The Future of Nursing 2020-2030 Charting a Path to Achieve Health Equity (2021) / Chapter Skim
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11 The Future of Nursing: Recommendations and Research Priorities
11 The Future of Nursing: Recommendations and Research Priorities
Pages 355-376
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From page 355... ...
The NACNEP report Integration of Social Determinants of Health in Nursing Education, Practice, and Research conveys the importance of investing in SDOH and research to strengthen the nursing workforce and help nurses provide more effective care, as well as design, implement, and assess new care models. In a year that was designated to honor and uplift nursing (the International Year of the Nurse and the Midwife 20201)
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From page 356... ...
. In this chapter, the committee provides its recommendations for charting a 10-year path forward to enable and support today's and the next generation of nurses to create fair and just opportunities for health and well-being for BOX 11-1 Achieving Health Equity Through Nursing: Desired Outcomes • Nurses are prepared to act individually, through teams, and across sectors to meet challenges associated with an aging population, access to primary care, mental and behavioral health problems, structural racism, high maternal mortality and morbidity, and elimination of the disproportionate disease burden carried by specific segments of the U.S.
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From page 357... ...
Creating a shared agenda will focus efforts and ensure that all nurses -- no matter where they are educated or where they practice -- are prepared, supported, and empowered to address SDOH and eliminate inequities in health and health care. Recommendation 1: In 2021, all national nursing organizations should initiate work to develop a shared agenda for addressing social determinants of health and achieving health equity.
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From page 358... ...
2 The Tri-Council for Nursing includes the following organizations as members: the American Association of Colleges of Nursing, the American Nurses Association, the American Organization for Nursing Leadership, the National Council of State Boards of Nursing, and the National League for Nursing. 3 The Council of Public Health Nursing Organizations includes the following organizations as mem bers: the Alliance of Nurses for Healthy Environments, the American Nurses Association, the American Public Health Association -- Public Health Nursing Section, the Association of Community Health Nursing Educators, the Association of Public Health Nurses, and the Rural Nurse Organization.
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From page 359... ...
Nursing schools, health care institutions, and public health and community health organizations can do significantly more to empower nurses to raise their voices and use their considerable expertise to improve people's lives, health, and well-being. Recommendation 2: By 2023, state and federal government agencies, health care and public health organizations, payers, and foundations should initiate substantive actions to enable the nursing workforce to address social determinants of health and health equity more comprehensively, regardless of practice setting.
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From page 360... ...
• HHS should establish a National Nursing Workforce Commission or alternatively, significantly invest in and enhance the current capacity of HRSA's National Advisory Council on Nurse Education and Practice. The membership of this body should comprise public and private health care payers, employers, government agencies, nurses, representatives of other health professions, and consumers, all from diverse backgrounds and sectors.
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From page 361... ...
• State and federal governments should provide sustainable funding to prepare sufficient numbers of baccalaureate, APRN, and PhD-level nurses to address SDOH, advance health equity, and increase access to primary care. • Employers should support nurses at all levels in all settings with the financial, technical, educational, and staffing resources to help them play a leading role in achieving health equity.
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From page 362... ...
° Establish a culture of physical and psychological safety and ethical practice in the workplace, including dismantling structural racism; addressing bullying and incivility; using evidence-informed ap proaches; investing in organizational infrastructure, such as resil ience engineering;5 and creating accountability for nurses' health and well-being outcomes. ° Create mechanisms, including organizational policy and regula tions, to protect nurses from retaliation when advocating on behalf of themselves and their patients and when reporting unsafe working conditions, biases, discrimination, and injustice.
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From page 363... ...
Policy makers and health care systems need to lift permanently all barriers that stand in the way of nurses in their efforts to address the root causes of poor health, expand access to care, and create more equitable communities. Recommendation 4: All organizations, including state and federal entities and employing organizations, should enable nurses to practice to the full extent of their education and training by removing barriers that prevent them from more fully addressing social needs and social determinants of
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From page 364... ...
) should be used where available to supersede restrictive state laws, including those addressing scope of practice, telehealth, and insurance coverage and payment, that decrease access to care and burden nursing practice, and to encourage nationwide adoption of the Nurse Licensure Compact.7 • The Health Care Regulator Collaborative should work to advance inter state compacts and the adoption of model legislation to improve access, standardize care quality, and build interprofessional collaboration and interstate cooperation.
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From page 365... ...
