Nurses make up the largest segment of the health care profession; there are approximately 3 million registered nurses in the United States. Nurses work in a wide variety of settings, including hospitals, public health centers, schools, and homes, and provide a continuum of services involving direct patient care, health promotion, patient education, and coordination of care. They serve in leadership roles, are researchers, and work to improve health care policy. As the health care system undergoes transformation, in part as a result of the Patient Protection and Affordable Care Act, the nursing profession is having a wide-ranging impact by providing patient-centered, accessible, and affordable care. In 2010, the Institute of Medicine released The Future of Nursing: Leading Change, Advancing Health, offering recommendations for nursing in the new health care landscape. The present report assesses progress made toward implementing those recommendations. This report also identifies areas that should be emphasized over the next 5 years to advance the recommendations’ implementation. The 10 recommendations offered in the present report are intended to help the Future of Nursing: Campaign for Action and the nursing profession effect change in the culture in which health care is provided by addressing scope of practice, education, collaborative leadership, and diversity in the nursing profession and improving the collection of nursing workforce data.
In the past decade, the changing climate of health care policy and practice has sharpened the national focus on the challenges of providing high-quality and affordable care to an aging and increasingly diverse population. The priorities of this changed climate will increasingly require the collaboration of health profes-
1 This summary does not include references. Citations for the discussion presented in the summary appear in the subsequent report chapters.
Key Areas Addressed by Recommendations from
The Future of Nursing: Leading Change, Advancing Health
- Remove scope-of-practice barriers.
- Expand opportunities for nurses to lead and diffuse collaborative improvement efforts.
- Implement nurse residency programs.
- Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020.
- Double the number of nurses with a doctorate by 2020.
- Ensure that nurses engage in lifelong learning.
- Prepare and enable nurses to lead change to advance health.
- Build an infrastructure for the collection and analysis of interprofessional health care workforce data.
sionals to provide patient-centered, coordinated, and community-based primary and specialty care services. Nurses, who are the largest group of health care professionals, are positioned to lead and partner in teams that provide services across the continuum of care (hospitals, ambulatory care, public health, schools, long-term care, and home health). Nurses also are positioned to provide leadership within a variety of health care systems and policy settings.
In 2008, the Robert Wood Johnson Foundation (RWJF) partnered with the Institute of Medicine (IOM) to establish an Initiative on the Future of Nursing, which convened a committee that in 2010 released the report The Future of Nursing: Leading Change, Advancing Health. This report offers a series of recommendations to advance nursing’s contributions to the new health care environment (see boxs-1 Box S-1). Shortly after release of the report, AARP and RWJF launched the Future of Nursing: Campaign for Action (the Campaign) to shepherd the implementation of the report’s recommendations. The Campaign, coordinated through the Center to Champion Nursing in America (CCNA), works nationally and through state Action Coalitions to advance its goals. The Campaign’s efforts target six major areas, or “pillars”:
- advancing education transformation,
- leveraging nursing leadership,
- removing barriers to practice and care,
- fostering interprofessional collaboration,
- promoting diversity, and
- bolstering workforce data.
Reports released by many other organizations (for example, the World Health Organization, the Carnegie Foundation, and the Tri-Council for Nursing) contemporaneously with The Future of Nursing call for similar changes. The Future of Nursing lent momentum to a movement that was under way, offering tangible and specific recommendations.
STUDY CHARGE AND APPROACH
In 2014, RWJF asked the IOM to convene a committee to assess progress made on implementing the recommendations of The Future of Nursing and identify areas that should be emphasized over the next 5 years to help the Campaign fulfill its aims. The committee considered the utilization of the report by the Campaign and other groups, the impact of the Campaign on areas peripheral to nursing, and the Campaign’s use of traditional and new media in meeting its goals. The present report, the product of these efforts, is based, in part, on three workshops organized by the committee that focused on practice, education, leadership, diversity, collaboration, and health workforce data.
The committee’s task did not include reexamining the merits of the recommendations of The Future of Nursing. Given the short time since the release of that report, the committee did not perform a comprehensive evaluation of the impact of the report’s recommendations or of the Campaign, but instead focused on progress achieved on the report’s goals. Further, the committee did not attribute progress or the lack thereof in areas of the report’s recommendations directly to the report or to the Campaign, recognizing that other factors were at play in the environment. The committee examined how the current context of health care delivery, nursing education, and practice could affect implementation of the report’s recommendations and identified barriers to and unintended consequences of their implementation. The committee also considered how the recommendations might yet be advanced.
