We cannot make significant improvements in the quality of healthcare unless nurses are on the forefront providing valuable insight and guidance as clinical and administrative leaders. The Institute of Medicine (IOM) and Robert Wood Johnson Foundation (RWJF) Special Committee Report on the Future of Nursing: Leading Change, Advancing Health, is encouraging and long overdue.
The Committee chaired by University of Miami President Donna Shalala is recommending that: scope of practice barriers in the United States be removed allowing nurses to practice to the full extent of their education and training, paths to higher levels of education and training be promoted, and nurses in partnership with physicians and other health professionals, lead in designing healthcare in America.
The advent of healthcare reform, coupled with critical physician shortages and millions of new patients coming into the healthcare system, make this the right time to eliminate limits on nurses’ scope of practice. The Committee’s report should serve as a call to action for everyone who believes patients in the U. S. are entitled to the finest healthcare available. Fighting the expansion of scope of practice is no longer a defensible strategy. Nurses need the ability to practice to the level of their experience and education.
The nursing practices issue will decide the very fate of patient care for everyone in this country. Current rules in Florida regulate and limit the level of care provided by nurses. Florida has outstanding, well-educated, advanced practice nurses with all the skills and training to provide excellent patient care. However, due to existing regulations, many of these nurses are not allowed to practice to the full extent of their abilities.
An American Association of Medical Colleges’ report published in November, indicated he U.S. will be dealing with a shortage of at least 65,000 physicians in this country by 2015. As a result of the Patient Protection and Affordable Care Act, an additional 32 million Americans will need healthcare coverage beginning in 2014, according a report issued by the National Institutes of Health. The current healthcare system cannot absorb the sudden influx of patients.
The increased need for primary care, the deficits in primary care providers and the research supporting the safety, quality and effectiveness of primary care provided by advanced practice nurses—those with a master’s or doctoral degree—led to the Committee’s recommendations that nurses need to play a greater role in chronic disease management, transitional care (e.g., hospital to the community) and prevention and wellness.
In the United States, 2.9 million nurses account for 80% of the total number of healthcare providers. The nurses who comprise the vast majority of employees in the healthcare system underscore their importance and impact on the delivery of patient care. Their sheer numbers, combined with their direct proximity to patients, and knowledge about what patients need, makes nurses particularly suited to advance strategies for improving care and saving resources.
For nurses’ to meet these additional responsibilities they need higher levels of education and training. The committee is recommending multiple pathways to increase the proportion of nurses with bachelor’s degree from 50% up to 80% by 2020, and calling for doubling of the number of nurses with doctoral degrees. Increasing the number of nurses with advanced practice and doctoral degrees will also create more nurse educators. Nursing schools are turning away thousands of qualified applicants because we don’t have enough faculty.
With staffing shortages, today’s nurses have less time to learn. Many graduates cite a lack of preparedness for the responsibilities they face in a new job or promotion, plus stress from over work contributes heavily to nursing turnover. To address this concern, the Committee is calling for State Boards of Nursing and accrediting bodies, to take actions to support nurses’ with the completion of a transition-to-practice program (nurse residency) after they have completed a pre-licensure or advanced practice degree program or when they are transitioning into new clinical practice areas.
In order to optimize the use of nurses in a reformed healthcare systems, bedside nurses and nurses in all levels and areas of practices need to step up to the plate and assume leadership positions. They must initiate changes that will translate into better care for patients. They must be part of the decision making of health care organizations. However, in order for this to be possible, leadership positions need to be available to nurses. This is why the IOM Committee report calls for opportunities to be expanded for nurses to lead and coordinate collaborative efforts to improve patient care.
This report should act as a catalyst to turn these recommendations into regulations and end the debate over scope of practice in states like Florida. The time has come to work together to implement an effective, affordable healthcare system that provides outstanding patient care, promotes patient safety, and is accessible and responsive to all patients. I am excited, proud and extremely hopeful that we will find a common ground in the United States and take a major step forward to improve patient care.
