The Future of Nursing Leading Change, Advancing Health (2011) / Chapter Skim
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7 Recommendations and Research Priorities
7 Recommendations and Research Priorities
Pages 269-284
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From page 269... ...
It has also discussed the workforce data needed to guide policy and workforce planning with respect to the numbers, types, and mix of professionals that will be required in an evolving health care environment. The primary objective of the committee in fulfilling its charge was to define a blueprint for action that includes recommendations for changes in public and institutional policies at the national, state, and local levels.
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From page 270... ...
While legal and regulatory constraints affect scopes of practice for advanced practice registered nurses, the major cross-cutting constraints originate in limitations of available resources -- both financial and human. These constraints are not new, nor are they unique to the nursing profession.
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From page 271... ...
Taken together, the recommendations are meant to provide a strong foundation for the development of a nursing workforce whose members are well educated and well prepared to practice to the full extent of their education, to meet the current and future health needs of patients, and to act as full partners in leading change and advancing health. Implementation of these recommendations will take time, resources, and a significant commitment from nurses and other health professionals; nurse educators; researchers; policy makers and government leaders at the federal, state, and local levels; foundations; and other key stakeholders.
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From page 272... ...
Nurses serving in primary care roles could expand access to care, educate people about health risks, promote healthy lifestyles and behaviors to prevent disease, manage chronic diseases, and coordinate care. The committee also focused on advanced practice registered nurses in its discussion of some topics, most notably scope of practice.
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From page 273... ...
Expanding the roles and capacity of the nursing profession will require significant up-front financial resources, but this investment, in the committee's view, will help secure a strong foundation for a future health care system that can provide high-quality, accessible, patient-centered care. Based on its expert opinion and the available evidence, the committee believes that, despite the fiscal challenges, implementation of its recommendations is necessary
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From page 274... ...
This does not mean, however, that the evidence currently available to support the committee's recommendations is sufficient to guide or motivate their implementation. The research priorities presented in Boxes 7-1 through 7-3 constitute key evidence gaps that need to be filled to convince key stakeholders that each recommendation is fundamental to the transformation of care delivered by nurses.
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From page 275... ...
Likewise, before agreeing to reorganize care and training in a way that supports nursing residencies, hospitals will likely want to understand the true costs of such programs, as well as the key ingredients for their success. And before state political leaders can be persuaded to enact legislation to expand and standardize the scope of practice for advanced practice registered nurses, they will need messages to convey to their constituents about what these changes will mean for acquiring timely access to high-quality primary care services.
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From page 276... ...
, that a strong evidence base, even if supported by the results of multiple randomized clinical trials funded by the National Institutes of Health, will not be sufficient to propel a new model, policy, or practice to a position of widespread acceptance and implementation. "Health care is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one location, they often disseminate slowly -- if at all.
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From page 277... ...
However, the committee urges health care providers, organizations, and policy makers to carry out the eight recommendations presented below to enable nurses to lead in the transformation of the health care system and advance the health of patients and communities throughout the nation. CONCLUSION The committee believes the implementation of its recommendations will help establish the needed groundwork in the nursing profession to further the
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From page 278... ...
• Extend the increase in Medicaid reimbursement rates for primary care physicians included in the ACA to advanced practice registered nurses providing similar primary care services. • Limit federal funding for nursing education programs to only those pro grams in states that have adopted the National Council of State Boards of Nursing Model Nursing Practice Act and Model Nursing Administra tive Rules (Article XVIII, Chapter 18)
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From page 279... ...
For the Federal Trade Commission and the Antitrust Division of the Department of Justice: • Review existing and proposed state regulations concerning advanced practice registered nurses to identify those that have anticompetitive ef fects without contributing to the health and safety of the public. States with unduly restrictive regulations should be urged to amend them to allow advanced practice registered nurses to provide care to patients in all circumstances in which they are qualified to do so.
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From page 280... ...
after they have completed a prelicensure or advanced practice degree program or when they are transitioning into new clinical practice areas. The following actions should be taken to implement and support nurse residency programs: • State boards of nursing, in collaboration with accrediting bodies such as the Joint Commission and the Community Health Accreditation Pro gram, should support nurses' completion of a residency program after they have completed a prelicensure or advanced practice degree program or when they are transitioning into new clinical practice areas.
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From page 281... ...
These leaders should partner with education accrediting bodies, private and public funders, and employers to ensure funding, monitor progress, and increase the diversity of students to create a workforce prepared to meet the demands of diverse populations across the lifespan. • The Commission on Collegiate Nursing Education, working in collabo ration with the National League for Nursing Accrediting Commission, should require all nursing schools to offer defined academic pathways, beyond articulation agreements, that promote seamless access for nurses to higher levels of education.
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From page 282... ...
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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From page 283... ...
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. The Workforce Commission and the Health Resources and Services Administration should collaborate with state licensing boards, state nursing workforce centers, and the Department of Labor in this effort to ensure that the data are timely and publicly accessible.
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From page 284... ...
• The Government Accountability Office should ensure that the Workforce Commission membership includes adequate nursing expertise. REFERENCES Berwick, D
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