The Future of Nursing was produced at a propitious moment in health care in the United States, a time of growing awareness that dramatic changes in the care delivery system were needed to accomplish the “Triple Aim” of better patient experience, better health of the public, and lower costs. The committee that developed the report anticipated that passage of the Patient Protection and Affordable Care Act (ACA) would necessitate that nurses play a larger role in bridging the gap between coverage and access. New delivery models emphasize teamwork, care coordination for specialty care and chronic disease management, prevention, and greater focus on population health and community-based care. New payment models are moving away from fee-for-service and episodic payment to value-based payment. Rapid advances in information technology are changing
the way health professionals and the public receive information and communicate with one another. Greater attention to preparing the health care workforce to meet growing and evolving needs has led to more emphasis on interprofessional education, teamwork training, and a better understanding of the roles of all health professionals in creating an optimal health care delivery system. While the committee that developed The Future of Nursing anticipated many of these changes, it could not have foreseen exactly how they would play out.
STUDY FINDINGS AND RECOMMENDATIONS
The present report’s recommendations are intended to help the Campaign, as well as policy makers, payers, and health professions organizations, make further progress toward implementing the recommendations of The Future of Nursing. The committee found that the Campaign has made significant progress in many aspects of this effort. In a short period of time, it has galvanized the nursing community through its work at the national level and through the 51 state Action Coalitions it has organized. The committee found that the Campaign has met or exceeded expectations in many areas. However, given the changing health care culture, particularly the increasing importance placed on interprofessional collaboration, the Campaign needs to engage a broader network of stakeholders. The present report also recommends addressing challenges in the areas of scope of practice, education, diversity, collaboration, leadership, and data. The committee believes these contributions can change the impact of nurses on the health care system and on patient care and outcomes.
In the committee’s view, the work of the Campaign and others would best be advanced if it were driven by the following three themes:
- the need to build a broader coalition to increase awareness of nurses’ ability to play a full role in health professions practice, education, collaboration, and leadership;
- the need to continue to make promoting diversity in the nursing workforce a priority; and
- the need for better data with which to assess and drive progress.
The committee hopes that, taken together, the 10 recommendations presented in this report provide a blueprint for advancing implementation of the recommendations of The Future of Nursing.
Removing Scope-of-Practice Barriers
The Future of Nursing proposes that advanced practice registered nurses (APRNs) could help build the workforce necessary to meet the country’s health care needs if permitted to practice to the full extent of their education and training.
In 2010, 13 states were classified as meeting criteria for full practice authority. Since then, 8 more states (Connecticut, Maryland, Minnesota, Nebraska, Nevada, North Dakota, Rhode Island, and Vermont) have changed their laws to give nurse practitioners (NPs) full practice and prescriptive authority. As of this writing, 17 states are categorized as having reduced practice authority and 12 as having restricted practice authority. Some states—for example, Kentucky, New York, Texas, and Utah—have made incremental improvements to their laws but are still categorized as having reduced or restricted practice authority for APRNs. These broad categorizations, while useful for classification purposes, mask a number of subtle differences among state laws. For example, Maine, a state with full practice authority, has legislative prohibitions against NP hospital privileges.
At the federal level, the Centers for Medicare & Medicaid Services in 2012 issued a final rule broadening the concept of medical staff, permitting hospitals to allow other practitioners (e.g., APRNs, physician assistants, and pharmacists) to perform all functions within their scope of practice. Despite this rule, medical staff membership and hospital privileges remain subject to existing state laws and business preferences. The Federal Trade Commission has engaged in competition advocacy for APRNs’ scope of practice in many states, providing letters, comments, and/or testimony.
While there has been on-the-ground collaboration between medicine and nursing, opposition by some physicians and physician organizations has been noted as a barrier to expansion of APRNs’ scope of practice. The health care environment continues to evolve and demand greater team-based and value-based care. There is growing evidence that new models of practice in which all health professionals practice to the full extent of their education and training offer greater efficiency and quality of services. Several studies have shown, moreover, that these care models enhance satisfaction among health care providers. This is an important contextual change since the release of The Future of Nursing, one that offers potential common ground for that report’s goals regarding scope-of-practice expansion.
