean for me to implement the recommendations. At the end of a shift have I practiced to the full extent of my education and training? I don't mean does my state nurse practice act, hospital, or the physicians allow me to, but do I practice as a nursing professional? Did I assess, diagnose, plan, intervene, and evaluate my patients for health restoration, maintenance, and promotion? Or, did I just focus on the myriad tasks that had to be accomplished? Did I follow and/or develop the multidisciplinary plan of care, not just physician orders? Did I communicate the care plan in a way that could be implemented by those following me? Does my charting reflect the care plan? In thinking about recent shifts, I wished I'd had more time to think about and practice in this professional manner. But instead of giving in to fatalistic thinking, I pushed myself to come up with simple ways we could facilitate professional nursing practice. I thought of three things I will share with my colleagues.
Regarding being full partners with physicians and other healthcare professionals, do I always act professionally with colleagues? Do I approach the healthcare team knowledgeably and assertively when I want to make care recommendations, request physician orders, or advocate for my patients? Read the report brief on interprofessional collaborative care teams (RWJF, 2011) and you'll be stimulated to think about how to collaborate in your work venue.
Regarding lifelong learning, do I plan for and seek out continuing nursing education (CNE) to maintain and grow my knowledge, or do I take whatever CNE is easiest or cheapest to renew my license? Do I make recommendations to the clinical nurse specialist, inservice educator, and managers for CNE that would be helpful to my practice? Recently I sent a “virtual journal club” plan to my director to share clinical articles among staff. I hope we implement the plan.
As I write, I wonder what staff nurses think about all this. Does implementing the FON report sound pie-in-the sky? I'm reminded that as a Christian, Jesus calls me to excellence in my work (Colossians 3:23–24). I am to live a life worthy of the calling I have received (Ephesians 4:1) remembering God's divine power has given me everything I need for life and godliness (2 Peter 1:3).
In the first century, the ancient Christians worked tirelessly and against huge opposition to follow Christ. The Apostle Paul wrote to one of the new struggling churches:
We constantly pray for you, that our God may count you worthy of his calling, and that by his power he may fulfill every good purpose of yours and every act prompted by your faith. We pray this so that the name of our Lord Jesus may be glorified in you, and you in him, according to the grace of our God and the Lord Jesus Christ. 2 Thessalonians 1:11, NIV
What would happen if we prayed for each other in this same manner?