ASSESSING PROGRESS on the
Institute of Medicine Report
THE FUTURE OF NURSING
Committee for Assessing Progress on Implementing the
Recommendations of the Institute of Medicine Report
The Future of Nursing: Leading Change, Advancing Health
Stuart H. Altman, Adrienne Stith Butler, Lauren Shern, Editors
Institute of Medicine
THE NATIONAL ACADEMIES PRESS
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This study was supported by Contract/Grant No. 72309 from the Robert Wood Johnson Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2016. Assessing Progress on the Institute of Medicine Report The Future of Nursing. Washington, DC: The National Academies Press.
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COMMITTEE FOR ASSESSING PROGRESS ON
IMPLEMENTING THE RECOMMENDATIONS OF THE
INSTITUTE OF MEDICINE REPORT
THE FUTURE OF NURSING:
LEADING CHANGE, ADVANCING HEALTH
STUART H. ALTMAN (Chair), Sol C. Chaikin Professor of National Health Policy, Heller Graduate School of Social Policy, Brandeis University, Weston, Massachusetts
CARMEN ALVAREZ, Assistant Professor, Department of Community-Public Health, Johns Hopkins University School of Nursing, Baltimore, Maryland
CYNTHIA C. BARGINERE, Senior Vice President and Chief Operating Officer, Rush University Hospital, Chicago, Illinois
RICHARD A. BERMAN, Interim Director, Patel College of Global Sustainability; Visiting Professor of Social Entrepreneurship, Muma College of Business; Professor, Institute for Advanced Discovery and Innovation, University of South Florida, Tampa
KAREN DONELAN, Senior Scientist in Health Policy, Mongan Institute for Health Policy, Massachusetts General Hospital, and Associate Professor of Medicine, Harvard Medical School, Boston, Massachusetts
SUZANNE FFOLKES, Vice President of Communications, Research!America, Alexandria, Virginia
PAULA GUBRUD, Associate Professor, Oregon Health & Science University School of Nursing, Portland
JACK NEEDLEMAN, Professor and Chair, Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
MICHELE J. ORZA, Senior Advisor to the Executive Director, Patient-Centered Outcomes Research Institute, Washington, DC
ROBERT L. PHILLIPS, JR., Vice President for Research and Policy, American Board of Family Medicine, Washington, DC
EDWARD SALSBERG, Director, Health Workforce Studies, George Washington University Health Workforce Institute and School of Nursing, Washington, DC
GEORGE E. THIBAULT, President, Josiah Macy Jr. Foundation, New York, New York
ADRIENNE STITH BUTLER, Senior Program Officer
LAUREN SHERN, Program Officer
THELMA COX, Administrative Assistant
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. 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:
David Auerbach, Massachusetts Health Policy Commission
Elizabeth H. Bradley, Yale School of Public Health
Patrick H. DeLeon, Uniformed Services University of the Health Sciences
Catherine Dower, Kaiser Permanente
Kathleen Gallo, North Shore–Long Island Jewish Health System
Ann Hubbard, Indian River State College
Judith R. Kunisch, Yale School of Nursing
Salimah H. Meghani, University of Pennsylvania School of Nursing
Wayne J. Riley, Vanderbilt University
John W. Rowe, Columbia University Mailman School of Public Health
William M. Sage, University of Texas at Austin
Richard Sorian, FleishmanHillard
Antonia M. Villarruel, University of Pennsylvania School of Nursing
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the report’s conclusions or
recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by Bobbie Berkowitz, Columbia University School of Nursing and Columbia University Medical Center, and Mark R. Cullen, Stanford University. 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.
