Reforming Healthcare by Reforming Nursing

¶ … IOM Future of Nursing Report

The Robert Wood Johnson Foundation (RWJF), which is located in Princeton, New Jersey and was founded from the Johnson & Johnson fortunes, is the largest health-focused philanthropy in the United States. The foundation provides grant money to successful applicants seeking to improve the health of U.S. citizens and to improve the provision of American health care. Grants offered by the Robert Wood Johnson Foundation are sizable, collectively amounting to approximately $400,000 million annually, and address a variety of health issues including these major categories: access to care, obesity in children, and training for doctors and nurses. Grants are often awarded for topics tangential to healthcare, such as access to fresh food, poverty and housing quality, and violence. Research conducted at the Institute of Medicine has contributed to the efforts of the Institute and RWJF to design, articulate, and implement nurse-led models of innovative practice with the potential to improve and transform healthcare systems in the United States.

The Future of Nursing: Leading Change, Advancing Health, the report completed by the Institute of Medicine is a comprehensive exploration of the role of nurses in healthcare systems as they currently exist and the potential transformative options that hold promise of substantively improving healthcare in the U.S. The report considers the increasingly complex and growing healthcare needs of the diverse and aging American population. A focus of the report recommendations is the nexus between nursing workforce readiness and the healthcare needs of people across their lifespans. The report intends an extensive reach, making recommendations for challenges that have been resistant to change, are pervasive across healthcare systems, and are truly transformative -- which means they may be considered radical in traditional contexts. The recommendations are designed to reform health care and the public healthcare systems by describing pathways to increase the capacity of the nursing educational programs in order to better address nursing shortages, and how to deliver nursing services in the interim in what will inevitably be a shortage environment. The U.S. Department of Health and Human Services reports that, "the U.S. will require 1.2 million new RNs by 2014 to meet the nursing needs of the country, 500,000 to replace those leaving practice and an additional 700,000 new RNs to meet growing demands for nursing services" (Portera, 2009).

The report recommendations address all levels of institutional policies. The report concludes that nurses should achieve higher levels of education and training which will ensure seamless academic progression, and ultimately position them to practice to the full extent of the education and training they have received. The redesign of health care in the United States should be conducted through a full partnership between nurses, physicians, and other health care provider professionals. In order to conduct effective policy-making and implement efficacious workforce planning, the data collected, analyzed, and disseminated must be improved, which will require funding improved infrastructure.

The state-based action coalitions associated with the Future of Nursing: Campaign for Action are a grassroots network of committed stakeholders who are actively engage in local and state level work with the intention of transforming healthcare via nursing. The coalitions are able to advance the goals of the campaign by capitalizing on the unique attributes of the states in which they reside. For instance, the network of stakeholders in the state of Montana is small and cohesive, which means that a statewide conference call takes on the character of a virtual town hall meeting. However, in the state of Indiana, the coalition is focusing on developing a training model that uses the inter-professional team as a structure to avoid discipline-specific training that exhibits all the problems of a silo-based orientation.

Two initiatives of the Action Coalition in my state that are of interest are Interprofessional Collaboration and Data. The purpose of Inter-professional Collaboration is as follows: "To ensure high quality, patient-centered care, nurses, physicians and other health professionals must collaborate in education and practice, and across all health care settings." The indicators of progress in my state include the development of partnerships that include cross-disciplinary diverse stakeholders in order to embed models of interprofessional collaboration in practice and in nurse preparation educational programs. The efforts in this area include opportunities for nurses to combine their traditional education with more holistic approaches to interventions used to support patients and their families. Transition-into-practice residency programs have not been available for long-term care facilities in the state. Accordingly, the coalition has developed the first such residency program of this type in the long-term care environment. This initiative is a substantive contribution to the development of more seamless academic progression through transitional nurse residency programs.

The purpose of the Data initiative is as follows: "Effective deployment of the health care workforce requires information -- data to tell us what kind of health providers we will need and with what skills. Yet major gaps exist in the workforce data we now have. Progress indicators include a national scan of 35 states to explore the approaches used in other states to manage data related to the healthcare workforce. From this environmental scan, the State has established a plan for improving the collection, analysis, and distribution of healthcare workforce data. Currently, the State is working to determine the financial requirements for establishing and maintaining a database to meet the needs and standards identified.