The Future of Nursing Leading Change, Advancing Health (2011) / Chapter Skim
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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.
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This is especially true for the nursing profession, which, with more than 3 million members, represents the largest segment of the health care workforce. STUDY CHARGE In 2008, the Robert Wood Johnson Foundation (RWJF)
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The committee may examine and produce recommendations related to the following issues, with the goal of identifying vital roles for nurses in designing and implementing a more effective and efficient health care system: • econceptualizing the role of nurses within the context of the entire work R force, the shortage, societal issues, and current and future technology; • xpanding nursing faculty, increasing the capacity of nursing schools, and E redesigning nursing education to assure that it can produce an adequate number of well-prepared nurses able to meet current and future health care demands; • xamining innovative solutions related to care delivery and health profes E sional education by focusing on nursing and the delivery of nursing ser vices; and • ttracting and retaining well-prepared nurses in multiple care settings, A including acute, ambulatory, primary care, long-term care, community, and public health. regular, close proximity to patients and scientific understanding of care processes across the continuum of care give them a unique ability to act as partners with other health professionals and to lead in the improvement and redesign of the health care system and its many practice environments, including hospitals, schools, homes, retail health clinics, long-term care facilities, battlefields, and community and public health centers.
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Restrictions on scope of practice, policy- and reimbursement-related limitations, and professional tensions have undermined the nursing profession's ability to provide and improve both general and advanced care. Producing a health care system that delivers the right care -- quality care that is patient centered, accessible, evidence based, and sustainable -- at the right time will require transforming the work environment, scope of practice, education, and numbers of America's nurses.
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Depending on the state, restrictions on the scope of practice of an advanced practice registered nurse may limit or deny altogether the authority to prescribe medications, admit patients to the hospital, assess patient conditions, and order and evaluate tests. Because many of the problems related to varied scopes of practice are the result of a patchwork of state regulatory regimes, the federal government is especially well situated to promote effective reforms by collecting and disseminating best practices from across the country and incentivizing their adoption.
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Nurses are being called upon to fill primary care roles and to help patients manage chronic illnesses, thereby preventing acute care episodes and disease progression. They 2 Versant is a nonprofit organization that provides, supervises, and evaluates nurse transition-to practice residency programs for children's and general acute care hospitals.
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Nurses also should be educated with physicians and other health professionals as students and throughout their careers. Finally, as efforts are made to improve the education system, greater emphasis must be placed on increasing the diversity of the workforce, including in the areas of gender and race/ethnicity, as well as ensuring that nurses are able to provide culturally relevant care.
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Achieving a transformation of the health care system and the practice environment will require a balance of skills and perspectives among physicians, nurses, and other health professionals. However, strategic health care workforce planning to achieve this balance is hampered by the lack of sufficiently reliable and granular data on, for example, the numbers and types of health professionals currently employed, where they are employed and in what roles, and what types of activities they perform.
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Once an infrastructure for collecting and analyzing workforce data is in place, systematic assessment and projection of nursing workforce requirements by role, skill mix, region, and demographics will be needed to inform necessary changes in nursing practice and education. The ACA mandates the creation of a National Health Care Workforce Commission whose mission is, among other things, to "[develop]
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For the Centers for Medicare and Medicaid Services: • Amend or clarify the requirements for hospital participation in the Medi care program to ensure that advanced practice registered nurses are eligible for clinical privileges, admitting privileges, and membership on medical staff. For the Office of Personnel Management: • Require insurers participating in the Federal Employees Health Benefits Program to include coverage of those services of advanced practice registered nurses that are within their scope of practice under applicable state law.
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Recommendation 3: Implement nurse residency programs. State boards of nursing, accrediting bodies, the federal government, and health care organizations should take actions to support nurses' completion of a transition-to-practice program (nurse residency)
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• Health care organizations, the Health Resources and Services Admin istration and Centers for Medicare and Medicaid Services, and philan thropic organizations should fund the development and implementation of nurse residency programs across all practice settings. • Health care organizations that offer nurse residency programs and foun dations should evaluate the effectiveness of the residency programs in improving the retention of nurses, expanding competencies, and improv ing patient outcomes.
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Accrediting bodies, schools of nursing, health care organizations, and continuing competency educators from multiple health professions should collaborate to ensure that nurses and nursing students and faculty continue their education and engage in lifelong learning to gain the competencies needed to provide care for diverse populations across the lifespan. • Faculty should partner with health care organizations to develop and prioritize competencies so curricula can be updated regularly to ensure that graduates at all levels are prepared to meet the current and future health needs of the population.
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Recommendation 8: Build an infrastructure for the collection and analysis of interprofessional health care workforce data. The National Health Care Workforce Commission, with oversight from the Government Accountability Office and the Health Resources and Services Administration, should lead a collaborative effort to improve research and the collection and analysis of data on health care workforce requirements.
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• The Workforce Commission and the Health Resources and Services Administration should retain, but bolster, the Health Resources and Services Administration's registered nurse sample survey by increasing the sample size, fielding the survey every other year, expanding the data collected on advanced practice registered nurses, and releasing survey results more quickly. • The Workforce Commission and the Health Resources and Services Administration should establish a monitoring system that uses the most current analytic approaches and data from the minimum data set to systematically measure and project nursing workforce requirements by role, skill mix, region, and demographics.
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