Influencing the Future of Nursing
As we embrace a future of ultra modern healthcare and technology, nurses and nursing are not coping enough with the demands of these two callers of change. We have allowed ourselves to fall asleep like a big giant unknowing of the great things only we can change.
The nursing shortage will last forever. We have to make some changes within the nursing infrastructure if we have to resolve this issue. It is just but one and major change that we can do if we have to influence the future of nursing and its practice to meet the needs of the 21st century. This is the purpose of this section: to encourage lobbying for legislative changes that can change nursing and the way we practice it.
Nursing Leaders to Hold Prestigious Federal Commissions
October 01, 2010
The U.S. Government Accountability Office (GAO) announced this week the appointments of several nurse leaders to two federal bodies created under the Patient Protection and Affordable Care Act.
Peter Buerhaus, PhD, RN, FAAN, nursing professor and Director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University Medical Center, was appointed to serve as Chair of the National Health Care Workforce Commission. This commission was established to serve as a resource to Congress and the Administration on the challenges facing the healthcare workforce. Sheldon Retchin, MD, MSPH, Vice President for Health Sciences at Virginia Commonwealth University, CEO of the VCU Health System, and champion for interdisciplinary cooperation, will serve as the commission's Vice Chair. Additionally, Mary Mincer Hansen, PhD, RN, Director of the Master's in Public Health Program at Des Moines University, will serve a two-year term on the commission. For more information on the commission and its appointees, see http://www.gao.gov/press
Earlier this week, the GAO announced the appointees to the Board of Governors for the Patient-Centered Outcomes Research Institute (PCORI), a non-profit organization created to assist patients, clinicians, purchasers, and policy-makers in making informed health decisions. PCORI will serve as a catalyst for research projects that provide quality, relevant evidence on how diseases, disorders, and other health conditions can effectively and appropriately be prevented, diagnosed, treated, monitored, and managed. Debra Barksdale, PhD, RN, CFNP, CANP, Associate Professor at the University of North Carolina at Chapel Hill School of Nursing, was selected to serve on the Board of Governors. For more information on the PCORI and its newly appointed board,see
The RWJF Initiative on the Future of Nursing at IOM
The Future of Nursing
Leading Change, Advancing Health
With more than 3 million members, the nursing profession is the largest segment of the nation’s
health care workforce. Working on the front lines of patient care, nurses can play a vital role in helping realize the objectives set forth in the 2010 Affordable Care Act, legislation that represents the broadest health care overhaul since the 1965 creation of the Medicare and Medicaid programs. A
number of barriers prevent nurses from being able to respond effectively to rapidly changing health care settings and an evolving health care system. These barriers need to be overcome to
ensure that nurses are well-positioned to lead change and advance health.
In 2008, The Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) launched a two-year initiative to respond to the need to assess and transform the nursing profession. The IOM appointed the Com¬mittee on the RWJF Initiative on the Future of Nursing, at the IOM, with the purpose of producing a report that would make recommendations for an action-oriented blueprint for the future of nursing.
Nurses practice in many settings, including hospitals, schools, homes, retail health clinics, long-term care facilities, battlefields, and community and public health centers. They have varying levels of education and competencies—from licensed practical nurses, who greatly contribute to direct patient care in nursing homes, to nurse scientists, who research and evaluate more effective ways of caring for patients and promoting health. The committee considered nurses across roles, settings, and education levels in its effort to envision the future of the profession. Through its deliberations, the committee developed four key messages that structure the recommendations presented in this report:
A number of barriers prevent nurses from being able to respond effectively to rapidly changing health care settings and an evolving health care system. These barriers need to be overcome to ensure that nurses are well-positioned to lead change and advance health.
1) Nurses should practice to the full extent of their education and
training.While most nurses are registered nurses (RNs), more than a quarter million nurses are advanced practice registered nurses (APRNs), who have masters or doctoral degrees and pass
national certification exams. Nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives all are licensed as APRNs.