Recommendation 1: Build Common Ground Around Scope of Practice and Other Issues in Policy and Practice. The Future of Nursing: Campaign for Action (the Campaign) should broaden its coalition to include more diverse stakeholders. The Campaign should build on its successes and work with other health professions groups, policy makers, and the community to build common ground around removing scope-of-practice restrictions, increasing interprofessional collaboration, and addressing other issues to improve health care practice in the interest of patients.
Achieving Higher Levels of Education
According to The Future of Nursing, transformation in the health care system and practice environments requires a corresponding transformation in nursing education. If nurses are to be prepared to meet increasingly complex patient needs, function as leaders, and advance the science of care, they need to achieve higher levels of education upon entering the workforce and throughout their careers.
In 2010, approximately half of the nation’s 3 million nurses held a baccalaureate or higher degree. The Future of Nursing recommends that this proportion be increased, suggesting an ambitious goal of 80 percent by 2020.
Baccalaureate program enrollment has increased substantially since 2010: entry-level baccalaureate enrollment increased from 147,935 in 2010 to 172,794 in 2014; accelerated baccalaureate enrollment increased from 13,605 to 16,935; and baccalaureate completion enrollment (so-called RN [registered nurse] to bachelor of science in nursing [BSN]) increased from 77,259 to 130,345.
The number of nursing programs, particularly 4-year college programs, grew significantly over the past decade. There is also an increasing preference for hiring BSNs; however, a majority of employers do not require a BSN. The increase in the quantity of baccalaureate programs is commendable; however, attention to the educational quality of these programs is essential to ensure that nurses—and patients—are reaping the assumed benefits of the additional education. The committee is concerned that the funding for nursing education has been relatively flat for the past decade, creating logistical problems for students (e.g., taking time away from work to pursue education) that are identified as barriers to obtaining a baccalaureate degree.
Transition-to-Practice Residency Programs
The Future of Nursing notes a high turnover rate among newly graduated nurses; some nurses leave their first job for a different care setting, but some leave the profession entirely. The report recommends that nurses be supported in their transition to practice through residency programs to help reduce attrition. The Future of Nursing focuses largely on residencies for postlicensure RNs but acknowledges that residencies would be useful for nurses transitioning to new care settings or entering practice as APRNs.
In 2011, the National Council of State Boards of Nursing (NCSBN) began to study transition-to-practice models for new nurse graduates in hospitals as well as in long-term care, home health, and other settings.
Transition-to-practice residencies appear to have some positive outcomes, including improved ability to organize, manage, and communicate, as well as
higher retention. These residencies vary considerably, and comprehensive data are sparse. It is difficult to gauge growth in programs overall, within particular settings, and for nurses of different educational levels. Despite their positive benefits, cost and a lack of data on the value of these programs remain barriers to broader implementation. This committee believes that residencies for both RNs and APRNs are beneficial and need to be encouraged, and that attention to residency programs for outpatient care is insufficient.
The small number of doctorate-trained nurses, who are needed to teach, perform research, and serve as leaders in clinical practice and health policy, remains a substantial barrier. In 2010, fewer than 1 percent of nurses held a doctoral degree. The Future of Nursing recommends doubling this number by 2020, but is not specific about types of doctoral programs (doctor of nursing practice [DNP], PhD in nursing, PhD in another field). Because doctoral degrees typically take years to complete, the committee was unable to assess progress on this recommendation.
Since fall 2010, enrollment in DNP programs has more than doubled, from 7,034 to 18,352 students (a 161 percent increase). Meanwhile, enrollment in PhD programs has increased by 15 percent over the past 5 years, with 5,290 students now pursuing the research-focused doctorate. An assessment of the mix of doctorally prepared nurses is needed, and more emphasis on PhD program expansion, incentives for nurses to return to school, and more scholarships for baccalaureate-to-PhD programs is warranted.
Many schools need more faculty, especially nurses with doctorates, to increase enrollment at all levels. Barriers cited to meeting this challenge include insufficient faculty expansion and funding, faculty recruiting difficulty, and the limited number of doctorally prepared nurses.
