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Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. doi: 10.17226/12956.
×

The Future of Nursing

LEADING CHANGE, ADVANCING HEALTH

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

Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. doi: 10.17226/12956.
×

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.

This study was supported by Contract No. 65815 between the National Academy of Sciences and the Robert Wood Johnson Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

Library of Congress Cataloging-in-Publication Data

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

The future of nursing : leading change, advancing health / Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-0-309-15823-7 (hardcover) — ISBN 978-0-309-15824-4 (pdf)

1. Nursing—Practice—United States. 2. Nursing—United States. 3. Leadership—United States. I. Robert Wood Johnson Foundation. II. Institute of Medicine (U.S.) III. Title.

[DNLM: 1. Nursing—trends—United States. 2. Education, Nursing—United States. 3. Health Policy—United States. 4. Leadership—United States. 5. Nurse's Role—United States. WY 16 AA1]

RT86.7.C65 2011

610.73—dc22

2010052816

Additional copies of this report are available from the

National Academies Press,

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For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.

Copyright 2011 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Cover credit: Photos reprinted with permission from Tom Semkow; Gregory Benson; Lisa Hollis, Cedars-Sinai Medical Center; and Sam Kittner/kittner.com.

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested citation: IOM (Institute of Medicine). 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. doi: 10.17226/12956.
×

“Knowing is not enough; we must apply.

Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. doi: 10.17226/12956.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine


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

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. doi: 10.17226/12956.
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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), President,

University of Miami, Coral Gables, FL

LINDA BURNES BOLTON (Vice Chair), Vice President and Chief Nursing Officer,

Cedars-Sinai Health System and Research Institute, Los Angeles, CA

MICHAEL R. BLEICH, Dean and Dr. Carol A. Lindeman Distinguished Professor, Vice Provost for Inter-professional Education and Development Oregon Health & Science University School of Nursing,

Portland

TROYEN A. BRENNAN, Executive Vice President, Chief Medical Officer,

CVS Caremark, Woonsocket, RI

ROBERT E. CAMPBELL, Vice Chairman (retired),

Johnson & Johnson, New Brunswick, NJ

LEAH DEVLIN, Professor of the Practice,

University of North Carolina at Chapel Hill School of Public Health, Raleigh

CATHERINE DOWER, Associate Director of Research,

Center for the Health Professions, University of California, San Francisco

ROSA GONZALEZ-GUARDA, Assistant Professor,

School of Nursing and Health Studies, University of Miami, Coral Gables, FL

DAVID C. GOODMAN, Professor of Pediatrics and of Health Policy, and Director,

Center for Health Policy Research, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH

JENNIE CHIN HANSEN, Chief Executive Officer,

American Geriatrics Society, New York

C. MARTIN HARRIS, Chief Information Officer,

Cleveland Clinic, OH

ANJLI AURORA HINMAN, Certified Nurse-Midwife,

Intown Midwifery, Atlanta, GA

WILLIAM D. NOVELLI, Distinguished Professor,

McDonough School of Business, Georgetown University, Washington, DC

LIANA ORSOLINI-HAIN, Nursing Instructor,

City College of San Francisco, CA

YOLANDA PARTIDA, Director,

National Center, Hablamos Juntos, and

Assistant Adjunct Professor,

Center for Medical Education and Research, University of California, San Francisco, Fresno

ROBERT D. REISCHAUER, President,

The Urban Institute, Washington, DC

JOHN W. ROWE, Professor,

Mailman School of Public Health, Department of Health Policy and Management, Columbia University, New York

BRUCE C. VLADECK, Senior Advisor,

Nexera Consulting, New York

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. doi: 10.17226/12956.
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Project Staff

SUSAN HASSMILLER, Study Director

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

LORI MELICHAR, Research Director

JULIE FAIRMAN, Distinguished Nurse Scholar-in-Residence

JUDITH A. SALERNO, Executive Officer,

IOM

Consultants

CHRISTINE GORMAN, Technical Writer

RONA BRIERE, Consultant Editor

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. doi: 10.17226/12956.
×

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 published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

John Benson, Jr., University of Nebraska Medical Center

Bobbie Berkowitz, University of Washington

George Boggs, American Association of Community Colleges

Marilyn P. Chow, Kaiser Permanente

Jordan J. Cohen, The George Washington University

Nancy W. Dickey, Texas A&M Health Science Center

Tine Hansen-Turton, National Nursing Centers Consortium and Public Health Management Corporation

