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Progress Implementing the IOM’s Future of Nursing Recommendations

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By Debra Wood, RN, contributor

December 13, 2013 - Three years since the Institute of Medicine (IOM) released the Future of Nursing: Leading Change, Advancing Health report, much progress has occurred, including raising awareness of the role the health care professionals play in improving America's health, promoting nurses’ academic progression and advancing changes in scope of practice so nurses can practice to the fullest extent based on their education and licensure.

Susan Reinhard: Campaign for Action is a long-term effort.
Susan C. Reinhard, PhD, RN, FAAN, suggested the Campaign for Action is a long-term effort to prepare nursing for the future.

“The report is about nurses stepping up and preparing for the future, educating themselves and making sure they have the skills for preparing to lead--all of the things we as a profession need to do to help advance health and health care for all,” said Susan C. Reinhard, PhD, RN, FAAN, senior vice president, AARP Public Policy Institute and chief strategist, Center to Champion Nursing in America in Washington, D.C.

The Center is responsible for implementing the Campaign for Action, which rolled out shortly after the report, with support from the Robert Wood Johnson Foundation (RWJF), and has brought together into state action coalitions nurses and interested lay people--consumers, business, insurers--to facilitate implementation of recommendations from the report.

The IOM developed the report and its recommendations to bring nursing forward into the future after an expert panel, from industry, academia and practice, reviewed scientific evidence. The report has changed some nurses’ lives and inspired them to obtain more education, reported Susan B. Hassmiller, PhD, RN, FAAN, senior adviser for nursing and director of the Future of Nursing: Campaign for Action, Robert Wood Johnson Foundation in Princeton, N.J.

“We continue to use [the report] as an impetus for moving forward on a number of issues,” said Cheryl Peterson, RN, director of nursing practice and policy at the American Nurses Association (ANA) in Silver Spring, Md.

Marsha Howell Adams, PhD, RN, CNE, ANEF, president of the National League for Nursing (NLN) in Washington and senior associate dean of academic programs and professor at the University of Alabama Capstone College of Nursing in Tuscaloosa, agreed that the profession has definitely made progress in implementing the report’s recommendations.

Action coalitions, in all 50 states, have raised visibility of the issues, sought financial support, established a sustainable infrastructure and set priorities. The Texas coalition, for instance, is raising funds through a Johnson & Johnson Texas Team Gala, which it hopes will generate $350,000, with 65 percent of the funds targeted to support regional action coalitions, reported Alexia Green, RN, PhD, FAAN, co-leader of Texas Team Advancing Health through Nursing, and professor and dean emeritus of the School of Nursing at Texas Tech University Health Sciences Center in Lubbock. Blue Cross Blue Shield of Texas and the Texas Nurses Association also have provided support.

State coalitions now are engaging in strategic activation. The RWJF has provided funding in 39 states.

“Now it’s time to get it done,” Hassmiller said.;

Academic progression for nurses 

The report set goals to increase the percentage of baccalaureate or higher-prepared nurses to 80 percent by 2020 and double the number of nurses with doctorates, indicating that a more highly educated workforce is needed to care for today’s and tomorrow’s populations.

In 2010, 49 percent of nurses held a baccalaureate degree, and that rose 1 percent in 2011. But enrollments were up 22.2 percent in RN-to-BSN programs from 2011 until 2012. There were 89,975 students in 2011 students enrolled in one of 646 programs, according to the American Association of Colleges of Nursing. There has been a 27 percent increase in enrollment in doctor of nursing practice (DNP) programs and a 4 percent increase in PhD nursing programs.

Susan Hassmiller reports progress implementing Future of Nursing recommendations.
Susan B. Hassmiller, PhD, RN, FAAN, indicated tremendous progress has been made in implementing the IOM’s Future of Nursing report, and more actions are underway.

Campaign efforts have focused on creating student-centric policies, such as common curriculums and standard competencies, so nurses furthering their education do not need to repeat courses or take excessive numbers of prerequisite courses. Leaders have found common areas of agreement, such as the need for more faculty and nurse practitioners. The American Nurses Credentialing Center has started requiring Magnet applicants to provide a plan for increasing baccalaureate-prepared nurses.

“Everybody wants to be part of this successful effort,” Hassmiller said. “We are building the infrastructure for seamless integration and a cultural shift.”

Community colleges are now accepting the fact that their graduates will need to continue their education, Hassmiller added, saying, “That cultural shift is an enormous accomplishment.”

The Academic Progression in Nursing (APIN) initiative, funded by the RWJF, provides funding for nine coalitions, including Texas, to work on strategies related to academic progression. The Tri-Council for Nursing, an alliance between the American Association of Colleges of Nursing, the American Nurses Association, the American Organization of Nurse Executives, and the National League for Nursing, administers the grants.

“All of the major nursing organizations are coming together,” Adams said.

Removing barriers to care 

Nurses could provide more health services if they all could practice to the full extent of their training, the IOM report indicated. To provide greater access to care, the campaign is working to modernize outdated policies.

Seven states have removed barriers to practice for advanced practice nurses. These include Iowa, Kentucky, Maryland, Nevada, North Dakota, Oregon and Rhode Island. In 2013, 16 states introduced legislation to remove scope of practice barriers. Texas relaxed some of its restrictions on APRN physician supervision, Green said.

“We see the barriers people try to put up, but we are addressing many of those,” said Peterson, adding that in 2014, more movement will occur in removing barriers in the RN scope of practice. “Everyone needs to practice to their full extent.”

Reinhard attributed much of the success to bringing consumers, business leaders and other organizations together in support of the changes. Hassmiller also credited AARP and the consumer voice with making a difference and solidifying the message. The campaign’s focus is on patients.

“We have goals to meet at the foundation about better health care and higher quality and better access,” Hassmiller said. “Nurses are a means to that end. This cannot be about nursing but about what is right for patients.”


Nurses have an opportunity to lead much of the change taking place in the health care system. While many of the coalitions have started working on leadership, developing nurses’ skills and promoting their appointment to decision-making boards, such as hospitals and health systems and journal editorial boards, will become a focus for the campaign.

“2014 will be the year of leadership,” Hassmiller said.

Currently about 6 percent of hospital boards include a nurse. State coalitions are surveying which boards already have a nurse and which nurses are interested in serving.

The ANA and NLN have leadership development programs to better move nursing forward. The ANA has focused on national committees, particularly in the quality arena. NLN offers mentorship programs for nurses aspiring to a leadership role or newly named to one, for nurses working with simulation, and for experienced deans of nursing schools.

Hassmiller suggested new nurses can gain experience by serving on committees.

“Nurses cannot afford to sit back and have someone else make decisions for them,” Hassmiller said.

The Texas Healthcare Trustees and Texas Team Advancing Health through Nursing will provide leadership training to more than 400 nurses to prepare them for board service and identify boards.

Interprofessional collaboration and diversity are other focus areas for 2014, Reinhard said.

ANA is working on care coordination, the RN role and how to measure RN contributions. NLN is holding a leadership conference called Integrating the 3Ds: Diversity, Disparity and Social Determinants, to educate nurse educators in strategies to sustain a racial, ethnic and gender-diverse nursing workforce.

“We are dealing with patients from differing backgrounds and resources,” Adams said. “This leadership conference is aimed at providing nurse educators with the tools to promote quality, safe care.”

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