While “The Future of Nursing: Leading Change, Advancing Health” doesn’t sound like a bestseller, the 620-page Institute of Medicine (IOM) report made an instant impact when it was released on Oct. 10 last year. Interest in the much-anticipated report was so high that the IOM’s website crashed.
The result of a two-year Robert Wood Johnson Foundation initiative to assess and transform nursing, the report’s findings and recommendations have spurred many nurses to action. The report states that because nurses comprise the largest segment of the health care work force and they’re are on the front lines of patient care, they should play a vital role in transforming the nation’s health care system.
To meet that challenge, the report recommends that nurses be allowed to practice to the full scope of their education and training. It calls for equipping them with higher levels of education and better data for future work force planning. Finally, it asks nurses to assume leadership positions and become full partners — with physicians and other health care professionals — in improving the health care system.
That their profession is trusted, capable, underutilized and adept at solving problems is not news to nurses. The American Nurses Association and the Tri-Council for Nursing have both strongly endorsed the IOM report, saying its findings and recommendations reflect their own work to advance the profession.
We talked to three prominent Georgia nursing leaders about the future of the profession and how nurses need to prepare for sweeping changes in the health care landscape. Here’s what they said.
LINDA McCAULEY
“What’s different is the timing. We’re at a tipping point,” said Linda McCauley, dean and professor at the Nell Hodgson Woodruff School of Nursing at Emory University and an advisor to the Institute of Medicine. In February, she spoke to a group of 350 health care leaders and multidisciplinary stakeholders at the first Georgia Nursing Summit to discuss the implications of the report and to plan how to implement its recommendations in the state.
“The IOM report isn’t just a nursing report,” McCauley said. “It’s a report that shows how nursing can play an integral part in solving the challenges that face health care in our country.”
The nurse of the future — a highly educated, well- informed, fully practicing and empowered practitioner — is needed now. Nurses know that and they are serving on national organizations, regional committees, grass-roots task forces and consumer-based coalitions with new commitment and a sense of urgency.
Nothing less than the health and well being of the nation’s growing and aging population is at stake.
The segment of the population 65 and older is projected to grow by 79 percent by 2030, and most people in that age group have at least one chronic illness. Under the Affordable Care Act, millions of people will gain insurance coverage, while at the same time there are shortages of nurses and primary care physicians.
“The demographics demand that we deliver health care differently,” McCauley said.
Higher education is a key component in preparing nurses for expanded roles in health care. More than half of registered nurses in Georgia enter the profession with an associate degree, and many never further their education once they join the work force.
“Yet, there is powerful, hospital-based evidence that links better-prepared nurses to better patient outcomes,” McCauley said. “And without higher-degreed nurses, we can’t hope to prepare enough educators and nurse leaders for the future.”
Nationally, schools of nursing are creating partnerships that will allow students to seamlessly move from an associate degree into a bachelor’s program. The goal is to have 80 percent of all nurses prepared at the bachelor’s-degree level by 2020.
Universities are expanding their master’s and doctoral programs to train nursing faculty, advanced practice nurses, nurse researchers and administrators.
“Nurses need more education because health care is more sophisticated and complex, and because they need the knowledge to be at the leadership table when decisions are being made,” McCauley said.
Although good clinical skills and compassion will always be needed at the bedside, “to give the best care, nurses have to understand the systems in which they operate. They must be willing to help design systems that work,” she said.
FRAN BEALL
As a young nurse in the midst of a staffing shortage in the early 1970s, Fran Beall was caring for nine critical care patients by herself one night. She insisted on help and wrote a letter to the administration stating that the patient/nurse ratio did not meet care standards and was endangering patients. The hospital listened, and as a result the critical care unit was staffed with four nurses per shift.
“You can moan about problems or you can do something about them,” said Beall, president of the Georgia Nurses Association and a nurse practitioner at the University Health Center at the University of Georgia in Athens.
During her long career, Beall has seen major changes in health care technology and nursing responsibilities. Nurse practitioner programs, which first began in 1965, acknowledged that nurses could make decisions, coordinate care and collaborate with other professionals.
“That moved the profession forward, as did the adoption of evidence-based practice,” Beall said.
As GNA president, she’s aware of many new state and national initiatives to strengthen nursing. Georgia and other states are pushing for nursing work force centers that would collect the data needed to make informed decisions about work force planning, training and policies. She’s seen the development of a national Consensus Model for APRN Regulation, which if adopted, would remove restrictive barriers to practice in many states, including Georgia.
“Nursing has come into its own, and we must go forward with one strong voice,” Beall said.
She predicted that tomorrow’s most successful nurses will be educated, passionate, politically aware and prepared to assume their rightful place as collaborators in improving health care.
“Nursing isn’t a job; it’s a profession, and it’s our responsibility to get the education and information we need to grow with it,” Beall said. “If ever there was a time for nurses to join their professional organizations, this is it.
“With so much change, nurses need to know what’s going on and how it impacts them and their patients. What better place to develop leadership skills?”
ANJLI AURORA HINMAN
When she was a nursing student at Emory University, Anjli Aurora Hinman honed her leadership skills as president of HealthStat (Health Students Taking Action), a student organization committed to addressing community health issues. In 2008, she graduated as a family nurse practitioner and a nurse midwife, and now has her own practice, Intown Midwifery.
A proponent of natural childbirth, Hinman aims to start Atlanta’s first birth center that would focus on low-risk, low-cost, family-centered care for pregnancy, delivery and beyond. The center would incorporate pediatric, mental health and other services.
“With the increasing population demands and challenges, nurses need to coordinate care, not just give care,” Hinman said. “The [IOM] report calls for nurses to step up and take action, and it recognizes the need for them to have more competencies in team work, leadership and systems management. Those skills need to go hand-in-hand with clinical skills.”
Hinman stepped up two years ago when she asked to serve on the IOM’s Future of Nursing report committee.
“It was an honor to work with so many experienced leaders, and [it was] eye-opening,” she said. “I learned and saw so many innovative examples of things that nurses are doing that are working.”
She was especially impressed with the nurse-led Family Health and Birth Center in Washington, D.C., which has decreased infant-mortality rates, low birth-weight and Caesarean sections among its patients — at about a tenth of the cost of hospital care.
The 11th Street Family Health Services Clinic in Philadelphia is a classic example of “nurses saying, ‘Here’s a problem, now let’s find a solution,’ ” Hinman said. “It’s giving an entire neighborhood access to comprehensive care. There’s primary and chronic care, mental health services and exercise programs.”
To see so many successful nursing solutions backed up by evidence was a proud moment for Hinman.
“The future of nursing is here. It’s just not everywhere,” she said.
She believes it’s time for nurses to harness their collective power and take an active part in the change that is happening.
“Don’t wait for it to come to you; go out and find it,” she urges her colleagues. “The only way things are going to get better is if we make them better.”
About the Author