Ann Hendrich, Ascension Health

Beverly Malone, National League for Nursing

Edward O’Neil, Center for the Health Professions, University of California, San Francisco

Robert L. Phillips, Jr., Robert Graham Center

Joy Reed, North Carolina Department of Health and Human Services

Thomas Ricketts, University of North Carolina School of Public Health

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Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. doi: 10.17226/12956.
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Vinod Sahney, Institute for Healthcare Improvement

Charlotte Yeh, AARP Services Incorporated

Heather Young, Betty Irene Moore School of Nursing, University of California, Davis

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Kristine Gebbie, School of Nursing, Hunter College City University of New York and Mark R. Cullen, Stanford University. Appointed by the National Research Council and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried 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 authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. doi: 10.17226/12956.
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Foreword

The founding documents of the Institute of Medicine (IOM) call for experts to discuss, debate, and examine possible solutions for the multitude of complex health concerns that face the United States and the world. Equally important is the timely implementation of those solutions in a way that improves health. The United States is at an important crossroads as health care reforms are being carried out and the system begins to change. The possibility of strengthening the largest component of the health care workforce—nurses—to become partners and leaders in improving the delivery of care and the health care system as a whole inspired the IOM to partner with the Robert Wood Johnson Foundation (RWJF) in creating the RWJF Initiative on the Future of Nursing, at the IOM. In this partnership, the IOM and RWJF were in agreement that accessible, high-quality care cannot be achieved without exceptional nursing care and leadership. By working together, the two organizations sought to bring more credibility and visibility to the topic than either could by working alone. The organizations merged staff and resources in an unprecedented partnership to explore challenges central to the future of the nursing profession.

To support this collaborative effort, the IOM welcomed staff from RWJF, as loaned employees, to provide specific content expertise in nursing, research, and communications. Combining staff from two different organizations was an experiment that integrated best practices from both organizations and inspired us to think in fresh ways about how we conduct our work. We are indebted to RWJF for the leadership, support, and partnership that made this endeavor possible.

I am deeply grateful to the committee—led by Donna Shalala, committee chair and former Secretary of the Department of Health and Human Services, and Linda Burnes Bolton, committee vice chair—and to the staff, especially Susan

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. doi: 10.17226/12956.
×

Hassmiller, Adrienne Stith Butler, Andrea Schultz, and Katharine Bothner, who produced this report. Their work will serve as a blueprint for how the nursing profession can transform itself into an ever more potent and relevant force for lasting solutions to enhance the quality and value of U.S. health care in ways that will meet the future health needs of diverse populations. The report calls on nurses, individually and as a profession, to embrace changes needed to promote health, prevent illness, and care for people in all settings across the lifespan. The nursing profession cannot make these changes on its own, however. The report calls for multisector support and interprofessional collaboration. In this sense, it calls on all health professionals and health care decision makers to work with nurses to make the changes needed for a more accessible, cost-effective, and high-quality health care system.

Since its foundation 40 years ago, the IOM has produced many reports echoing the theme of high-quality, safe, effective, evidence-based, and patient-centered care. The present report expands on this theme by addressing the critical role of nursing. It demonstrates that achieving a successful health care system in the future rests on the future of nursing.


Harvey V. Fineberg, M.D., Ph.D.

President, Institute of Medicine

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. doi: 10.17226/12956.
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Preface

This report is being published at a time of great opportunity in health care. Legislation passed in March 2010 will provide insurance coverage for 32 million more Americans. The implications of this new demand on the nation’s health care system are significant. How can the system accommodate the increased demand while improving the quality of health care services provided to the American public?

Nursing represents the largest sector of the health professions, with more than 3 million registered nurses in the United States. The question presented to the committee that produced this report was: What roles can nursing assume to address the increasing demand for safe, high-quality, and effective health care services? In the near term, the new health care laws identify great challenges in the management of chronic conditions, primary care (including care coordination and transitional care), prevention and wellness, and the prevention of adverse events (such as hospital-acquired infections). The demand for better provision of mental health services, school health services, long-term care, and palliative care (including end-of-life care) is increasing as well. Whether improvements in all these areas of care will slow the rate of growth in health care expenditures remains to be seen; however, experts believe they will result in better health outcomes.

