argues, the ways in which nurses were educated and practiced during the 20th century are no longer adequate for dealing with the realities of health care in the 21st century. Outdated regulations, attitudes, policies, and habits continue to restrict the innovations the nursing profession can bring to health care at a time of tremendous complexity and change.

In the course of its deliberations, the committee formulated four key messages that inform the discussion in Chapters 36 and structure its recommendations for transforming the nursing profession:

  1. Nurses should practice to the full extent of their education and training.

  2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.

  3. Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States.

  4. Effective workforce planning and policy making require better data collection and an improved information infrastructure.

These key messages speak to the need to transform the nursing profession in three crucial areas—practice, education, and leadership—as well as to collect better data on the health care workforce to inform planning for the necessary changes to the nursing profession and the overall health care system.

The Need to Transform Practice

Key Message #1: Nurses should practice to the full extent of their education and training.

To ensure that all Americans have access to needed health care services and that nurses’ unique contributions to the health care team are maximized, federal and state actions are required to update and standardize scope-of-practice regulations to take advantage of the full capacity and education of APRNs. States and insurance companies must follow through with specific regulatory, policy, and financial changes that give patients the freedom to choose from a range of providers, including APRNs, to best meet their health needs. Removing regulatory, policy, and financial barriers to promote patient choice and patient-centered care should be foundational in the building of a reformed health care system.

Additionally, to the extent that the nursing profession envisions its future as confined to acute care settings, such as inpatient hospitals, its ability to help shape the future U.S. health care system will be greatly limited. As noted earlier, care in the future is likely to shift from the hospital to the community setting (O’Neil, 2009). Yet the majority of nurses still work in acute care settings; according to



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