The Future of Nursing Initiatives and Progress

This is such an exciting time for the nursing profession. Because of our past and present influential nurse leaders, educators, and the organizations that value and support us, we are poised to bring the profession of nursing to new heights. Nurses play an integral role in health care, and there is a significant need for greater involvement on all levels. Now more than ever with the Institute of Medicine’s The Future of Nursing report and the Affordable Care Act, nurses must be prepared to assume leadership positions in organizations as well as within the political arena to affect the changes that are vital to the future health care of all populations on a local, national, and global scale.

In 2008, the Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) launched a two-year initiative to respond to the need to assess and transform the nursing profession. A committee was formed and a blueprint for the future of nursing was created. The report, titled The Future of Nursing: Leading Change, Advancing Health, was published in 2010. The report includes four key messages and eight recommendations. The four key messages of the report are:

Nurses should practice to the full extent of their education and training;
Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression;
Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States; and
Effective workforce planning and policy making require better data collection and an improved information infrastructure.

In response to the report, the American Association of Retired Persons and the RWJF launched the Future of Nursing Campaign for Action to facilitate implementation of these key messages and recommendations. There is an action coalition in every state and they all have the same goals; however, they do have autonomy to address the issues in relation to the specific needs of their individual states. Progress has been made in all areas, but there is much more to do, and it is vital for all nurses, future nurses, and other stakeholders to be involved in this initiative. The focus of the action coalitions is to address the following pillars that relate to The Future of Nursing report:

advancing education transformation;
leveraging nursing leadership;
removing barriers to practice and care;
fostering interprofessional collaboration;
promoting diversity; and
bolstering workforce data.

These pillars relate to the recommendations contained in the report. The latest report, Assessing Progress on the Institute of Medicine Report The Future of Nursing, highlights the progress made in health care delivery and the scope of practice; collaboration; leadership; education; diversity in the nursing profession; and workforce data.

The recommendation related to health care delivery and scope of practice posits that all advanced practice nurses be able to practice to the full extent of their education and training. Although progress has been made, barriers still exist. To date, 19 states allow for full practice, 18 states have reduced practice, and 13 states have restricted practice, according to the American Association of Nurse Practitioners. According to the Assessing Progress on the Institute of Medicine Report The Future of Nursing, policymakers, nursing, and health professions groups must collaborate to increase interprofessional collaboration and remove scope of practice barriers.

There are two recommendations that address leadership with the premise being that nurses must be prepared to serve as leaders within organizations and on the executive and policy levels. According to a 2014 survey conducted by the American Hospital Association’s Center for Healthcare Governance, there are approximately 6% of nurses serving on a board. There have been several initiatives developed, such as the American Nurses Advocacy Institute (ANAI), which the American Nurses Association launched in 2009. ANAI is a program designed to increase the political competence of nurses, thus promoting stronger advocacy on nursing related issues at the state and federal levels. In addition, the American Association of Colleges of Nurses (AACN) offers a Faculty Policy Intensive, a four-day immersion program designed to prepare faculty interested in taking an active role in health care policy; the RWJF has programs such as Nurse Executive Fellowships to develop new leaders, and the Nurses on Boards Coalition is focused on improving the health of communities and the nation by placing 10,000 nurses on boards by the year 2020.

Transforming nursing education encompasses four recommendations from The Future of Nursing report—increasing the number of baccalaureate prepared nurses to 80% by 2020, doubling the number of doctorally prepared nurses, increasing transition into practice residency programs, and promoting professional development and lifelong learning. According to the AACN, there are 187 practice sites in 32 states that offer the year-long residency, and more than 40,000 nurses have completed the program. A formal curriculum serves as the framework for the residency, and the faculty and staff of the University Healthsystem Consortium institutions who developed the curriculum review it annually for updates and revisions. The statistics on the number of BSN-prepared nurses vary. There are reports that currently 51% of the 3 million nurse in the U.S. hold a BSN, and there has been an increase in enrollment in generic BSN programs and RN-to-BSN programs. Many programs also have articulation agreements with the Associate Degree programs for seamless transition, and there are also some dual degree programs. The number of doctorally-prepared nurses, which was only 1% in 2010 with enrollment in DNP programs doubled, and there was a 15% increase in PhD programs.

The Campaign has made diversity one of its pillars, and there are many organizations that are focused on a more diverse workforce that is representative of the populations we serve. For example, the New York State Action Coalition developed a Diversity Toolkit that provides resources for organizations to utilize to develop and sustain a diverse workforce.

Statistics on workforce data have improved; however, there remains a need to have an improved structure for data collection on a local and national level to understand resources and needs for continued growth and development of our workforce.

Northern Metropolitan Region Action Coalition

The Northern Metropolitan Region (NorMet) Action Coalition works under the umbrella of the New York State Action Coalition (NYSAC) and was developed in 2011. The organizational structure includes nurse co-leads and committee chairs. This region includes seven counties: Westchester, Putnam, Duchess, Rockland, Orange, Sullivan, and Ulster. The priority recommendation for the NorMet Region is to increase the number of BSN-prepared nurses to 80% by 2020. To address this, the BSN 80-20 Committee developed an Aspiring Protégé Toolkit, which is a mentor program geared to improve retention of nurses in BSN programs. Another priority is to prepare nurses to lead to advance health. This committee includes two Jonas Scholars who completed a leadership video project, Calling All Nurses: Step Up and Lead, and continues to address this recommendation. There is also an Outreach Committee that is focused on networking, public speaking, and increasing membership. Another priority is to promote diversity. The NYSAC also developed a Diversity Toolkit to facilitate the expansion of a more diverse workforce. The action coalition continues to address the key recommendations in accordance with the NYSAC.