After nurses obtain their degrees, lifelong learning is necessary to provide quality care. Continuing education and competence have not kept pace with the needs of the increasingly complex, team-based health care system. Nurses and other providers will increasingly need to update skills for providing care in both hospital and community-based settings. One obstacle to progress on this recommendation of The Future of Nursing is a lack of data on continuing education for nurses, as well as on whether nurse certification and credentialing lead to better patient outcomes. Greater understanding of the impact of nurse certification and credentialing has implications not only for advancing lifelong learning but also for scope of practice and care delivery and for collaboration and leadership to improve the design of the health care system and care delivery.
Recommendation 2: Continue Pathways Toward Increasing the Percentage of Nurses with a Baccalaureate Degree. The Campaign, the nursing education community, and state systems of higher education should continue efforts aimed at strengthening academic pathways for nurses toward the baccalaureate degree—both entry-level baccalaureate and baccalaureate completion programs.
- Efforts to expand and encourage partnerships between community colleges and 4-year universities, as well as other models for establishing these pathways, should continue to be promulgated. Employers play a critical role in promoting educational progression and should be encouraged to provide financial and logistical support for employees pursuing a baccalaureate degree.
- In addition, the quality of new programs should be monitored to ensure consistency in effective educational practices and to ensure the ability of nursing graduates to qualify to attend other accredited schools as they pursue advanced studies. This monitoring could be conducted through a national accrediting body such as the Commission on Collegiate Nursing Education or the American Commission for Education in Nursing.
Recommendation 3: Create and Fund Transition-to-Practice Residency Programs. The Campaign, in coordination with health care providers, health care delivery organizations, and payers, should lead efforts to explore ways of creating and funding transition-to-practice residency programs at both the registered nurse and advanced practice registered nurse levels. Such programs are needed in all practice settings, including community-based practices and long-term care. These efforts should include determining the most appropriate program models; setting standards for programs; exploring funding and business case models; and creating an overarching structure with which to track and evaluate the quality, effectiveness, and impact of transition-to-practice programs. With respect to funding models,
- government agencies, philanthropic organizations, and foundations should support these programs on a temporary basis to help better understand how the programs should be designed; and
- health care organizations should support these programs on a permanent basis as they can be beneficial in the evolving value-based payment system.
Recommendation 4: Promote Nurses’ Pursuit of Doctoral Degrees. The Campaign should make efforts, through incentives and expansion of programs, to promote nurses’ pursuit of both the doctor of nursing practice (DNP) and PhD degrees so as to have an adequate supply of
nurses for clinical care, research, faculty, and leadership positions. More emphasis should be placed on increasing the number of PhD nurses in particular. To maximize the potential value of their additional education, nurses should be encouraged to pursue these degrees early in their careers. DNP and PhD programs should offer coursework that prepares students to serve as faculty, including preparing them to teach in an evolving health care system that is less focused on acute care than has previously been the case.
Recommendation 5: Promote Nurses’ Interprofessional and Lifelong Learning. The Campaign should encourage nursing organizations, education programs, and professional societies, as well as individual nurses, to make lifelong learning a priority so that nurses are prepared to work in evolving health care environments. Lifelong learning should include continuing education that will enable nurses to gain, preserve, and measure the skills needed in the variety of environments and settings in which health care will be provided going forward, particularly community-based, outpatient, long-term care, primary care, and ambulatory settings. Nurses should work with other health care professionals to create opportunities for interprofessional collaboration and education. The Campaign could serve as a convener to bring together stakeholders from multiple areas of health care to discuss opportunities and strategies for interdisciplinary collaboration in this area.
Need for Diversity in the Nursing Workforce
African Americans make up 13.6 percent of the general population aged 20 to 40, but 10.7 percent of the RN workforce, 10.3 percent of associate’s degree graduates, and 9.3 percent of baccalaureate graduates. The disparity is even greater for Hispanics/Latinos, who make up 20.3 percent of the general population aged 20 to 40, but only 5.6 percent of the RN workforce, 8.8 percent of associate’s degree graduates, and 7.0 percent of baccalaureate graduates. Men make up just 9.2 percent of the RN workforce, 11.7 percent of baccalaureate nursing students, and 11.6 percent of graduates.
