When the Robert Wood Johnson Foundation and the Institute of Medicine launched a two-year effort to assess and, ultimately, transform nursing in 2008, health care reform was only a campaign promise. By the time the initiative’s report – “The Future of Nursing: Leading Change, Advancing Health” – was released, the 2010 Affordable Care Act was law.
In February, about 350 nurses, nurse leaders, students and leaders from education, business and government gathered at the Loudermilk Center in Atlanta to discuss the implications of the report. The Georgia Nursing Summit included panel discussions, a question-and-answer format and breakout sessions for work groups to discuss each of the landmark report’s eight recommendations.
The combination of an aging population, a shortage of nurses and primary care physicians, and new health care reform laws made the timing of the summit particularly apropos.
“This is the time for transformation of health care through nursing,” said keynote presenter Lucy Marion, Ph.D., RN, FAAN, dean and professor at Georgia Health Sciences University’s College of Nursing.
Linda McCauley, RN, Ph.D., FAAN, dean and professor of Emory University’s Nell Hodgson Woodruff School of Nursing, said that high-quality, patient-centered care requires a metamorphosis of the health care delivery system.
“There’s no disagreement that there needs to be a change. We are at a different time and place,” said McCauley, a member of the Institute of Medicine.
The landmark report is an evidence-based document that resulted from a collaboration of thousands of health care professionals and other leaders. The report addressed more than just the future of nursing; it took a larger look at the future of health care.
“What the report really is about is improving the health of our nation,” said Lisa Wright Eichelberger, Ph.D., RN, professor and dean of the College of Health at Clayton State University. “We’ve got to change our current way of thinking. We’ve got to be open to a different way of doing things.”
The key message of the report was clear: nurses need to be educated at a higher level and then be allowed to practice to the full extent of their training so they can become partners in redesigning health care in the United States. The report contained eight recommendations for nursing:
1. Remove scope-of-practice barriers.
2. Expand opportunities for nurses to lead and diffuse collaborative improvement efforts.
3. Implement nurse residency programs.
4. Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020.
5. Double the number of nurses with a doctorate degree by 2020.
6. Ensure that nurses engage in lifelong learning.
7. Prepare and enable nurses to lead change to advance health care.
8. Build an infrastructure for the collection and analysis of inter-professional health care work force data.
Panelists at the event agreed that the need for change is even more acute in Georgia, where about 1.2 million people will gain insurance coverage due to the Affordable Care Act and there’s a projected shortfall of 300 to 400 primary care providers. With more people gaining access to primary care and not enough physicians to serve them, more advance practice nurses are needed to fill the gaps.
“We need to get ahead of this. We’re already behind,” said Georgia Labor Commissioner Mark Butler, who spoke at the summit. “We already have a nursing shortage but it’s getting worse.”
Summit speakers cited the limits to what advance practice nurses (APRNs) are allowed to do in Georgia as an obstacle to improving health care delivery. Georgia is one of seven states that require physician review of prescription orders and one of 29 states that require physician oversight for APRNs to diagnose, treat and prescribe. Practice barriers for advance practice nurses were a reason that Georgia earned an “F” for APRN regulation in the 2007 Consumer Choice ranking.
Butler told nurses that the scope of practice for APRNs needs to be broadened.
“You guys are the front line in health care and we need to be more flexible in what we allow you to do,” he said.
Dr. Wright Caughman, interim executive vice president for Health Affairs at Emory University; CEO of Woodruff Health Sciences Center; and chairman of Emory Healthcare, agreed.
“We need to change our archaic laws,” he said.
Caughman cited nurses’ combination of knowledge and caring as proof that an expansion of nursing practice is needed to improve health care in the state. “Nurses have the skills and passion to get it done.”
Panelist Anjli Aurora Hinman, CNM, FNP-BC, MPH, a nurse midwife at Intown Midwifery in Atlanta, said that while nurses are always ranked among the most-trusted workers in the U.S., they’re not seen by many opinion-makers as having a strong voice for change. She called for nurses to have a place at the table with doctors, teachers, legislators and business leaders.
“Full partners; that’s what we need to be,” she said.
Karen Minyard, Ph.D., MSN, executive director of the Georgia Health Policy Center at Georgia State University’s Andrew Young School of Policy Studies, called for more involvement by nurses in primary care, with larger roles for certified nurse midwives and nurse-managed clinics. She also urged nurses to make their voices heard.
“How do we influence decisions?” she asked.
One way to do that is to become part of the process. Each of the breakout groups at the summit will form task forces to address one of the Institute of Medicine recommendations, said Jasmine Hoffman, director of communications at Emory University’s nursing school and a member of the summit planning committee.
There will be regional meetings in different cities throughout the year to further the work of the task forces.
The Georgia planning group has submitted an application to the Robert Wood Johnson Foundation to become an official Future of Nursing Regional Action Coalition. That designation would give the Georgia group access to technical assistance from the foundation. As of press time, the Nursing Regional Action Coalition notifications had not been made, Hoffman said.
Several of the speakers at the summit stressed the importance of an interdisciplinary approach to fixing the health care system.
“We can give the highest-quality health care at the best price if we work as a team,” Caughman said.
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