A Summary of the February 2010 Forum on the Future of Nursing

EDUCATION

Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

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Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine

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THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, N.W. • Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. Support for this project was provided by the Robert Wood Johnson Foundation (Contract No. 65815). Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project. International Standard Book Number-13: 978-0-309-15282-2 International Standard Book Number-10: 0-309-15282-8 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624- 6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2010 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Cover credit: Photos by Sam Kittner/kittner.com. Suggested citation: IOM (Institute of Medicine). 2010. A summary of the February 2010 forum on the future of nursing: Education. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE ON THE ROBERT WOOD JOHNSON FOUNDATION INITIATIVE ON THE FUTURE OF NURSING, AT THE INSTITUTE OF MEDICINE DONNA E. SHALALA (Chair), University of Miami, Coral Gables, FL LINDA BURNES BOLTON (Vice Chair), Cedars-Sinai Health System and Research Institute, Los Angeles, CA MICHAEL BLEICH, Oregon Health & Science University School of Nursing, Portland TROYEN A. BRENNAN, CVS Caremark, Woonsocket, RI ROBERT E. CAMPBELL, Johnson & Johnson (retired), New Brunswick, NJ LEAH DEVLIN, University of North Carolina at Chapel Hill, School of Public Health CATHERINE DOWER, University of California–San Francisco ROSA GONZALEZ-GUARDA, University of Miami, Coral Gables, FL DAVID C. GOODMAN, Dartmouth Medical School, Hanover, NH JENNIE CHIN HANSEN, AARP, Washington, DC C. MARTIN HARRIS, Cleveland Clinic, Cleveland, OH ANJLI AURORA HINMAN, Intown Midwifery, Atlanta, GA WILLIAM D. NOVELLI, Georgetown University, Washington, DC LIANA ORSOLINI-HAIN, City College of San Francisco, CA YOLANDA PARTIDA, University of California–San Francisco, Fresno ROBERT D. REISCHAUER, Urban Institute, Washington, DC JOHN W. ROWE, Columbia University, New York BRUCE C. VLADECK, Nexera Consulting, New York Study Staff JUDITH A. SALERNO, Executive Officer SUSAN HASSMILLER, Director, Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine ADRIENNE STITH BUTLER, Senior Program Officer ANDREA M. SCHULTZ, Associate Program Officer KATHARINE BOTHNER, Research Associate THELMA L. COX, Administrative Assistant TONIA E. DICKERSON, Senior Program Assistant GINA IVEY, Communications Director, Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine v

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LORI MELICHAR, Research Director, Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine JULIE FAIRMAN, Nurse Scholar-in-Residence Consultants PAUL LIGHT, New York University STEVE OLSON, Technical Writer vi

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Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its pub- lished report as sound as possible and to ensure that the report meets in- stitutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confi- dential to protect the integrity of the process. We wish to thank the fol- lowing individuals for their review of this report: Sr. Rosemary Donley, Duquesne University School of Nursing Greer Glazer, College of Nursing and Health Sciences, University of Massachusetts–Boston Hugh H. Tilson, University of North Carolina at Chapel Hill, School of Public Health Rachael Watman, John A. Hartford Foundation Although the reviewers listed above have provided many construc- tive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was over- seen by Ada Sue Hinshaw, Graduate School of Nursing, Uniformed Services University of the Health Sciences. Appointed by the National Research Council and the Institute of Medicine, she was responsible for making certain that an independent examination of this report was car- ried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authors and the institution. vii

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Preface The Initiative on the Future of Nursing, a collaborative effort of the Robert Wood Johnson Foundation (RWJF) and the Institute of Med- icine (IOM), took place during a pivotal period in the history of health care in the United States. From the beginning of the 2-year initiative, the national conversation was dominated by the effort to achieve meaningful reforms in its health care system, culminating with President Barack Obama signing the Patient Protection and Affordable Care Act into law on March 23, 2010. It was a fascinating time to serve as members of the IOM committee that was charged with developing a set of action-oriented recommendations for the future of nursing—the profession that makes up the single largest component of the health care system. On February 22, 2010, just a month before that historic day in health care reform, the Initiative on the Future of Nursing held the last public forum in a series of three at the University of Texas MD Anderson Can- cer Center. This forum, which covered the education of nurses, consisted of three armchair discussions. Each discussion was led by a moderator from the committee and focused on three broad, overlapping subjects: what to teach, how to teach, and where to teach. The verbal exchange among the discussants and moderators, prompted by additional questions from committee members at the forum, produced a wide-ranging and informative examination of questions that are critical to the future of nursing education. Additionally, testimony presented by 12 individuals and comments made by members of the audience during an open- microphone session provided the committee with valuable input from a range of perspectives. ix

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x PREFACE Several important messages flowed from the forum discussions, including: • The new basics in nursing education are collaboration within the profession and across other health professions, communication, and systems thinking; • Nurses, particularly nurse educators, need to keep up with a rap- idly changing knowledge base and new technologies throughout their careers to ensure a well-educated workforce; • Care for older adults, increasingly occurring outside of acute care settings, will be a large and growing component of nursing in the future, and the nursing education system needs to prepare educators and practitioners for that reality; • The nation will face serious consequences if the number of nurs- ing educators is not adequate to develop a more diverse nursing workforce adequate in both number and competencies to meet the needs of diverse populations across the lifespan; • Technology—such as that used in high-fidelity simulations—that fosters problem-solving and critical-thinking skills in nurses will be essential for nursing education to produce sufficient numbers of competent, well-educated nurses; • Resources and partnerships available in the community should be used to prepare nurses who can serve their communities; • Articulation agreements and education consortiums among dif- ferent kinds of institutions can provide multiple entry points and continued opportunities for progression through an educational and career ladder; and • In addition to necessary skill sets, nursing education needs to provide students with the ability to mature as professionals and to continue learning throughout their careers. While the health care legislation signed into law in March is momen- tous, the discussions leading up to the legislation were marked by a notable deficiency. The voices of nurses did not play a prominent role in the debate over health care reform, even though nurses are central to the delivery of high-quality, safe, effective care. The Initiative on the Future of Nursing has provided an opportunity for the perspective of nurses and other stakeholders to enter the ongoing discussion about the future of the profession and how it should play a role in ensuring the health of Americans.

