October 05, 2010 — Washington, D.C. — Still hampered by workforce shortages and barriers that impede their ranks from delivering health care to the full extent of their education and training, nurses may have gotten the much-needed shot in the arm they need to transform their occupation with the release on Tuesday of an Institute of Medicine (IOM) report recommending sweeping changes for improving their profession.
The report, the product of a special committee chaired by University of Miami President Donna E. Shalala, recommends everything from higher levels of education and training for nurses and greater opportunities for their ranks to hold leadership positions to the removal of “scope of practice” obstacles imposed by states, federal agencies, and health care agencies that impede nurses’ ability to practice their profession to its fullest.
“This is, we believe, a landmark report,” Shalala said Tuesday at the National Press Club in Washington, D.C., where she and a contingent of committee members and other key players detailed the major proposals of the document. “It will usher in the golden age of nursing in which nursing takes its rightful leadership place in American health care.”
The report, “The Future of Nursing: Leading Change, Advancing Health,” comes two years after the Princeton, New Jersey-based Robert Wood Johnson Foundation partnered with the IOM to assess the needs of and look at ways to improve the nursing profession.
“It was the first opportunity that we had to examine the nursing profession in its broadest and most complete representation,” said Harvey Fineberg, president of the IOM. “The recommendations that emerged from the study committee recognize how critical the work of nurses is to protecting the health of our nation, and the report aims at empowering nurses to be even more effective in making long-lasting improvements in quality, access, and the value of health care for all Americans.”
Noting that nurses, at more than 3 million strong, represent the largest segment of the nation’s health care workforce, Fineberg called them “critical to the health and health care of America,” praising their ranks for delivering care in settings that range from the battlefield to nursing homes.
But despite their place on the front lines of patient care, nurses represent an occupation in need, as was evident when Shalala, who served as Secretary of Health and Human Services in the Clinton administration, outlined the committee’s findings.
“We begin by insisting that nurses be able to practice to the full extent of their education and training,” Shalala explained. “This is as important for the two-thirds of the nursing population that work in hospitals and other acute-care settings as it is for the nurse practitioners that are often identified when we discuss scope of practice.”
The need for nurses, especially advanced practice registered nurses, to deliver care without facing barriers will become even more critical now that millions more people will have access to health care with the recent passage of President Obama’s health reform bill, the committee report says.
A more diverse U.S. population, which includes Baby Boomers and people of different racial and ethnic backgrounds, also will necessitate the need to ensure nurses are able to practice to their full potential, said Rosa Maria Gonzalez-Guarda, an assistant professor at UM’s School of Nursing and Health Studies, who served as a member on the committee.
“Our recommendations do not specifically address diversity [in the nursing profession] but do so in an indirect way by promoting education at programs at the community college level,” Gonzalez-Guarda explained. “And the most diverse nurses are those trained at the community level.”
Shalala noted the report’s call for higher levels of education and training for nurses through an improved educational system, revealing the committee’s ambitious recommendation that 80 percent of the nurses in the U.S. have bachelor’s degrees within a decade.
“We’re not talking about eliminating any existing programs, simply making certain that there is a transition from program to program that’s affordable and accessible for the nursing population so that they can improve their skill and education level in a way that will provide opportunities to improve outcomes and safety for our patients,” Shalala said.
Before she arrived in the nation’s capital for the press briefing, Gonzalez-Guarda, along with UM School of Nursing and Health Studies Dean Nilda P. Peragallo, met with reporters, where they noted several programs at UM’s nursing school that bolster education opportunities for nurses, such as the school’s RN-to-BSN program; master’s programs in midwifery, family nurse practitioner, and other fields; a doctor of nursing practice degree; and other programs.
The former HHS Secretary, the longest-serving in U.S. history, reaffirmed the committee’s endorsement that nurses should work with physicians and other health care workers to reform the nation’s health care system.
“The fact is, it’s people on the ground who are delivering care who need to redesign the system,” Shalala said. “We need to make certain that nursing…is more than represented at the table but often leading the discussion for care delivery reform. Those leadership roles, which exist today but not as consistently as they need to, will determine the quality of health care in the future.”
The report also calls for effective workforce planning and policymaking, saying that such a goal can only be achieved through better data collection and a more effective information infrastructure.
Risa Lavizzo-Mourey, president of the Robert Wood Johnson Foundation, described the report as “courageous, sharply drawn, straightforward, and based on thorough evidence and solid research.”
“Some of the conclusions are likely to be controversial, but that is because they are consequential,” said Lavizzo-Mourey, adding that it will take cooperation and collaboration between the public and private sectors to ensure that the committee’s recommendations are carried out.
Committee Vice Chair Linda Burnes Bolton, who serves as vice president and chief nursing officer at Cedars-Sinai Health System and Research Institute in Los Angeles, said the report “speaks to the American people.”
“It says that it is actually possible that we cannot only improve access to health care, which the health care reform bill will do, but we will actually be able to deliver the type of care people who live, work and play in our country want to receive.”
Committee members, who answered questions from the media after the briefing on the report’s contents, will meet in Washington, D.C. next month to discuss plans for implementing the panel’s recommendations, which were arrived at through town hall meetings in Los Angeles, Houston, and Philadelphia; site visits at health care facilities across the nation; and input from nurses and physicians who served on the committee.
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