Nurses outnumber any other health care professional. More importantly who other than nurses know better the two foundational concepts of true health care; prevention and wellness? Not only that nurses are the most trusted health care professional and the ones who spend the most time in direct care and execution of treatment. Thus their knowledge expertise, experience and adaptability will be vital for successful health care in the years to come.
It is against this background that the Institute of Medicine and Robert Wood Johnson Foundation held a series of public forums that discussed nurses’ role in transforming health care. A two year initiative, their highly anticipated findings were presented recently. This article will present a brief overview of their most important observations and recommendations. Lest anyone think this is a report destined for a dusty bookshelf in a government office, rest assured that stakeholders are already taking action. The Initiative on the Future of Nursing is meeting this week to discuss how the recommendations can be implemented
This report’s audience was directed at not only nurses but those who could be partners in transforming nursing. They include policy makers from the different levels of government, industry executives, academics, and nurses’ peers in health care. Collaboration will enable necessary change.
The first ‘key message’ that the committee presented was that nurses should be allowed to practice to the full extent of their license. Why doesn’t this happen now? Individual state regulations are a haphazard mishmash. The extent to which a nurse can practice is based solely on geography and politics and has nothing to do with training, education, or experience. Some states have detailed up to date regulations others have vague policies that have not kept pace with the changing health care system. An extreme example is Kansas City, where depending on which side of the city a nurse practitioner lives he or she will be subject to different regulations than her peer on the other side. In the Texas example cited above, NPs may practice only on military bases in that state. Off base their practice is more restricted.
The committee recommends that regulatory agencies allow scope of practice changes for NPs and APRNs especially Medicare. For example APRNs should be allowed to certify for home health care, skilled nursing facilities, or assess for admissions. Similar primary care services should be reimbursed through health plans and insurers need to change their coverage, and follow through with timely credentialing.
Scope of practice restrictions affects community and public health the most. Yet this is the part of the health care system that is crucial to access. Nurses working in partnership with community organizations are a critical entry point for potential patients. With their training in comprehensive compassionate assessment and evaluation nurses will ensure citizens will be directed to proper care as needed at any life stage. Allowing nurses to practice to the full extent of their licenses will prevent costly medical crises that rob a person of independence and dignity. Nurses have already initiated such programs as LIFE(Living Independently For Elders) PACE (Program of All inclusive Care), and nurse managed health clinics.
As the population ages allowing these changes will be crucial for access to millions more senior citizens. The report also recommends that federal funding for nursing education programs be restricted to states that have adopted the National Council of State Boards of Nursing advanced practice registered nurse model regulations. The Federal Trade Commission should review current and proposed legislation with regards to APRNs to ensure fair competition.
The report also recommended that the education system through improved efficiency encourage nurses to advance in their education with the goal of having 80% of nurses with a baccalaureate degree and double the current number with a doctorate in the next decade. Employers should encourage further education by such means as scholarships, tuition reimbursement, loan forgiveness, online learning, salary differentials, and promotion. The challenge of dropout rate of new grads needs to be addressed through the creation of nurse residency programs. Also the profession needs to encourage diversity and cultural relevance. Both leadership principles and collaboration should be incorporated in the nursing curriculum.
The increased education will allow nurses to become full partners in shaping policy and health care entrepreneurship with their peers in the health care system. No longer will policy be something that happens to nurses. They will take leadership roles at all levels of health care, for example by identifying problems, areas where health care could be made more efficient, and executing and evaluating improvement. Mentorship will play a major role in bringing new nurse leaders into the profession.
Medical centers and educational institutions need to make a conscious effort to pool funds and collaborate to create opportunities for nurses to lead interprofessional teams for research and to redesign practice environments. This is especially true in spreading best practices. There are many innovations and quality advancements but they are mostly regional in nature. To truly transform health care nationally, these best practices need to become more widely known and adopted. It bears repeating that nurses because of time spent in direct care are in the best place to make this happen. Two examples of nurse led innovations that would positively affect the health care system on a national basis are Transforming Care at the Bedside and the Transition Care model.
The report stresses the need for an improved infrastructure for data collection and analysis which will enable policymakers to apply this data to future policy such as revising state rules on scope of practice. Federal and state levels need to coordinate the collection of this data. Of primary importance is the tracking of the number of different health care professionals by region.
In conclusion, this report is important because of the research is evidence based and was composed with wide consultation through public forums. Any large scale consequential change needs initiative and leadership. Nurses can be empowered to provide this if resources are available for continuing education and lifelong learning and they take their rightful place as partners in transforming health care.
Sources: http://www.dallasnews.com/sharedcontent/dwsdn/opinion/editorials/stories/DN_nurses_29edi.ART.State.Edition/4b7aa94.html
http://www.rwjf.org/pr/product.jsp?id=70450; http://rwjf.org/files/research/Future%20of%20Nursing_Leading%20Change%20Advancing%20Health.pdf
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