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The Future of Nursing, Nearly 5 Years Later

Created May 28 2015, 08:00 PM by Lippincott Solutions
  • scope of practice
  • Advancing Health
  • nurse leadership
  • Future of Nursing- Leading Change
  • advanced practice nurse
  • BSN
  • DNP
  • Institute of Medicine

Friday, May 29, 2015

When the Institute of Medicine released “The Future of Nursing: Leading Change, Advancing Health” report in October 2010, the nursing profession embraced all 600-plus glorious pages. (Organized medicine? Not so much. But more on that later.)

“This may be nursing’s shining moment,” Catherine L. Gilliss, PhD, RN, FAAN, then-president of the American Academy of Nursing, told the New York Times.

The landmark report was the result of two years of discussion and study by a national panel of healthcare experts about the role nurses could, and should, play in improving the healthcare system. Findings, such as the recommendation that nurses should be full partners in redesigning the U.S. healthcare system and that nurses should practice at the full extent of their training, were applauded heartily by nursing leaders who had been championing such ideas for decades.

But the report went a step beyond simply endorsing the vital role nurses deserve in healthcare reform. It recommended specific action steps to help nurses get there. What’s more, on a couple of them it suggested a deadline: 2020.

Here’s a look at where the profession stands in implementing recommendations almost five years later, courtesy of the Future of Nursing: Campaign for Action’s dashboard indicators of progress made.

Recommendation: Increase the proportion of nurses with bachelor’s degrees to 80% by 2020.

When that recommendation was issued in 2010, 49% of employed nurses held at least a bachelor’s degree. As of 2013, the latest year for which data is available, that percentage crept up to 51%. However, it’s likely to bump up much higher in coming years as a result of new hospital policies that express a strong hiring preference for BSN-prepared nurses and even require currently employed RNs to return to school and earn a BSN.

Recommendation: Double the number of nurses with a doctorate by 2020.

Between 2010 and 2013, enrollment in DNP (doctor of nursing practice) programs nearly doubled to more than 14,000 enrollees, according to figures from the American Association of Colleges of Nursing. Nurse enrollment in PhD programs, meanwhile, topped 5,000 in 2013. Because doctoral programs take years to complete, the Campaign for Action is focusing its current tracking efforts on enrollments to gauge progress, which has clearly been made. Later, the campaign plans to track actual graduations from DNP and PhD programs.

Recommendation: Remove scope-of-practice barriers that prohibit advanced practice nurses from practicing to the full extent of their education and training.

Twenty states currently provide full practice authority to advanced practice nurses, which means there’s still work to be done in the other 30. Peeling back limits can be difficult, though, as well-funded medical groups historically tend to oppose any legislative and regulatory efforts to remove physician oversight of advanced practice nurses. “Patient safety!” they cry. But with volumes of research supporting the safe, quality care that advanced practice nurses consistently provide (which, by the way, helped inform the very report that’s now recommending the removal of practice barriers), that rationale is starting to ring hollow.

Recommendation: Expand opportunities for nurses to lead and disseminate collaborative improvement efforts.

It’s difficult to measure interprofessional collaboration in the workplace, but a look at the nation’s top nursing schools shows an increasing number of courses mixing RN students with students from other healthcare disciplines. Ideally, the trend should increase familiarity among future professionals and will eventually translate to enhanced collaboration in hospitals and other healthcare settings.

Recommendation: Healthcare decisionmakers should ensure leadership positions are available to, and filled by, nurses.

On this front, the news isn’t great. In 2011, 6% of hospital boards included RN members. Over the next three years, that percentage dropped one point. Furthermore, the campaign reports that no nurses currently serve on the board of directors of the top five pharmaceutical companies, top five health systems or top five insurance companies.

Clearly, work remains in awarding the profession the influence and power it deserves. But consider this: Who better to get it done than the three million nurses the Institute of Medicine so heartily endorses as leaders of change? It boils down to a matter of time. And in fewer than five years, some solid progress has already been made.

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