Topic 1: The Future Of Nursing In An Evolving Health Care System

Objectives:

1. Discuss the influence of the “The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity” report on the nursing profession.

2. Discuss the role of state-based action coalitions in advancing the goals of “The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity,” report for nursing.

3. Explain how nursing advocates overcome barriers to advancement.

Assignment 1

Discuss the events that have contributed (or will continue to contribute) to the nursing shortage, or that contribute to a shortage in a region or specialty. Discuss at least one way that the nursing profession is currently working toward a resolution of this problem.

Assignment 2

Explain how health care reform has helped shift the focus from a disease-oriented health care system to one of wellness and prevention. Discuss ways in which health care will continue this trend and explain the role of nursing in supporting and facilitating this shift.

Assignment 3

Future of Nursing Report

Review “The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity,” and explore the “Campaign for Action: State Action Coalition” website, both located in the topic Resources. In a 1,000-1,250-word paper, discuss the influence “The Future of Nursing: Leading Change, Advancing Health” and state-based action coalitions have had on nursing practice, nursing education, and nursing workforce development, and how they continue to advance the goals for the nursing profession.

Rubric Criteria

National Academies of Sciences, Engineering, and Medicine and Future of Nursing Report

16.5 points

Criteria Description

A description of the work of the National Academies of Sciences, Engineering, and Medicine that led to the Future of Nursing report.

5. Target

16.5 points

A clear and accurate description of the work of the National Academies of Sciences, Engineering, and Medicine that led to the Future of Nursing report is presented.

Current Trends and Education

16.5 points

Criteria Description

An explanation of current trends in the nursing workforce and how nursing education is adapting to meet the needs.

5. Target

16.5 points

A clear and accurate explanation of current trends in the nursing workforce, how nursing education is adapting to meet the needs, and the role of the nurse in leading change of the profession is discussed.

State-Based Action Coalitions and Their Help in Advancing Goals form National Academy of Sciences re

16.5 points

Criteria Description

A discussion of the role of state-based action coalitions and how they help advance the goals in the National Academy of Sciences report.

5. Target

16.5 points

A clear and accurate discussion of the role of state-based action coalitions and how they help advance the goals in the National Academy of Sciences report is presented.

State Action Coalition Initiatives Advancing Nursing Profession

33 points

Criteria Description

A discussion of two initiatives spearheaded by a state action coalition and how they advance the nursing profession.

5. Target

33 points

A clear and accurate discussion of two initiatives spearheaded by a state action coalition and how they advance the nursing profession is present.

Barriers to Advancement

33 points

Criteria Description

A description of barriers to advancement that currently exist in the state and how nursing advocates in the state overcome barriers.

5. Target

33 points

A clear and accurate description of barriers to advancement that currently exist in the state and how nursing advocates in the state overcome barriers is present.

Thesis, Position, or Purpose

11.55 points

Criteria Description

Communicates reason for writing and demonstrates awareness of audience.

5. Target

11.55 points

The thesis, position, or purpose is clearly communicated throughout and clearly directed to a specific audience.

Development, Structure, and Conclusion

11.55 points

Criteria Description

Advances position or purpose throughout writing; conclusion aligns to and evolves from development.

5. Target

11.55 points

The thesis, position, or purpose is logically advanced throughout. The progression of ideas is coherent and unified. A clear and logical conclusion aligns to the development of the purpose.

Evidence

9.9 points

Criteria Description

Selects and integrates evidence to support and advance position/purpose; considers other perspectives.

5. Target

9.9 points

Specific and appropriate evidence is included. Relevant perspectives of others are clearly considered.

Mechanics of Writing

9.9 points

Criteria Description

Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.

5. Target

9.9 points

No mechanical errors are present. Appropriate language choice and sentence structure are used throughout.

Format/Documentation

6.6 points

Criteria Description

Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.

5. Target

6.6 points

No errors in formatting or documentation are present.

The Future of Nursing in an Evolving Health Care SystemBy Stacey Whitney

Essential Questions

· What is the purpose of the Institute of Medicine’s 2010 report 
The Future of Nursing: Leading Change Advancing Health?

· How do the four key messages from 
The Future of Nursing propose change in the nursing profession?

· What recommendations were proposed as a result of 
The Future of Nursing?

· What has contributed to the nursing shortage?

