Applying the IOM/RWJ Future of Nursing Report’s Recommendations: A Challenge and an Opportunity for Nurse Educators

When the controversial Affordable Care Act was signed into law on March 23, 2010, it represented the most ambitious overhaul of our country’s healthcare system since the passage of Medicare in 1965. Two years later, all eyes are on the Supreme Court as it debates whether the act is in accordance with the U.S. Constitution. Those of us actually engaged in educating the largest sector of the U.S. healthcare workforce, our nursing professionals, realize that at least for our field, the ship of change has sailed, regardless of the court’s decision. The most sweeping transformation of the nursing profession in our nation’s history is already underway, fueled by the groundbreaking report released jointly by the Robert Wood Johnson Foundation and the Institute of Medicine in 2010: The Future of Nursing: Leading Change, Advancing Health. As we prepare America’s future nursing professionals to meet the challenge, it is helpful to organize our efforts around the report’s four major missives:

 

Florida law prohibits advanced practice nurses from prescribing controlled substances, limiting the level of care advanced practice nurses can provide to their patients, especially Family and Acute Care Nurse Practitioners, and Certified Registered Nurse Anesthetists. Without the full privileges for which their education has prepared them, nurses may not be able to provide adequate medication coverage for certain conditions, or even prescribe non-controlled substances for patients on certain insurance plans that require a provider to have a federal DEA number. Institutional and regulatory limits on nurses’ scope of practice need to be reexamined if our advanced practice graduates are to assume their new roles as leaders in America’s reformed healthcare system.

 

The key word here is “seamless”. It falls to us at the helm of nursing education programs to advocate for the funding of scholarships for RN to BSN and accelerated BSN programs, the latter designed for individuals who hold undergraduate degrees in fields other than nursing – and who often make the best and most motivated students. Special attention must be paid to ensure that these programs are accessible to racial and ethnic minority students so as to ensure that our most educated nurses mirror the diversity of the U.S. population. We must also encourage stronger employer incentives to increase the formal education and the achievement of terminal degrees such as Ph.D.’s and DNP’s among America’s working nurses. The connection between safe patient care and higher education, supported by persuasive evidence, should catalyze these efforts.

 

The RWJ-IOM report calls for doubling the number of nurses with doctoral degrees and increasing nursing professionals with bachelor’s degrees to 80% of the workforce by 2020. This will challenge the critical nurse faculty shortage. It is crucial that we lure our higher-educated nurses to academia, thus feeding the pipeline to educate the next generation of nurses.

 

The development of interdisciplinary collaboration and practice is crucial to the progression of nursing’s future. In my present role as co-Chair of the Bipartisan Policy Center’s Health Project Workforce Committee I can attest to the importance of inter-professional education and practice in the delivery of team-based, patient-centered care. We must find a way to engage our counterparts in schools of allopathic and osteopathic medicine, schools of dentistry and colleges of pharmacy, among others, in this conversation.

 

It is impossible to discuss the future of the nursing profession without mentioning the challenges and opportunities resulting from the technological explosion of the 21st century. We have the capacity for a system of healthcare/healthcare workforce data collection and storage that would have been unheard of a few years ago in terms of comprehensiveness, timeliness and public accessibility. Nevertheless, the lack of “real time” data on the health care workforce planning does not allow us as educators to adequately assess the type of nurses that are needed, where and how they should be deployed, and the expertise they need to provide the most valuable contributions to the health of society. Nurse educators face an additional challenge – developing faculty expertise to the level of the available technology. Ensuring that our emerging nursing workforce is equipped with the skills to contribute to and take advantage of the new data collection and information infrastructure is one of the transformative educational challenges of 21st century nursing education.