While The Future of Nursing does not offer a specific recommendation on this topic, it does identify lack of diversity as a challenge for the nursing profession and indicates that a more diverse workforce will better meet current and future health care needs and provide more culturally relevant care. Associate’s degree nursing programs and community colleges appear to provide entry into the nursing profession for underrepresented populations. Initiatives to retain diverse and underrepresented students in nursing education programs include financial support, mentorship, social and academic support, and professional counseling.
Only 5 years after the release of The Future of Nursing, it is too soon to see
significant changes in the diversity of the national nursing workforce that may be attributable to the report’s recommendations or the activities of the Campaign and others. Changing the diversity of the overall nurse workforce is a slow process because only a small percentage of the workforce leaves and enters each year.
To be successful, any effort to improve the diversity of the nursing workforce must focus on each step along the professional pathway from recruitment to educational programs, retention and success within those programs, graduation and placement in a job, and retention and advancement within a nursing career.
Recommendation 6: Make Diversity in the Nursing Workforce a Priority. The Campaign should continue to emphasize recruitment and retention of a diverse nursing workforce as a major priority for both its national efforts and the state Action Coalitions. In broadening its coalition to include more diverse stakeholders (see Recommendation 1), the Campaign should work with others to assess progress and exchange information about strategies that are effective in increasing the diversity of the health workforce. To that end, the Campaign should take the following actions:
- Develop a comprehensive, specific diversity plan with actionable steps that can be taken by state Action Coalitions and by nursing and other health professions stakeholders, including trade organizations and educational institutions.
- To assist planning and policy making at the state level, use the Campaign’s dashboard infrastructure to develop and publish annual data reports on the diversity of nursing and other health professions graduates and enrollees by state, and compare the representation of minorities in each state with their representation in the state’s general population.
- Convene an advisory group to identify best practices from both within and outside of the Campaign that are improving the diversity of the nursing and other health professions workforce to reflect that of the general population. Areas for research and assessment might include barriers that prevent individuals from diverse backgrounds from entering the nursing profession and from achieving higher levels of education, modes of academic progression to promote diversity in nursing programs at all levels, and the use of holistic admissions policies and need-based aid to support students from underrepresented and economically challenged backgrounds in obtaining nursing degrees. Results of these studies could be disseminated to key relevant stakeholders, including schools of nursing and employers.
- Assist state Action Coalitions in obtaining funds available for the development of new, innovative, targeted programs and strategies aimed at increasing the diversity of nursing students and the nurs-
ing workforce and/or for the identification and tailoring of those programs that have been shown to be effective.
- Collect data to ensure that the call for higher educational attainment among nurses has positive implications for diversity (including economic, racial/ethnic, geographic, and gender diversity). The Campaign should research the opportunities for and barriers to utilization of baccalaureate completion programs by underrepresented minorities and economically and educationally disadvantaged individuals so that the Campaign and other stakeholders can more effectively implement programs to advance the educational attainment of African Americans, Hispanics/Latinos, and other underrepresented groups in nursing.
- Encourage state Action Coalitions to work with their state nursing workforce centers and state boards of nursing to collect and make available data on variables that can be used to assess progress toward increasing the diversity of the nurse workforce, the nursing student population, and nursing faculty.
Collaboration, Leadership, and Communication
The Future of Nursing includes recommendations for nurses to lead and disseminate collaborative improvement efforts and to lead change to advance health. Nurses are needed to lead and participate in the ongoing reforms to the system, to direct research on evidence-based improvements to care, to translate research findings to the practice environment, to be full partners on the health care team, and to advocate for policy change.
Expansion in the area of collaboration has been supported by the Campaign and state Action Coalitions, and by organizations such as the Josiah Macy Jr. Foundation and the Interprofessional Education Collaborative (IPEC). Going forward, the scope of The Future of Nursing recommendation to expand opportunities for nurses to lead and diffuse collaborative improvement efforts will need to be broadened to acknowledge that no profession can lead and expand interprofessional collaboration alone. Collaboration requires all members of a team working to their full potential on behalf of the patient and with respect for the contributions of other professions to the work. The Campaign acknowledged that this shift was needed in 2013 when it asked its state Action Coalitions to look beyond nursing as they worked to improve health and health care for individuals and families.