What nursing brings to the future is a steadfast commitment to patient care, improved safety and quality, and better outcomes. Most of the near-term challenges identified in the health care reform legislation speak to traditional and current strengths of the nursing profession in such areas as care coordination, health promotion, and quality improvement. How well nurses are trained and do their jobs is inextricably tied to most health care quality measures that have been

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. doi: 10.17226/12956.
×

targeted for improvement over the past few years. Thus for nursing, health care reform provides an opportunity for the profession to meet the demand for safe, high-quality, patient-centered, and equitable health care services. We believe nurses have key roles to play as team members and leaders for a reformed and better-integrated, patient-centered health care system.

This report begins with the assumption that nursing can fill such new and expanded roles in a redesigned health care system. To take advantage of these opportunities, however, nurses must be allowed to practice in accordance with their professional training, and the education they receive must better prepare them to deliver patient-centered, equitable, safe, high-quality health care services. Additionally, they must engage with physicians and other health care professionals to deliver efficient and effective care and assume leadership roles in the redesign of the health care system. In particular, we believe that preparation of an expanded workforce, necessary to serve the millions who will now have access to health insurance for the first time, will require changes in nursing scopes of practice, advances in the education of nurses across all levels, improvements in the practice of nursing across the continuum of care, transformation in the utilization of nurses across settings, and leadership at all levels so nurses can be deployed effectively and appropriately as partners in the health care team.

In 2008, the Robert Wood Johnson Foundation (RWJF) approached the Institute of Medicine (IOM) to propose a partnership between the two organizations to assess and respond to the need to transform the nursing profession to meet these challenges. The resulting collaborative partnership created a unique blend of organizational expertise and content expertise, drawing on the IOM’s mission to serve as adviser to the nation to improve health and RWJF’s longstanding commitment to ensuring that the nursing workforce has the necessary capacity, in terms of numbers, skills, and competence, to meet the present and future health care needs of the public. Recognizing that the nursing profession faces the challenges outlined above, RWJF and the IOM established a 2-year Initiative on the Future of Nursing. The cornerstone of the initiative is the work of this IOM committee. The Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine was tasked with producing a report containing recommendations for an action-oriented blueprint for the future of nursing, including changes in public and institutional policies at the national, state, and local levels. The specific charge to the committee is presented in Box P-1.

The committee held five meetings that included three technical workshops, which were designed to gather information on topics related to the study charge. In addition to these meetings, the committee hosted three public forums on the fu-

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Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. doi: 10.17226/12956.
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BOX P-1

Committee Charge

An ad hoc committee will examine the capacity of the nursing workforce to meet the demands of a reformed health care and public health system. It will develop a set of bold national recommendations, including ones that address the delivery of nursing services in a shortage environment and the capacity of the nursing education system. In its report, the committee will define a clear agenda and blueprint for action including changes in public and institutional policies at the national, state, and local levels. Its recommendations would address a range of system changes, including innovative ways to solve the nursing shortage in the United States.

The committee may examine and produce recommendations related to the following issues, with the goal of identifying vital roles for nurses in designing and implementing a more effective and efficient health care system:

  • Reconceptualizing the role of nurses within the context of the entire workforce, the shortage, societal issues, and current and future technology;

  • Expanding nursing faculty, increasing the capacity of nursing schools, and redesigning nursing education to assure that it can produce an adequate number of well-prepared nurses able to meet current and future health care demands;

  • Examining innovative solutions related to care delivery and health professional education by focusing on nursing and the delivery of nursing services; and

  • Attracting and retaining well-prepared nurses in multiple care settings, including acute, ambulatory, primary care, long-term care, community, and public health.

ture of nursing that focused on acute care; care in the community, with emphasis on community health, public health, primary care, and long-term care; and nursing education. Summaries of these forums have been published separately, are available at www.iom.edu/nursing, and are included on the CD-ROM in the back of this report. The committee also conducted a series of site visits in conjunction with each public forum to learn how nurses function in various health care and educational settings. In addition to the workshops, forums, and site visits, the committee collected testimony and welcomed public input throughout the study process, conducted a literature review, and commissioned a series of papers from a research network of esteemed colleagues.

