When the Robert Wood Johnson Foundation (RWJF) collaborated with the Institute of Medicine (IOM) in 2008, the Committee Initiative was born (Future of Nursing, 2010). The initiative's goal was to analyze and respond to the need to alter the nursing profession in order to fulfill the growing demand for safe, high-quality, and effective healthcare services. In 2010, the RWJF Committee Initiative published a report titled "The Future of Nursing: Leading Transformation, Improving Health." In the report, the members of the committee observed that the nursing profession has the capacity to effect wide-reaching changes in the healthcare system because of its numbers and adaptive capacity.
The members of the initiative gave key messages on the role of nurses in realizing a transformed health care system. The report also developed several recommendations regarding the national nursing education system as well as the service delivery in an environment where nurses are insufficient. The report recommended that there should be the removal of scope-of-practice barriers, expansion of opportunities for nurses to lead and diffuse collaborative improvement efforts, and implementation of nurse residency programs. Additionally, the government ought to increase the proportion of nurses with a baccalaureate degree to 80% by 2020, double the number of nurses with a doctorate by 2020, and ensure that nurses engage in lifelong learning. The health practitioners are supposed to be prepared and enabled by the system to lead change to advance health. Lastly, an infrastructure should be built for the collection and analysis of interprofessional health care workforce data.
The Importance of the IOM “Future of Nursing” Report.
The RWJF Committee Initiative report has been a fundamental tool in coercing leaders and other stakeholders the United States government and health delivery system to implement its recommendations at both the state and local levels. In the second part of the report (A Fundamental Transformation of the Nursing Profession), the committee members explored the changes that should be implemented regarding the nursing practice, education, and workforce development.
On transforming nursing practice, they outlined their first key message that nurses should be given the permission to practice to the full extent of their training and education. According to the report, nurses have the chance to play a vital role in the transformation of the health care system to achieve an easily accessible, high-quality, and value-centered environment for patients (Future of Nursing, 2010). It, however, stated that for nurses to reach their full potential in achieving the above-stated functions, there needed to be the removal of outdated policies, regulations and cultural barriers that all act as constraints to the nursing practice. The report gave examples of the innovations that have erupted as a result of versatile, adaptive, and a well-educated nursing profession. Improved access to care for the poor and rural residents, a reduction in the number of working hours for resident physicians, and reduced lengths of hospital stay are some of these innovations.
The report further observed that nurses pay a significant role in the prevention of medical errors and reducing the rates of infection. They also facilitate the transition of patients from the hospital to their homes. As the report provides, there are redesigned roles for nurses as evidenced in the Department of Veteran Affairs (VA), the Geisinger Health System of Pennsylvania, and the Kaiser Permanente. These serve to show how nurses can help achieve a more competent health care system if allowed to practice without limitations. For instance, they can be authorized to prescribe drugs without the supervision of a physician. The report here serves the purpose of eliciting how important the nursing profession is especially when barriers to their practice are removed. To help expand the scope of practice for nurses, a consensus model for the education, training, and regulation of Advanced Practice Registered Nurses (APRNs) was established.
About transforming nursing education, the report gave its second key message. It provided that nurses are supposed to achieve greater levels of education and training. This should be achieved through an upgraded education system that provides a smooth academic progression. The goal of the nursing education is to prepare nurses to meet various patients' needs, enable them to function as leaders and assist them to get scientific knowledge for the benefit of the patients and for the deliverance of safe, quality patient care.
To achieve greater access to primary health care, the committee indicated that the number of nurses with a BSN ought to be increased from 50 to 80 percent by the year 2020. The number of nurses with a doctorate should also be increased so that some of them can take the roles of faculty and research. To achieve the targets above the members suggested that mechanisms should be put in place to attract nursing faculty and present broad clinical education placements. The report also said that nurses should be provided with market-based salary adjustments and more scholarships availed for nursing students to advance their studies. The report reviewed more hurdles that hinder proper education for nurses. It also provides the different means in which the problems can be solved.
The RWJF Committee Initiative report also explored how nurses can develop more leadership qualities. It concludes that they should have a full partnership with physicians and other health professionals for the purpose of redesigning the health care in the United States. Nurses are advised to take up leadership positions in different community settings such as hospitals, boards, schools, and political and business arenas. They should, in turn, mentor others in the process. In so doing, they will make connections both inside and outside the health care setting.
State-Based Coalitions.
After the release of the IOM report, State-Based Action Coalitions were formed to facilitate the implementation of the recommendations given in the report. They work through a campaign program (Campaign for Action) that engages healthcare professionals, educators, policymakers, and business leaders. This enables them to respond to the increasing demand for safe, high-quality, and effective health care in the country.
The work of these coalitions is being appreciated in the whole country. For instance, the California Action Coalition (CA AC) has done great work to advance nursing education and leadership. It has promoted nursing education to a level that in 2015, 61.5% of nurses in California had a BSN or higher (California Action Coalition, 2016). In 2015, the coalition rolled out an initiative to update the California 2008 Nursing Education Redesign – White Paper, to inform nursing education on what ought to be done to cater for the changes in health care demands (California Action Coalition, 2016). The report gave recommendations on what should be done to advance nursing education in California. These proposals will see the establishment of a more goal-oriented education system for nurses in California.
The CA AC also came up with LifeMoxie mentorship program in partnership with the Association of California Nurse Leaders and Kaiser Permanente. This program has enabled 217 mentor/mentee pairs to participate in an active program. Mentees are given support and coaching while working on projects. The of nurses currently serving in boards in California are known. This helps in assessing where support is needed for preparing future members of the board. The program ensures that the mentees are trained in various leadership positions and prepared for future leadership positions.
The biggest problem facing new initiatives by the CA AC is legislation as most proposals are not provided for in the constitution and state rules. However, nurse advocates are doing their best in advocating for changes in the nursing education system for the achievement of the recommendations outlined in the IOM report.
References
Institute of Medicine (US). Committee on the Robert Wood Johnson Foundation Initiative on the
Future of Nursing. (2011). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press.
California Action Coalition Recommendations (2016). Retrieved from
https://www.caactioncoalition.org/news/california-action-coalition-recommendations/