Introduction

Health care in America is undoubtedly complex and challenging to navigate. It is an ever-changing system that connects many health care professionals and related service providers toward the common goal of providing quality patient care. The future of the nursing profession hinges on making positive changes related to the health care needs of patients of all ages and the preparedness of the nursing work force. The Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) identified the need to assess and respond to the necessary transformation of the nursing profession and, in 2008, assigned a committee to produce a report of recommendations. This chapter will review the future of nursing in an evolving health care system based on the IOM report in context, the initiatives related to the IOM report, and the current and future nursing shortage.

The Institute of Medicine Report

·

The IOM, a division of the National Academies of Sciences, Engineering, and Medicine, consists of medical professionals who work to provide evidence-based research and recommendations related to public health and science. The IOM recognized that the nursing workforce of approximately 3 million nurses has the largest potential impact of implementing change in the current health care system. The IOM also recognized that nurses are the largest component of the health care workforce in the United States. Nurses offer invaluable insight and have the ability to join forces with other health care professionals to provide safe and effective care for all patients, as encouraged by the 


Affordable Care Act (ACA)

. The ACA has directly linked health care provider and organizational pay and reimbursement to value and performance. The IOM appointed a committee in conjunction with the RWJF in 2008 to implement a 2-year formal assessment related to the future of nursing. The committee published a report in 2010 entitled 
The Future of Nursing: Leading Change, Advancing Health that identified how the nursing profession should implement change for the betterment of the future of nursing (Institute of Medicine [IOM] 2011).

The IOM’s seminal report indicates that the United States has the ability to transform the health care system and that nurses should play a primary role in the transformation, thereby legitimizing nursing as a profession (Mensik, 2017). Harvey Fineberg, president of the IOM stated, “The report aims at empowering nurses to be even more effective and making long-lasting improvements to quality, access, and the value of healthcare for all Americans” (Hendren, 2010, para. 21). The report provides key messages and suggestions that offer guidance to:

1. Ensure that nurses practice to the full extent of their education and training,

2. Improve nursing education,

3. Provide opportunities for nurses to assume leadership positions and to serve as full partners in health care redesign and improvement efforts, and

4. Improve data collection for workforce planning and policy making (Hendren, 2010).

Recommendations Related to the IOM Report

·

The responsibility to improve health care for the future does not depend on the nursing profession alone. Other entities, such as government, businesses, professional associations, health care organizations, and insurance companies, all need to be involved in the process (Mensik, 2017); however, recognizing that the nursing profession should provide a primary role in changing and improving health care, the IOM report states that nurses should respond as leaders in health care. Table 1.1 shows the recommendations for change in the nursing discipline identified in the IOM report (2011).

Table 1.1

IOM Key Message Recommendations for Improvement of Nursing as a Discipline

Note. Adapted from 
The Future of Nursing: Leading Change, Advancing Health, by the Institute of Medicine, 2011. Copyright 2011 by the National Academies Press, Washington, DC.

Transforming Nursing Education

·

Fundamental changes in nurse education are needed to reach the goals of the IOM report. Nursing education needs to be transformed to prepare graduates to work collaboratively and effectively in a variety of settings. Nursing education goals remain unchanged:

1. Nurses must be prepared to meet the patients’ diverse needs.

2. Nurses must function as leaders.

3. Nurses must advance science to benefit patients.

4. Nurses, as health professionals, must deliver safe, quality patient care (IOM, 2011).

The expected outcomes of these fundamental changes have a direct relationship to improved patient outcomes. For instance, a correlation has been established between increased levels of nursing education and mortality rates in acute care settings (IOM, 2011). Simply put, a more educated nursing workforce leads to improved patient care; therefore, emphasis should be placed on the adequate preparation of new graduates for entry into practice, increased levels of education for those already in practice, and new opportunities for ongoing professional development that prepares nurses to meet the needs of patients across a variety of roles in primary, acute, long-term and community settings (IOM, 2011).

Nursing is unique in that there are multiple ways to enter the field. Although necessary to meet complex demands and periods of nursing shortage, multiple pathways have also created confusion regarding educational expectations across groups (IOM, 2011). The IOM recommendation for nursing education states that change in prelicensure and postlicensure nursing programs is needed along with greater emphasis on achieving higher levels of education. The report suggests that graduates of nursing programs need competency in the following areas:

· continuous improvement of the quality and safety of health care systems

· informatics,

· evidence-based practice,

· knowledge of complex systems,

· ongoing leadership and management capabilities,

· population health and population-based care management, and

· health policy knowledge, skills, and attitudes (Marquis & Huston, 2017).