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. doi: 10.17226/12956.
×

For this committee, the IOM assembled an extraordinary group of professionals, including experts from areas such as business, academia, health care delivery, and health policy. The team brought diverse perspectives to the table that went well outside the nursing profession. Most of the members did not have a degree in nursing and were not involved in nursing education, practice, research, or governance. We are grateful to these committee members and to the exceptionally talented staff of the IOM and RWJF, all of whom worked hard with enthusiasm, great skill, flexibility, clarity, and drive.


Donna E. Shalala, Ph.D., FAAN

Chair


Linda Burnes Bolton, Dr.P.H., R.N., FAAN

Vice Chair

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. doi: 10.17226/12956.
×

Acknowledgments

To begin, the committee would like to thank the sponsor of this study. Funds for the committee’s work were provided by the Robert Wood Johnson Foundation (RWJF).

Numerous individuals and organizations made important contributions to the study process and this report. The committee wishes to express its gratitude for each of these contributions, although space does not permit identifying all of them here. Appendix A lists the individuals who provided valuable information at the committee’s open workshops and its three forums on the future of nursing. In conjunction with each of the forums, the committee also visited several clinical sites to gather information on the role of nurses in various settings; these visits helped the committee understand the experiences of nurses and other health professionals and administrators. The committee greatly appreciates the time and information provided by all of these individuals.

The committee also gratefully acknowledges the contributions of the many individuals who provided data and research support. The RWJF Nursing Research Network, led by Lori Melichar and coordinated by Patricia (Polly) Pittman with the assistance of Emily Bass of AcademyHealth, created a series of research products that synthesized, translated, and disseminated information to inform the committee’s deliberations. Research products from this network were managed by Linda Aiken, University of Pennsylvania; Peter Buerhaus, Vanderbilt University; Christine Kovner, New York University; and Joanne Spetz, University of California, San Francisco.

The committee would like to thank as well the authors whose commissioned papers added to the evidence base for the study: Barbara L. Nichols, Catherine R. Davis, and Donna R. Richardson of the Commission on Graduates of Foreign

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. doi: 10.17226/12956.
×

Nursing Schools International; Barbara J. Safriet, Lewis and Clark Law School; Julie Sochalski, University of Pennsylvania School of Nursing, and Jonathan Weiner, Johns Hopkins University Bloomberg School of Public Health; Linda Cronenwett of the University of North Carolina at Chapel Hill School of Nursing, Christine A. Tanner of Oregon Health & Science University School of Nursing, Catherine L. Gilliss of Duke University School of Nursing, Kathleen Dracup of the University of California, San Francisco School of Nursing, Donald M. Berwick, Institute for Healthcare Improvement, Virginia Tilden, University of Nebraska Medical Center College of Nursing, and Linda H. Aiken of the University of Pennsylvania School of Nursing; and Linda Norlander, Group Health Home Care and Hospice. The committee also thanks the following fellows of the RWJF Executive Nurse Leadership Program: Susan Birch, Jody Chrastek, Erin Denholm, Karen Drenkard, Lynne M. Dunphy, Christina Esperat, Kathryn Fiandt, Jill Fuller, Catherine Garner, Mary Ellen Glasgow, Tine Hansen-Turton, Loretta Heuer, Cynda Hylton Rushton, Jane Kirschling, Richard C. MacIntyre, Rosalie O. Mainous, Gloria McNeal, Wanda Montalvo, Teri A. Murray, Mary E. Newell, Victoria Niederhauser, Suzanne Prevost, Maxine Proskurowski, Cynthia Teel, Donna Torrisi, and Marykay Vandriel.

Finally, the committee acknowledges the following individuals who provided additional data, reports, and support to the committee: Kathy Apple, National Council of State Boards of Nursing; William Baer and Lauren Peay, Arnold & Porter, LLP; Geraldine “Polly” Bednash and the staff of the American Association of Colleges of Nursing; Richard Blizzard, the Gallup Organization; Julie Dashiell, RWJF; Tine Hansen-Turton, National Nursing Center Consortium; Charlene Hanson, Georgia Southern University; Paul C. Light, New York University; Beverly Malone and the staff of the National League for Nursing; Diana Mason and Joy Jacobson, Hunter College, City University of New York; Mark B. McClellan, The Brookings Institution; Mary D. Naylor, University of Pennsyl-vania; Julienne M. Palbusa, The National Academies; Ciaran S. Phibbs, Veterans Affairs Medical Center; Deborah Sampson, Boston College School of Nursing; Shoshanna Sofaer, City University of New York; Kevin M. Stange, University of Michigan; and Ellen-Marie Whelan, Center for American Progress.