• Reform value-based payment by ° using clinical performance measures stratified by such risk factors as race, ethnicity, and socioeconomic status; ° supporting nursing interventions through clinical performance measures that incentivize reductions in health disparities between more and less advantaged populations, improvements in measures for at-risk populations, and attainment of absolute target levels of high-quality performance for at-risk populations; and ° incorporating disparities-sensitive measures that support and incen tivize nursing interventions that advance health equity (e.g., process measures such as care management and team-based care for chronic conditions; outcomes such as prevention of hospitalizations for ambulatory care–sensitive conditions)
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From page 366... ...
Given the rapid acceleration of technical advances, nurses practicing in the coming decade will need to be adept at and comfortable with using emerging technology and have the skills to support others in doing the same. Nurses are well positioned to design, adopt, and adapt new technologies in practice and leverage data on SDOH to identify and address the needs of populations, individualize care, and reduce health disparities. With care expanding beyond the walls of traditional health care settings, including hospitals and clinics, the deployment of such advanced technologies as artificial intelligence and telehealth can assist nurses in connecting to health care networks, reaching individuals in their homes and other settings, and promoting health and well-being within communities. As key stakeholders in the design, adoption, and evaluation of new care tools, nurses also need to understand how to use new technologies to reduce rather than exacerbate inequities.
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From page 367... ...
encompass nursing-specific care processes that improve visualization of data on SDOH and associated decision making by nurses. • Employ nurses with requisite expertise in informatics to improve indi vidual and population health through large-scale integration of data on SDOH into nursing practice, as well as expertise in the use of telehealth and advanced digital technologies.
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From page 368... ...
Nurses should have this content updated and reinforced throughout their careers through continuing education. Recommendation 7: Nursing education programs, including continuing education, and accreditors and the National Council of State Boards of Nursing should ensure that nurses are prepared to address social determinants of health and achieve health equity.
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From page 369... ...
Learning experiences should include working with underserved populations in such settings as federally qualified health centers, rural health clinics, and IHS designated sites. • Incorporate in all nurse doctoral education content related to SDOH, population health, environmental health, trauma-informed care, health equity, and social justice.
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From page 370... ...
But fundamental reforms and a stronger disaster preparedness infrastructure are needed to improve nursing education, practice, and policy so nurses are fully protected during such events and can better protect and care for recovering populations. Recommendation 8: To enable nurses to address inequities within communities, federal agencies and other key stakeholders within and outside the nursing profession should strengthen and protect the nursing workforce during the response to such public health emergencies as the COVID-19 pandemic and natural disasters, including those related to climate change.
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From page 371... ...
• The American Association of Colleges of Nursing, the National League for Nursing, and the Organization for Associate Degree Nursing should lead transformational change in nursing education to address work force development in disaster nursing and public health preparedness. NCSBN should expand content in licensing examinations to cover ac tual responsibilities of nurses in disaster and public health emergency response. • Employers should incorporate the expertise of nurses to proactively de velop and implement an emergency response plan for natural disasters and public health emergencies in coordination with local, state, national, and federal partners.
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From page 372... ...
This effort should emphasize rapidly translating evidence-based inter ventions into real-world clinical practice and community-based settings to improve health equity and population health outcomes, and applying implementation science strategies in the process of scaling these inter ventions and strategies. • Identify effective multisector team approaches to improving health eq uity and addressing social needs and SDOH, including clearly defining roles and assessing the value of nurses in these models.
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From page 373... ...
Disaster Preparedness and Assess gaps in nurses' preparedness for their roles in disaster Public Health Emergency preparedness and public health emergency response to improve the Response profession's capacity and ability to advocate for population health and health equity in the context of such events. Establish a research agenda regarding nurses' roles in these areas based on a thorough needs assessment and documentation of gaps in the research literature, nursing knowledge and skills, and available resources.
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From page 374... ...
Examine efforts to increase nurses' ability to • improve access to mental and behavioral health care, and ensure the effectiveness of related interventions and services; • improve access to primary health care and ensure the effectiveness of primary care delivery systems; • improve maternal health outcomes and the delivery of maternal health care; • improve the care provided to the nation's aging population, particularly frail older adults; and • control health care spending, reduce costs, and increase the value of nurses' contributions to improving health and health care delivery. Examine approaches that can effectively prepare faculty to teach content related to SDOH, health equity, and structural racism.
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From page 375... ...
Design, implement, and rigorously evaluate interventions that build psychological safety among health care teams. FINAL THOUGHTS The nursing profession is vital to the nation's creation of a culture of health, reduction of health disparities, and improvement in the health and well-being of the population.
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From page 376... ...
The nation's health care system is also at an inflection point in terms of meeting consumers' health needs in ways and in places commensurate with their preferences. It is imperative that the nursing profession focus on the training and competency development needed to prepare nurses, including advanced practice nurses, to work competently in home and community-based as well as acute care settings and to lead efforts to build a culture of health and health equity.
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