full extent of their education, training, and competencies; and foster interprofessional collaboration. Achieving such a shift will enable the health care system to provide higher-quality care, reduce errors, and increase safety. Providing care in this way and in these areas taps traditional strengths of the nursing profession. This chapter argues that nurses are so well poised to address these needs by virtue of their numbers, scientific knowledge, and adaptive capacity that the health care system should take advantage of the contributions they can make by assuming enhanced and reconceptualized roles.

Nursing is one of the most versatile occupations within the health care workforce.1 In the 150 years since Florence Nightingale developed and promoted the concept of an educated workforce of caregivers for the sick, modern nursing has reinvented itself a number of times as health care has advanced and changed (Lynaugh, 2008). As a result of the nursing profession’s versatility and adaptive capacity, new career pathways for nurses have evolved, attracting a larger and more broadly talented applicant pool and leading to expanded scopes of practice and responsibilities for nurses. Nurses have been an enabling force for change in health care along many dimensions (Aiken et al., 2009). Among the many innovations that a versatile, adaptive, and well-educated nursing profession have helped make possible are

  • the evolution of the high-technology hospital;

  • the possibility for physicians to combine office and hospital practice;

  • lengths of hospital stay that are among the shortest in the world;

  • reductions in the work hours of resident physicians to improve patient safety;

  • expansion of national primary care capacity;

  • improved access to care for the poor and for rural residents;

  • respite and palliative care, including hospice;

  • care coordination for chronically ill and elderly people; and

  • greater access to specialty care and focused consultation (e.g., incontinence consultation, home parenteral nutrition services, and sleep apnea evaluations) that complement the care of physicians and other providers.

With every passing decade, nursing has become an increasingly integral part of health care services, so that a future without large numbers of nurses is impossible to envision.


This discussion draws on a paper commissioned by the committee on “Nursing Education Policy Priorities,” prepared by Linda H. Aiken, University of Pennsylvania (see Appendix I on CD-ROM).

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