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Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. doi: 10.17226/12956.
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Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. doi: 10.17226/12956.
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Tables, Figures, and Boxes

TABLES

1-1

 

Types of Advanced Practice Registered Nurses (APRNs),

 

26

1-A1

 

Providers of Nursing Care: Numbers, Preparation/Training, and Roles,

 

43

1-A2

 

Pathways in Nursing Education,

 

44

3-1

 

Complexity of Evaluation and Management Services Provided Under Medicare Claims Data for 2000, by Practitioner Type,

 

90

3-2

 

Medicare Claims Payment Structure by Provider Type,

 

104

3-3

 

Plans Regarding Nursing Employment, by Graduation Cohort, 2008,

 

119

3-4

 

Changes in Position Setting, by 2007 Setting, for Registered Nurses Who Graduated in 2001–2008,

 

11

3-A1

 

State-by-State Regulatory Requirements for Physician Involvement in Care Provided by Nurse Practitioners,

 

157

4-1

 

Average Earnings of Full-Time RNs, by Highest Nursing or Nursing-Related Education and Job Title,

 

172

4-2

 

Years Between Completion of Initial and Highest RN Degrees,

 

187

4-3

 

Average Annual Earnings of Nurses Who Work Full Time as Faculty in Their Principal Nursing Position, 2008,

 

187

4-4

 

Average Earnings by Job Title of Principal Position for Nurses Working Full Time,

 

188

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. doi: 10.17226/12956.
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4-5

 

Estimated Distribution of Master’s and Doctoral Degrees as Highest Nursing or Nursing-Related Educational Preparation, 2000–2008,

 

19

E-1

 

Demographic and Educational Characteristics of Registered Nurses, by Age,

 

370

J-1

 

NCLEX Examination Statistics, 2007,

 

575

J-2

 

Titles of Nursing Personnel from Select Countries,

 

577

J-3

 

Historic Suppliers of Registered Nurses to the U.S. Workforce,

 

608

J-4

 

Emerging Suppliers of Registered Nurses to the U.S. Workforce,

 

621

FIGURES

1-1

 

Employment settings of registered nurses,

 

24

1-2

 

Employment settings of RNs, by highest nursing or nursing-related education,

 

25

3-1

 

Map of the number of NPs per primary care MD by county, 2009,

 

89

3-2

 

Map of the number of physician assistants per primary care MD by county, 2009,

 

89

3-3

 

Requirements for physician–nurse collaboration, by state, as a barrier to access to primary care,

 

99

3-4

 

Physician opinions about the impact of allowing nurse practitioners to practice independently,

 

113

3-5

 

Patient satisfaction with retail-based health clinics,

 

113

3-6

 

Reasons cited for not working in nursing, by age group,

 

118

3-7

 

Age distribution of registered nurses, 1980–2008,

 

12

3-8

 

Average age of nurses at various levels of education and of MDs,

 

127

3-9

 

Distribution of registered nurses and the U.S. population by racial/ethnic background,

 

129

4-1

 

Trends in graduations from basic RN programs, by type, 2002–2008,

 

16

4-2

 

Highest nursing or nursing-related education by urban/rural residence,

 

178

4-3

 

Distance between nursing education program and workplace for early-career nurses (graduated 2007–2008),

 

17

4-4

 

Numbers of qualified applicants not accepted in ADN and BSN programs,

 

182

4-5

 

Age distribution of nurses who work as faculty,

 

183

Suggested Citation:"Front Matter." Institute of Medicine. 2011. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press. doi: 10.17226/12956.
×

4-6

 

Distribution of the registered nurse population by highest nursing or nursing-related educational preparation,

 

1980–2008, 18

4-7

 

Growth trends in different nursing programs,

 

196

4-8

 

Percentage of minority students enrolled in nursing programs by race/ethnicity and program type, 2008–2009,

 

20

5-1

 