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PREFACE xi As the U.S. health care system continues to evolve, the role of nurses also needs to evolve. Nurses must strike a delicate balance among ad- vancing science, translating and applying research, and caring for indi- viduals and families across all settings. Preparing nurses to achieve this balance is a significant challenge. The education system should ensure that nurses have the intellectual capacity, human responsiveness, flexibil- ity, and leadership skills to provide care and promote health whenever and wherever needed. Education leaders and faculty need to prepare nurses with the competencies they need now and in the future. They need to prepare nurses to work and assume leadership roles not just in hospi- tals, but in communities, clinics, homes, and everywhere else nurses are needed. As Dr. John R. Lumpkin, senior vice president and director of the Health Care Group at RWJF, said during his introduction to the forum, nurses must be involved in planning, carrying out, and leading changes in the health care system. The committee’s job is to figure out how to make that imperative a reality. Donna E. Shalala Committee Chair Michael Bleich Committee Member and Forum Planning Group Chair

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Acknowledgments The Robert Wood Johnson Foundation (RWJF) Initiative on the Future of Nursing, at the Institute of Medicine, wishes to thank all those who contributed to the success of the Forum on the Future of Nursing: Education. The forum was graciously hosted by the University of Texas MD Anderson Cancer Center; its staff, particularly Cheryl Franklin, Lisa Green, Demetria Marks, Barbara Summers, and Cherie Wade, pro- vided valuable support throughout the planning process and the forum. The Initiative would like to thank the speakers, panelists, and all who provided testimony at the forum; the insight and experience that was shared greatly contributed to the committee’s deliberations. The Initia- tive would also like to recognize the alumni from various RWJF fellow and scholar programs who participated in the forum. These individuals met to reflect on the day’s discussions and offered the committee several innovative ideas to consider for the future of nursing education. While in Houston, the Initiative had the opportunity to visit a number of nearby education and training programs for nurses and other professionals. The Initiative would like to express gratitude to the following individuals, and their colleagues, for warmly welcoming us into their learning communities: Ann Coleman, Karen Lyon, and Kelly Vandenberg at Texas Woman’s University; Jenny Knotts, Debbie Nguyen, and Lori Wheaton at the National Aeronautics and Space Ad- ministration; and Patricia Starck and Michelle Thomas at the University of Texas Health Science Center at Houston School of Nursing. The forum planning group, chaired by Michael Bleich, skill- fully shaped the day’s events. The group included Troy Brennan, Linda Burnes Bolton, Jennie Chin Hansen, David Goodman, xiii

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xiv ACKNOWLEDGMENTS Anjli Aurora Hinman, Liana Orsolini-Hain, Donna E. Shalala, and Bruce Vladeck. For their steadfast and creative work throughout the course of the forum, we would like to recognize the Initiative staff members, led by Susan Hassmiller and Adrienne Stith Butler, with guidance and over- sight from Judith Salerno. The following individuals were involved in planning the forum, day-of support, and production of this summary: Katharine Bothner, Thelma Cox, Julie Dashiell, Tonia Dickerson, Gina Ivey, Lori Melichar, Abbey Meltzer, and Andrea Schultz. The forum was webcast by ON24 and transcribed by Joy Biletz. The Initia- tive is grateful to Steve Olson for his editorial and writing assistance, Laura Penny for copyediting the summary, and Dan Banks for designing the cover. We would also like to recognize the contributions of the fol- lowing staff and consultants to this activity: Clyde Behney, Christie Bell, Julie Fairman, Christine Gorman, Amy Levey, Paul Light, Tamara Parr, Sharon Reis, Christine Stencel, Vilija Teel, Lauren Tobias, Jackie Turner, Gary Walker, and Jordan Wyndelts. Finally, the Initiative would like to express its appreciation to RWJF, whose generous financial support, and mission to improve the health and health care of all Americans, made the forum possible.

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Contents 1 INTRODUCTION 1 Site Visits, 3 Robert Wood Johnson Foundation Solutions Session, 3 Welcoming Remarks, 4 2 WHAT TO TEACH 7 Basic Nursing Education, 8 Advanced Nursing Education, 12 Question and Answer Session, 16 3 HOW TO TEACH 19 Technology in Nursing Education, 20 Online Education, 22 Nurse Residency Programs, 25 A Model for Interdisciplinary Education, 26 Question and Answer Session, 29 4 WHERE TO TEACH 31 The Education Consortium Model, 32 Baccalaureates Through Community Colleges, 34 Academic-Practice Partnerships, 35 Area Health Education Centers, 38 Question and Answer Session, 40 5 TESTIMONY 41 Concluding Remarks, 52 xv

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xvi CONTENTS APPENDIXES A References 55 B Agenda 59 C Speaker Biosketches 63