Despite recommendations indicating baccalaureate completion for entry into practice, numerous barriers related to nursing education exist (see Table 1.2).

Table 1.2

IOM Identified Barriers to Meeting Educational Needs of Nursing Undergraduates

Note. Adapted from 
The Future of Nursing: Leading Change, Advancing Health, by the Institute of Medicine, 2011. Copyright 2011 by the National Academies Press, Washington, DC.

Several approaches have been taken to encourage educational advancement among nurses toward attainment of baccalaureate preparation of 80% of RNs by 2020. Many hospitals and health care agencies have developed incentives for nurses to continue their education. Still others have changed their hiring practices to align with the American Nurses Credentialing Center (ANCC) Magnet Recognition Program—a standard that emphasizes nursing excellence and promotes advanced degrees and continuing education for all staff (American Nurses Credentialing Center, n.d.). Employee educational assistance programs to aid in tuition costs and salary incentives are common. The IOM encourages innovative programs to attract nursing faculty, obtain clinical placements for students, and adopt a framework for continuous lifelong learning (IOM, 2011).

Check for Understanding

1. The IOM sees nursing play what role in the transformation of health care?

2. How do the IOM recommendations apply to the future of nursing?

3. Why is transforming education important to nursing?

Transforming Nursing Practice

·

Nurses have the opportunity to be involved in the transformation of the health care system. Empowering nursing professionals to practice to the full extent of their education and training will play a major role in successfully meeting the goals established by the IOM as well as improving the system of delivery for patient-centered primary and community care.

As the health care system changes, interprofessional collaboration will allow providers to apply innovative and cost-effective approaches to care delivery that eliminate redundancy, reduce errors, and increase safety (IOM, 2011). Addressing ineffective care and fragmentation of service delivery is key to positive health outcomes. Health care delivery models must be reevaluated to ensure a collaborative infrastructure that best utilizes the skills of all health care providers, including nurses in all care settings. One example provided in the IOM report includes advanced practice registered nurses (APRNs) practicing in schools and workplaces, performing public health community assessment, screenings, and disease surveillance as a means of ensuring health promotion and disease prevention (Finkelman, 2016).

The IOM examined existing regulatory barriers that are hindering the practice of health professionals and identified many variations in licensing and nurse practice acts across states. Despite changes in the health care system that warrant revision to the APRN scope-of-practice, many states have not updated their laws to address inconsistencies in scope of practice for APRNs. This has resulted in the inability of APRNs to practice to the extent of their training, leading to confusion and inefficiencies at point-of-care. The autonomy to see primary care patients, prescription writing authority, hospital admission privileges, and the ability to order and diagnose are just a few examples of varied scope of practice resulting in the misuse of APRNs. Combined with Medicaid and Medicare payment policies often linked to out-of-state nurse practice laws, APRNs are also often reimbursed at a lower rate, effectively devaluing the education and training APRNs have received (IOM, 2011). A shift in focus to independent practice is needed to address the varied interpretations of scope of practice from state to state.

Nursing Shortage

·

Meeting the goals of the IOM report is a significant challenge for the nursing profession, as there are insufficient numbers of qualified nurses to fill roles at all levels of care. Nursing is comprised of a multigenerational workforce, with a large population of nurses who are nearing retirement. In 2013, 55% of RNs were 50 years of age or older (Finkelman, 2016). The American Association for Colleges of Nursing (AACN) projects that the demand for nursing professionals will increase by 16% between the years 2014–2024. More than one million job openings will be available for nurses. The AACN has identified several factors influencing the nursing shortage:

· Many in the current nursing workforce are nearing retirement age.

· Nursing school enrollment is not increasing fast enough to meet the projected demand for RN and APRN services.

· A shortage of nursing school faculty is restricting nursing program enrollments. Nursing schools do not have enough faculty to allow all interested students to enroll in nursing programs.

· Changing demographics indicate a need for more nurses to care for the aging population.

· Nurses’ stress levels are increasing because of insufficient staffing, which, in turn, is reducing job satisfaction, causing more nurses to leave the profession.

· Access to health care is affected by high nurse retirement and turnover rates (American Association of Colleges of Nursing, 2017).

Check for Understanding