Opinion leaders’ predictions of the amount of influence nurses will have on health care reform,

 

240

5-2

 

Opinion leaders’ views on the amount of influence nurses should have on various areas of health care,

 

241

6-1

 

Forecast supply of and demand for full-time equivalent (FTE) RNs, 2009–2030,

 

25

6-2

 

Trends in new licenses, U.S.- and foreign-educated RNs, 2002–2008,

 

26

6-3

 

Factors to consider when assessing the health care workforce supply,

 

263

6-4

 

Factors to consider when assessing health care workforce demand,

 

263

D-1

 

APRN Regulatory Model,

 

333

D-2

 

Relationship Among Educational Competencies, Licensure, & Certification in the Role/Population Foci and Education and Credentialing in a Specialty,

 

339

F-1

 

RN-to-population ratio, 1980–2008,

 

38

F-2

 

Geographic variation in rates of hospital-based RNs per 1,000 population (2006),

 

388

BOXES

P-1

 

Committee Charge,

 

xiii

S-1

 

Committee Charge,

 

3

2-1

 

Case Study: When Patients and Families Call a Code,

 

52

2-2

 

Case Study: Nurse Midwives and Birth Centers,

 

56

2-3

 

Nurse Profile: Carolina Sandoval,

 

60

2-4

 

Nurse Profile: Lisa Ayers,

 

62

2-5

 

Case Study: Living Independently for Elders (LIFE),

 

68

2-6

 

Case Study: The Transitional Care Model,

 

70

2-7

 

Case Study: The Nurse–Family Partnership,

 

73

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3-1

 

Variation in State Licensure Regulations,

 

100

3-2

 

Case Study: Advanced Practice Registered Nurses,

 

108

3-3

 

Case Study: The Patient-Centered Medical Home,

 

134

3-4

 

Case Study: 11th Street Family Health Services of Drexel University,

 

138

3-5

 

Case Study: Technology at Cedars-Sinai Medical Center,

 

146

4-1

 

Costs of Health Professional Education,

 

169

4-2

 

Case Study: The Oregon Consortium for Nursing Education (OCNE),

 

174

4-3

 

Case Study: Community Colleges Offering the BSN,

 

180

4-4

 

Nurse Profile: Jennifer Wenzel*,

 

184

4-5

 

Case Study: The Dedicated Education Unit,

 

192

4-6

 

Case Study: Nursing for Life—The RN Career Transition Program,

 

204

5-1

 

Results of Gallup Poll “Nursing Leadership from Bedside to Boardroom: Opinion Leaders’ Perceptions,”

 

224

5-2

 

Case Study: Arkansas Aging Initiative,

 

226

5-3

 

Nurse Profile: Connie Hill,

 

230

5-4

 

Nurse Profile: Kenya D. Haney and Billy A. Caceres,

 

232

5-5

 

Nurse Profile: Mary Ann Christopher,

 

236

5-6

 

Case Study: Prescription for Pennsylvania,

 

248

7-1

 

Research Priorities for Transforming Nursing Practice,

 

274

7-2

 

Research Priorities for Transforming Nursing Education,

 

276

7-3

 

Research Priorities for Transforming Nursing Leadership,

 

277

A-1

 

Technical Workshop #1,

 

292

A-2

 

Technical Workshop #2,

 

293

A-3

 

Technical Workshop #3,

 

294

A-4

 

Forum on the Future of Nursing: Acute Care,

 

295

A-5

 

Forum on the Future of Nursing: Care in the Community,

 

296

A-6

 

Forum on the Future of Nursing: Education,

 

298

A-7

 

Testimony Questions for the Forum on the Future of Nursing: Acute Care,

 

300

A-8

 

Testimony Questions for the Forum on the Future of Nursing: Care in the Community,

 

302

A-9

 

Testimony Questions for the Forum on the Future of Nursing: Education,

 

304

*

This nurse profile was inadvertently omitted from the prepublication version of this report.