In 2010, the Institute of Medicine (IOM) released a landmark report titled The Future of Nursing: Leading Change, Advancing Health. In the preface to the report, the chair and vice chair of the committee, Donna Shalala and Linda Burnes Bolton, stated that the passage of the Patient Protection and Affordable Care Act, also in 2010, would require that the U.S. health care system expand to accommodate a significant increase in demand for services, particularly those needed to manage patients with chronic conditions or mental health conditions or to provide basic primary care. They noted that nurses were in a unique position to take on a leadership role in helping the nation attain these goals. They stated that “nurses have a key role to play as team members and leaders for a reformed and better integrated patient-centered health care system.”
The Future of Nursing was sponsored by the Robert Wood Johnson Foundation (RWJF), and senior staff of RWJF helped the IOM gather material for the 2-year study. Following the publication of the report, RWJF supported the creation of the Future of Nursing: Campaign for Action (the Campaign) and its 51 state Action Coalitions. The efforts of outside groups devoted to the implementation of the IOM report’s recommendations have been extraordinary.
It has now been 5 years since The Future of Nursing was issued, and RWJF asked the IOM to assess the progress made toward implementing the report’s recommendations and to identify areas that should be emphasized over the next 5 years to help the Campaign fulfill the recommendations. The committee convened to carry out this study was not asked to reexamine the merits of or amend the recommendations of The Future of Nursing. I was delighted when the new president of the now National Academy of Medicine, Dr. Victor Dzau, asked me
to chair the committee and take on this task. The field of nursing has been of special interest to me since I published my first book—Present and Future Supply of Registered Nurses—in the early 1970s. After reviewing The Future of Nursing and analyzing the information collected as part of the present study, it is clear to me that the nursing profession is a far more important component of the U.S. health care system than it was 45 years ago.
The committee conducted three public workshops and met as a group four times. In addition, it held three full-committee and several smaller subcommittee phone meetings. I am especially appreciative of the time commitment and pursuit of excellence of the 11 other members of our committee. Without their expertise, their experience, and their knowledge of the information that could be used to assess the changes that have occurred in the health care system, this report could not have been completed. We also are indebted to the staff of RWJF for their help in assembling this information. We appreciate as well the efforts of the three IOM staff members and the consultant writer who guided us through the study and the writing of this report. In particular, the dedication and drive of our study director, Adrienne Stith Butler, were irreplaceable.
Clearly much has been accomplished by the Campaign and other stakeholders, and it is readily apparent that The Future of Nursing was a catalyst for a number of new activities and accelerated several trends that had begun before the report was completed. The present report is timely in that it allows for reflection on the progress that has been achieved over the past 5 years in implementing the recommendations of The Future of Nursing, while leaving time for the Campaign and others to adjust to the many changes occurring in nursing and the health care system. The committee worked diligently over a short period of time to assemble and review the available data and evidence to help in understanding the changes that have occurred in the field of nursing—the structure of its education system, who is entering the field and in which programs, where nurses are employed, the attitudes of others about the appropriate role of nurses, and, where possible, how the expanded use of nurses has impacted the quality of patient care. With the help of this assessment, the committee generated a number of recommendations, which we hope will assist the Campaign, its state Action Coalitions, and other groups and stakeholders in positively impacting the field of nursing and improving the U.S. health care system.
Stuart H. Altman, Chair
Committee for Assessing Progress on
Implementing the Recommendations of the
Institute of Medicine Report
The Future of Nursing: Leading Change, Advancing Health
Many individuals and organizations made important contributions to the study committee’s process and to this report. The committee wishes to thank these individuals, but recognizes that attempts to identify all of them and to acknowledge their contributions would require more space than is available in this brief section.
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. The committee also gratefully acknowledges the contributions of the many individuals and organizations that assisted in the conduct of the study. Their perspectives were valuable in understanding the work undertaken to implement the recommendations from the Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health. The committee thanks those individuals who provided important presentations and oral testimony at its open workshops. Appendix A lists these individuals and their affiliations. Written testimony received from nearly 100 individuals and organizations also helped the committee understand the status of implementation of the recommendations. The committee is grateful for the time, effort, and valuable information provided by all of these dedicated individuals and organizations. We are immensely grateful for the organizations that provided the committee with data and other inputs: the Accreditation Commission for Education in Nursing (ACEN), the American Association of Colleges of Nursing (AACN), the Center to Champion Nursing in America (CCNA), the Commission on Collegiate Nursing Education (CCNE),
the National League for Nursing (NLN), the Robert Wood Johnson Foundation (RWJF), and TCC Group.
