With more than 3 million nurses in the US, the nursing profession is the largest segment of the nation’s health care workforce and can play an important role in the rapidly changing health care environment.
Every day, nurses must deliver high-quality, patient-centered care while facing the challenges of a shortage of primary care providers, increasingly complex technology and new regulatory and organizational conditions.
But as legislation known as the 2010 Affordable Care Act will grant 32 million more Americans insurance coverage and usher in other changes, the nursing profession must be better positioned to meet the myriad demands, according to a recent report by the Institute of Medicine (IOM).
In response, the UCSF School of Nursing on Feb. 1 convened a panel to discuss the recommendations of the IOM’s Future of Nursing report, which include making changes in public and institutional policies and practices at the national, state and local levels.
“We are woefully and inadequately prepared for health care reform,” said panelist Josh Adler, MD, chief medical officer of the UCSF Medical Center, referring to the 4.4 million additional Californians who will gain health insurance. “Quality of care is highly variable across the state and this fragmentation needs to be addressed.”
UCSF School of Nursing’s future dean David Vlahov, PhD, RN, who will assume the leadership post on April 1, agreed that the pressure is on to respond effectively to health reform.
“Leveraging the report is very important now because health reform will happen as the role of nurses is articulated within a more national health system,” he said. “It’s like surfers always want the biggest wave coming at them, well health care reform is the biggest wave you can get.”
A Blueprint for the Future of Nursing
The IOM report, titled “The Future of Nursing: Leading Change, Advancing Health,” was produced by a committee with expertise in fields such as public health, federal and state administration, policy and economics. During the course of two years, the committee conducted meetings, public workshops and forums and developed four key recommendations:
- 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 care professionals, in redesigning health care in the United States.
- Effective workforce planning and policy making require better data collection and information infrastructure.
To put these messages into practice, the report recommends establishing residency training for nurses, increasing the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and doubling the number who pursue doctorates.
Additionally, obstacles such as limiting nurses' scope of practice should be removed so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care, the report states.
“Much of the IOM report serves as a blueprint for our educational mission and capitalizes on the research we already do,” Vlahov said.
California was selected as one of five states to begin implementing these recommendations, and was “selected because the infrastructure is in place for the state to come together in a collaborative manner to address the issues,” said panelist Deloras Jones, executive director of the California Institute for Nursing & Health Care. “It has a history of getting results and can build educational capacity.”
To make these changes, Jones says the larger community, including established and reputable academic health centers such as UCSF must be engaged. “We need [UCSF] to step forward and help us create actionable plans for the state of California,” she said. “We need you to be thought leaders and inform dialogue going forward.”
While there isn’t a specific timeframe for adopting the recommendations, Adler said he welcomes proposals now for innovative ways to increase access to primary care.
And UCSF already has much of the philosophy and infrastructure in place to implement the IOM recommendations.
“The notion of interprofessionalism is critical, which we’ve already experimented with at UCSF. But it should be a lifelong activity,” said Adler.
The recently opened UCSF Teaching and Learning Center -- a 22,000-square-foot educational center dedicated to creating a culture of collaboration among future nurses, doctors, dentists and pharmacists through a flexible learning environment – is the latest way UCSF has embraced the culture of interprofessional health education.
Adler also said team-based patient care, innovation and expanded roles for advance practice nurses are key elements to adapting care for the future. “Innovation and care is never at its best in a silo.”
Photos by Susan Merrell