Because licensing and practice rules vary across states, the regulations regarding scope-of-practice—which defines the activities that a quali¬fied nurse may perform—have varying effects on different types of nurses in different parts of the country. For example, while some states have regulations that allow nurse practitioners to see patients and prescribe medications without a physician’s supervision, a majority of states do not. Consequently, the tasks nurse practitioners are allowed to perform are determined not by their education and training but by the unique state laws under which they work.
The report offers recommendations for a variety of stakeholders—from state legislators to the Centers for Medicare & Medicaid Services to the Congress—to ensure that nurses can practice to the full extent of their education and training. The federal government is particularly well suited to promote reform of states’ scope-of-practice laws by sharing and providing incen¬tives for the adoption of best practices. One sub-recommendation is directed to the Federal Trade Commission, which has long targeted anti-competitive conduct in the health care market, including restrictions on the business practices of health care providers, as well as policies that could act as a barrier to entry for new competitors in the market.
High turnover rates among new nurses underscore the importance of transition-to-practice residency programs, which help manage the transition from nursing school to practice and help new graduates further develop the skills needed to deliver safe, quality care. While nurse residency programs sometimes are supported in hospitals and large health systems, they focus primarily on acute care. However, residency programs need to be developed and evaluated in community settings.
2) Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.To ensure the delivery of safe, patient-centered care across settings, the nursing education system must be improved. Patient needs have become more complicated, and nurses need to attain requisite competencies to deliver high-quality care. These competencies include leadership, health policy, system improvement, research and evidence-based practice, and teamwork and col-laboration, as well as competency in specific content areas including community and public health and geriatrics. Nurses also are being called upon to fill expanding roles and to master technological tools and information management systems while collaborating and coordinating care across teams of health professionals.
Nurses must achieve higher levels of education and training to respond to these increasing
demands. Education should include opportunities for seamless transition into higher degree programs—from licensed practical nurse (LPN)/licensed vocational nurse (LVN) diplomas; to the
associate’s (ADN) and bachelor’s (BSN) degrees; to master’s, PhD, and doctor of nursing practice (DNP) degrees. Nurses also should be educated with physicians and other health professionals
both as students and throughout their careers in lifelong learning opportunities. And to improve the quality of patient care, a greater emphasis must be placed on making the nursing workforce
more diverse, particularly in the areas of gender and race/ethnicity.
3)Nurses should be full partners, with physicians and other health care professionals,
in redesigning health care in the United States.
Efforts to cultivate and promote leaders within the nursing profession—from the front lines of care to the boardroom—will prepare nurses with the skills needed to help improve health care and advance their profession. As leaders, nurses must act as full partners in redesign efforts, be accountable for their own contributions to delivering high-quality care, and work collaboratively with leaders from other health professions.
Being a full partner involves taking responsibility for identifying problems and areas of system waste, devising and implementing improvement plans, tracking improvement over time, and mak-ing necessary adjustments to realize established goals. In the health policy arena, nurses should participate in, and sometimes lead, decision making and be engaged in health care reform-related implementation efforts. Nurses also should serve actively on advisory boards on which policy decisions are made to advance health systems and improve patient care.
In order to ensure that nurses are ready to assume leadership roles, nursing education pro¬grams need to embed leadership-related compe¬tencies throughout. In addition, leadership devel¬opment and mentoring programs need to be made available for nurses at all levels, and a culture that promotes and values leadership needs to be fostered. All nurses must take responsibility for their personal and professional growth by developing leadership competencies and exercising these competencies across all care settings.
4) Effective workforce planning and policy making require better data collection and
an improved information infrastructure.
Planning for fundamental, wide-ranging changes in the education and deployment of the nursing workforce will require comprehensive data on the numbers and types of health professionals—including nurses—currently available and required to meet future needs. Once an improved infrastructure for collecting and analyzing workforce data is in place, systematic assessment, and projection of workforce requirements by role, skill mix, region, and demographics will be needed to inform changes in nursing practice and education.
The 2010 Affordable Care Act mandates the creation of both a National Health Care Workforce Commission to help gauge the demand for health care workers and a National Center for Workforce Analysis to support workforce data collection and analysis. These programs should place a priority on systematic monitoring of the supply of health care workers across professions, review of the data and methods needed to develop.