Finally, many within the National Academies of Sciences, Engineering, and Medicine were helpful to the study staff. We would like to thank Clyde Behney, Laura DeStefano, Chelsea Frakes, Greta Gorman, Nicole Joy, Ellen Kimmel, Fariha Mahmud, Rebecca Morgan, Bettina Ritter, Jennifer Walsh, and Colleen Willis for their invaluable assistance.
|AACN||American Association of Colleges of Nursing|
|AAMC||Association of American Medical Colleges|
|AANP||American Association of Nurse Practitioners|
|ACA||Patient Protection and Affordable Care Act|
|ACCME||Accreditation Council for Continuing Medical Education|
|ACEN||Accreditation Commission for Education in Nursing|
|ACP||American College of Physicians|
|ACPE||Accreditation Council for Pharmacy Education|
|ACS||American Community Survey|
|ADN||associate degree in nursing|
|AMA||American Medical Association|
|ANA||American Nurses Association|
|ANCC||American Nurses Credentialing Center|
|AONE||American Organization of Nurse Executives|
|APIN||Academic Progression in Nursing|
|APRN||advanced practice registered nurse|
|ARRA||American Recovery and Reinvestment Act|
|BSN||bachelor of science in nursing|
|Campaign||Future of Nursing: Campaign for Action|
|CCNA||Center to Champion Nursing in America|
|CCNE||Commission on Collegiate Nursing Education|
|CDC||Centers for Disease Control and Prevention|
|CHC||Community Health Center, Inc.|
|CMA||California Medical Association|
|CMMI||Center for Medicare & Medicaid Innovation|
|CMS||Centers for Medicare & Medicaid Services|
|CNM||certified nurse midwife|
|CNO||chief nursing officer|
|CPS||Current Population Survey|
|CRNA||certified registered nurse anesthetist|
|DNP||doctor of nursing practice|
|FQHC||federally qualified health center|
|FTC||Federal Trade Commission|
|GNE||(Medicare) Graduate Nursing Education|
|HPAC||Health Professions Accreditors Collaborative|
|HRSA||Health Resources and Services Administration|
|INQRI||Interdisciplinary Nursing Quality Research Initiative|
|IOM||Institute of Medicine|
|IPEC||Interprofessional Education Collaborative|
|IPEDS||Integrated Postsecondary Education Data System|
|LPN||licensed practical nurse|
|LVN||licensed vocational nurse|
|MDS||Minimum Data Set|
|MSN||master of science in nursing|
|NAMCS||National Ambulatory Medical Care Survey|
|NCES||National Center for Education Statistics|
|NCIN||New Careers in Nursing|
|NCIPE||National Center for Interprofessional Practice and Education|
|NCLEX||National Council Licensure Examination|
|NCSBN||National Council of State Boards of Nursing|
|NHIS||National Health Interview Survey|
|NLN||National League for Nursing|
|NMHC||nurse-managed health clinic|
|NMNEC||New Mexico Nursing Education Consortium|
|NPI||National Provider Identifier|
|NSSNP||National Sample Survey of Nurse Practitioners|
|NSSRN||National Sample Survey of Registered Nurses|
|OHSU||Oregon Health & Science University|
|PIN||Partners Investing in Nursing’s Future|
|RWJF||Robert Wood Johnson Foundation|
|SIP||State Implementation Program|
|SOC||Standard Occupational Classification|
|UHC||University HealthSystem Consortium|
|VA||U.S. Department of Veterans Affairs|
|VHA||Veterans Health Administration|