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F-1

 

RN Ambulatory Care Workforce,

 

383

F-2

 

Processes and Policy Initiatives Producing Health Care Workforce Skill Mix Changes,

 

393

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Acronyms and Abbreviations*

AACN American Association of Colleges of Nursing

AAI Arkansas Aging Initiative

AAMC Association of American Medical Colleges

AARP American Association of Retired Persons

ACA Affordable Care Act

ACO accountable care organization

ADN associate’s degree in nursing

AIDS acquired immune deficiency syndrome

AMA American Medical Association

ANA American Nurses Association

ANCC American Nurses Credentialing Center

AONE American Organization of Nurse Executives

APRN advanced practice registered nurse

ARRA American Recovery and Reinvestment Act

BSN bachelor’s of science in nursing

CBO Congressional Budget Office

CCNE Commission on Collegiate Nursing Education

CHC community health center

CMA California Medical Association

CMS Centers for Medicare and Medicaid Services

*

The acronyms and abbreviations used in the Summary and Chapters 17 appear in this list.

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CNA certified nursing assistant

CNL clinical nurse leader

CNM certified nurse midwife

CNO chief nursing officer

CNS clinical nurse specialist

CRNA certified registered nurse anesthetist

CSA California Society of Anesthesiologists

DEU dedicated education unit

DNP doctor of nursing practice

DRG diagnosis-related group

EHR electronic health record

FHBC Family Health and Birth Center

FQHC federally qualified health center

FTC Federal Trade Commission

FTE full-time equivalent

GAO Government Accountability Office

GCHSSC Gulf Coast Health Services Steering Committee

HealthSTAT Health Students Taking Action Together

HEET Hospital Employee Education and Training

HHS Health and Human Services

HIT health information technology

HIV human immunodeficiency virus

HNC Harambee Nursing Center

HRSA Health Resources and Services Administration

ICU Intensive Care Unit

IHI Institute for Healthcare Improvement

INLP Integrated Nurse Leadership Program

INQRI Interdisciplinary Nursing Quality Research Initiative

IOM Institute of Medicine

LIFE Living Independently for Elders

LPN/LVN licensed practical nurse/licensed vocational nurse

MD medical doctor

MedPAC Medicare Payment Advisory Commission

MSN master’s of science in nursing

Page xxvii Cite
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NA nursing assistant

NAQC Nursing Alliance for Quality Care

NASN National Association of School Nurses

NCEMNA National Coalition of Ethnic Minority Nurse Associations

NCLEX-RN National Council Licensure Examination for Registered Nurses

NCQA National Committee for Quality Assurance

NCSBN National Council of State Boards of Nursing

NFP Nurse–Family Partnership

NHIT national health care information technology

NHWC National Health Workforce Commission

NLN National League for Nursing

NMHC nurse-managed health clinic

NNCC National Nursing Centers Consortium

NP nurse practitioner

NQF National Quality Forum

NRN Nursing Research Network

NSNA National Student Nurses Association

NSSRN National Sample Survey of Registered Nurses

OCNE Oregon Consortium for Nursing Education

OHSU Oregon Health and Science University

OPM Office of Personnel Management

PACE Program of All-Inclusive Care for the Elderly

PCMH Patient-Centered Medical Home™

PhD doctor of philosophy

RN registered nurse

RWJF Robert Wood Johnson Foundation

SAMHSA Substance Abuse and Mental Health Services Administration

SEIU Service Employees International Union

SOPP Scope of Practice Partnership

TCAB Transforming Care at the Bedside

TCM Transitional Care Model

TIGER Technology Informatics Guiding Education Reform

TWU Texas Woman’s University

UAMS University of Arkansas for Medical Sciences

UHC University HealthSystem Consortium

UP University of Portland

UPMC University of Pittsburgh Medical Center

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USF University of South Florida

UTH University of Texas Health Science Center at Houston School of Nursing

VA Department of Veterans Affairs

VANA Veterans Affairs Nursing Academy

VNACJ Visiting Nurse Association of Central Jersey

VNSNY Visiting Nurse Service of New York

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The Future of Nursing: Leading Change, Advancing Health Get This Book
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The Future of Nursing explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system.

At more than 3 million in number, nurses make up the single largest segment of the health care work force. They also spend the greatest amount of time in delivering patient care as a profession. Nurses therefore have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care as envisioned in the Affordable Care Act (ACA) enacted this year.

Nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States. To ensure its members are well-prepared, the profession should institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates. Furthermore, regulatory and institutional obstacles -- including limits on 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.

In this book, the Institute of Medicine makes recommendations for an action-oriented blueprint for the future of nursing.

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