According to The Future of Nursing, nurses are needed in leadership positions to contribute their unique perspective and expertise on such issues as health care delivery, quality, and safety. A 2011 survey of 1,000 hospitals found that nurses account for only 6 percent of board membership, compared with 20 percent for physicians; in 2014, the percentage of physician board members remained the same, while the percentage of board members that are nurses decreased to 5 percent.
Opportunities in leadership have been established and expanded by nursing education programs, nursing associations, and private organizations. While some progress has been observed in nurses appointed to health-related boards, there is a lack of data on nurses serving as leaders in other areas, and the data that are available are fragmented and incomplete. There is no single source of information about nurse training in leadership, entrepreneurship, or innovation.
Effective communication with groups within and outside of the nursing profession is critical to collaboration and leadership efforts. The Campaign has engaged targeted audiences through strategic communication initiatives that have leveraged both traditional media and new media platforms. The Speakers Bureau has sent Campaign representatives and leaders to various conferences across the country to raise awareness of and inform key audiences about the recommendations of The Future of Nursing and to gather relevant data and information to advance Campaign goals. Online communication tools provide Campaign volunteers with comprehensive materials with which to engage media, policy makers, and interested stakeholders.
The Campaign acknowledges that the capacity and ability of state Action Coalitions to communicate about their efforts vary greatly. Further, while the goal is to engage a wide range of stakeholders, the Campaign acknowledges that its efforts have been focused largely on engaging nurses. Strong relationships are needed with health policy and business reporters; editors and columnists at national, state, and local news outlets; and bloggers who cover related issues.
Recommendation 7: Expand Efforts and Opportunities for Interprofessional Collaboration and Leadership Development for Nurses. As the Campaign broadens its coalition (see Recommendation 1), it should expand its focus on supporting and promoting (1) interprofessional collaboration and opportunities for nurses to design, implement, and diffuse collaborative programs in care and delivery; and (2) interdisciplinary development programs that focus on leadership. Health care professionals from all disciplines should work together in the planning
and implementation of strategies for improving health care, particularly in an interprofessional and collaborative environment. Interdisciplinary development programs and activities should:
- Feature content in leadership, management, entrepreneurship, innovation, and other skills that will enable nurses to help ensure that the public receives accessible and quality health care. Courses could be offered through or in partnership with other professional schools. The Campaign should monitor nursing programs that offer these types of courses and programs and track nurses’ participation, if possible, in order to assess progress.
- Include interprofessional and collaborative development or continuing competence in leadership skills—for example, through the participation of nurses in spokesperson and communication programs designed to teach persuasive communication skills that will facilitate their leading and managing collaborative efforts.
Recommendation 8: Promote the Involvement of Nurses in the Redesign of Care Delivery and Payment Systems. The Campaign should work with payers, health care organizations, providers, employers, and regulators to involve nurses in the redesign of care delivery and payment systems. To this end, the Campaign should encourage nurses to serve in executive and leadership positions in government, for-profit and nonprofit organizations, health care delivery systems (e.g., as hospital chief executive officers or chief operations officers), and advisory committees. The Campaign should expand its metrics to measure the progress of nurses in these areas. Types of organizations targeted by this recommendation could include
- health care systems;
- insurance companies and for-profit health care delivery systems (e.g., Minute Clinic);
- not-for-profit organizations that work to improve health care (e.g., the National Quality Forum);
- the National Academy of Medicine and other professional membership groups; and
- federal, state, and local governmental bodies related to health (e.g., the Veterans Health Administration, U.S. Department of Defense, Centers for Medicare & Medicaid Services).
Recommendation 9: Communicate with a Wider and More Diverse Audience to Gain Broad Support for Campaign Objectives. The Campaign should expand the scope of its communication strategies to connect with a broader, more diverse, consumer-oriented audience and galvanize support at the grassroots level. The Campaign, including its state Action
Coalitions, should bolster communication efforts geared toward the general public and consumers using messages that go beyond nursing and focus on improving health and health care for consumers and their families. The Campaign should recruit more allies in the health care community (such as physicians, pharmacists, and other professionals, as well as those outside of health care, such as business leaders, employers, and policy makers) as health care stakeholders to further demonstrate a collaborative approach in advancing the recommendations of The Future of Nursing.