To ensure the delivery of safe, patient-centered care across settings, the nursing education system must be improved. Patient needs have become more complicated, and nurses need to attain requisite competencies to deliver high-quality care.
The United States has the opportunity to transform its health care system, and nurses can and should play a fundamental role in this transformation. However, the power to improve the current regulatory, business, and organizational conditions does not rest solely with nurses; government, businesses, health care organizations, professional associations, and the insurance industry all must play a role.
The recommendations presented in this report are directed to individual policy makers; national, state, and local government leaders; payers; and health care researchers, executives, and professionals—including nurses and others—as well as to larger groups such as licensing bodies, educational institutions, philanthropic organizations, and consumer advocacy organizations. Working together, these many diverse parties can help ensure that the health care system provides seamless, affordable, quality care that is accessible to all and leads to improved health.
HR 4601 The National Nurse Act of 2010
On February 4, 2010, Congressman Earl Blumenauer (OR-3) introduced HR 4601, The National Nurse Act of 2010 into the second session of the 111th Congress. This legislation encompasses the major components of the Office of the National Nurse.
This legislation would designate the Chief Nurse Officer of the U.S. Public Health
Services as the "National Nurse" to elevate the authority and visibility of that office.
Chronic conditions such as diabetes, asthma, obesity, and others pose the single greatest
threat to the health of Americans and the nation's economy. Nurses provide key services
for the prevention and management of these conditions and this legislation is necessary
to support further work needed to promote prevention, improve outcomes, and guide
national, state and local efforts in addressing the nation's health.
This is the ideal time to make the Office of the National Nurse a reality. The current
administration and Congress have a clear commitment to wellness promotion and illness
prevention. There is convincing evidence that American health-care reform can be
dramatically advanced by deploying the greatest and most trusted national health
resource, America's nurses. Establishing the Office of the National Nurse would be a
practical first step in publicly acknowledging the need for a focus on wellness and
prevention. This legislation would provide the nation with a trusted professional
representative from nursing to kickoff the move to prevention in any kind of healthcare
system America will have.
The National Nurse would provide a visible nurse leader to advocate for enhanced
prevention efforts for all communities, a representative who would meet with health care leaders to determine ways to address continued health disparities and poor health literacy.
Nurses as organizations and individuals, should support this legislation as a means to achieve the goals of better health, decreased health disparity and improved health literacy.
The National Nursing Network Organization is planning to travel to Washington DC in March to lobby for this bill.
Source: National Nursing Network Organization
“NURSES BUILDING A HEALTHY AMERICA”
Antonio B. Jayoma, RN, MSPHN, MBA, CCRN
Sometimes, nurses find themselves unaware or misinformed on the relevant professional issues that are affecting them or yet to affect them personally and in delivery of health care. Recent stem cell research developments and health care reforms are sample topics that nurses tend to be oblivious about.
Last year’s theme for Nurses Week Celebrations say, “Nurses Building a Healthy America”. It is a topic that the American Nurses Association (ANA) had talked about extensively and endorsed significantly, including the status of the current nursing shortage (www.nursingworld.org/).
But what does that mean to us as health care providers? We believe that, as nurses, we can build a healthy American society. We have the capacity to propel our profession towards that direction. If it means that we have to go back to the basic tenet of health care and health care delivery, then so be it. More emphasis will be placed on primary health care. It is a kind of health care that everyone has an access to it. It is where the community and other health-related sectors are encouraged to participate. Utilization of appropriate and cost-effective methods of delivery is deemed necessary and health care thrusts are geared towards health promotion and prevention of diseases or illnesses (www.ifrc.org/Docs/pubs/health/chapter8.pdf).
The theme realistically coincides with the current financial struggles in our society. This is the best one suited for nurses to think about. Everybody knows that while budget cutbacks are common now, resources will eventually be scarce. But nurses are known to be resilient when necessary. They can be creative, resourceful, and innovative in delivery of health care as long as they are meeting goals and expectations safely and satisfactorily.
The International Council of Nurses (ICN) headquartered in Geneva, Switzerland states that while innovation is central to maintaining and improving quality of care, nurses are expected to be flexible with the constant changes and challenges they are facing in health care.