the education requirements for the necessary skills and competencies to provide quality care.

Many important messages emerged from the presentations, discussions, and site visits, including the following:

  • Budgets for public health and community health programs are being cut at a time when these programs are needed most to care for aging populations and when greater emphasis is being placed on prevention, wellness, chronic disease management, and moving care into the community.

  • Nursing in the community occurs through partnerships with many other individuals and organizations, and nurses need to take a leadership role in establishing these vital partnerships. Fostering this type of collaboration could improve the continuum of care between acute and community care settings.

  • Technology has the potential to transform the lives of nurses providing care in the community, as well as their patients, just as it is transforming commerce, education, communications, and entertainment for the public.

  • Varying scopes of practice across states have, in some cases, prevented nurses from providing care to the fullest extent possible at the community level.

  • Nurse-managed health clinics offer opportunities to expand access; provide quality, evidence-based care; and improve outcomes for individuals who may not otherwise receive needed care. These clinics also provide the necessary support to engage individuals in wellness and prevention activities.

  • Nursing students need to have greater exposure to principles of community care, leadership, and care provision through changes in nursing school curricula and increased opportunities to gain experience in community care settings.

  • The delivery of quality nursing care has the potential to provide value across community settings and can be achieved though effective leadership, policy, and accountability.

Site Visits and Solutions Session

Prior to the forum, several members of the IOM committee visited a number of community-based health centers across Philadelphia. The six Philadelphia sites visited by committee members and the RWJF fellows and scholars were the Living Independently for Elders (LIFE) program at the University of Pennsylvania School of Nursing, the Sayre High School School-Based Health Clinic, Community Health Center #3 of the Philadelphia Department of Health, Health



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