Need for Better Data for Assessing and Driving Progress
Major gaps exist in understanding the numbers and types of health professionals, where they are employed, and what roles they fill. This knowledge is critical to support new models of health care delivery. The Future of Nursing report recommends that an infrastructure be built and led by the National Health Care Workforce Commission to improve the collection and analysis of data on the health care workforce. Because the National Health Care Workforce Commission has not been funded by Congress, this recommendation cannot be implemented as it was written. Nonetheless, progress has been made over the past 5 years in the collection and analysis of workforce data for both the nursing workforce and other health professions.
Barriers to the collection of data on the nursing workforce include the lack of national indicators providing consistent information from states, lag time in the collection and reporting of data, the lack of standardized databases with which to track ideal indicators of progress, and the need to use proxy measures to assess progress toward this recommendation of The Future of Nursing (given the short time frame for seeing progress in the outcomes of the report’s recommendations). Little progress has been made on building a national infrastructure that could integrate the diverse sources of the necessary data, identify gaps, and improve and expand usable data not just on the nursing workforce but on the entire health care workforce.
Recommendation 10: Improve Workforce Data Collection. The Campaign should promote collaboration among organizations that collect workforce-related data. Given the absence of the National Health Care Workforce Commission, the Campaign can use its strong brand and partnerships to help improve the collection of data on the nursing workforce.
- The Campaign should play a role in convening, supporting, and promoting collaboration among organizations and associations to consider how they might create more robust datasets and how various datasets can be organized and made available to researchers,
policy makers, and planners. Specifically, the Campaign should encourage
- – organizations and agencies to build national databases that could be shared and accessed by the Health Resources and Services Administration (HRSA) and researchers;
- – states to implement the Minimum Data Set (MDS) and to share their data with the National Council of State Boards of Nursing (NCSBN) so they can build a national dataset on practicing nurses; and
- – nursing organizations that currently engage in independent data collection efforts (such as American Association of Colleges of Nursing, the National League for Nursing, NCSBN, and the American Association of Nurse Practitioners) to collaborate and share their data to build more comprehensive datasets. Other organizations representing providers that employ nurses and other health professionals, such as the American Hospital Association,2 should be invited to participate in this collaboration.
- The federal government and states should expand existing data collection activities to better measure and monitor the roles of registered nurses and advanced practice registered nurses. This expansion should include the collection of data on current and former licensees in the American Community Survey and a sampling of services provided by nurse practitioners and physician assistants for their own patient panels and outside of physician offices in the National Ambulatory Medical Care Survey.
- HRSA should undertake a combined National Sample Survey of Registered Nurses and National Sample Survey of Nurse Practitioners that can be administered more frequently than once every 4 years. This effort should include the involvement of national and state nursing organizations. HRSA should continue to promote the use of the MDS and assist in and support its implementation.
The Future of Nursing includes a number of recommendations aimed at ensuring that nurses, who represent the largest segment of the health care profession, are prepared to help fill the need for quality health care in a delivery system that is shifting rapidly and fundamentally. The release of the report in 2010 and the launch of the Campaign were timely, coinciding with the ACA’s creation of new models of care to accommodate the large numbers of people previously
2 This text was revised since the publication of the final book to correct American Heart Association to American Hospital Association.
without access to health insurance. These models focus on teamwork, care coordination, and prevention—models in which nurses can contribute a great deal of knowledge and skill.
The committee found that continued progress will require greater focus and effort in certain specific areas. Continued work is needed to remove scope-of-practice barriers; pathways to higher education need to be strengthened, with specific emphasis on increasing diversity; avenues for continuing competence need to be strengthened; and data on a wide range of outcomes are needed—from the education and makeup of the workforce to the services nurses provide and ways in which they lead. A major and overarching need is for the nursing community, including the Campaign, to build and strengthen coalitions with stakeholders outside of nursing. Nurses need to practice collaboratively; continue to develop skills and competencies in leadership and innovation; and work with other professionals, as no one profession alone can meet the complex needs of the future of health care. The committee hopes that its recommendations will be helpful to the Campaign and other organizations as they work to improve access to quality health care for all.