This paper examines the Institute of Medicine's landmark report, The Future of Nursing: Leading Change, Advancing Health, and the role of the Robert Wood Johnson Foundation in advancing its goals. It outlines the report's key recommendations — including expanding nursing education capacity, enabling nurses to practice to the full extent of their training, and forging stronger interprofessional partnerships. The paper also discusses state-based action coalitions working to implement these recommendations at the local level, with particular attention to two initiatives: Interprofessional Collaboration and Data collection. Together, these efforts aim to address persistent nursing shortages, improve workforce planning, and transform the delivery of healthcare across the United States.
The paper demonstrates policy analysis through a top-down, then bottom-up approach: it first establishes the national policy framework (IOM report and RWJF priorities), then evaluates how those policies translate into on-the-ground state action. This dual-lens method shows how national recommendations gain traction — or face obstacles — at the implementation level, which is a hallmark of effective health policy writing.
The paper opens by contextualizing the RWJF and its partnership with the IOM. It then summarizes the Future of Nursing report's scope and core recommendations before shifting to the state coalition network. The final sections each address one coalition initiative — Interprofessional Collaboration and Data — in dedicated, focused passages, closing with a discussion of barriers and proposed solutions for mandatory data participation.
The Robert Wood Johnson Foundation (RWJF), located in Princeton, New Jersey and 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 healthcare. Grants offered by the Robert Wood Johnson Foundation are sizable, collectively amounting to approximately $400 million annually, and address a variety of health issues including these major categories: access to care, childhood obesity, and training for doctors and nurses. Grants are often awarded for topics tangential to healthcare, such as access to fresh food, poverty, housing quality, and violence. Research conducted at the Institute of Medicine has contributed to the efforts of both the Institute and the 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 United States. The report considers the increasingly complex and growing healthcare needs of the diverse and aging American population. A central focus of the report's 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 healthcare and public healthcare systems by describing pathways to increase the capacity of nursing educational programs in order to better address nursing shortages, and to explain how to deliver nursing services in the interim within 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" (Potera, 2009).
The report recommendations address all levels of institutional policy. 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 healthcare in the United States should be conducted through a full partnership between nurses, physicians, and other healthcare professionals. In order to conduct effective policymaking and implement efficacious workforce planning, the data collected, analyzed, and disseminated must be improved, which will require funding for improved infrastructure.
The state-based action coalitions associated with The Future of Nursing: Campaign for Action form a grassroots network of committed stakeholders who are actively engaged in local and state-level work with the intention of transforming healthcare through nursing. The coalitions advance the goals of the campaign by capitalizing on the unique attributes of the states in which they operate. 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. In the state of Indiana, by contrast, the coalition is focusing on developing a training model that uses the interprofessional team as a structure to avoid discipline-specific training that exhibits all the problems of a silo-based orientation.
Maintenance of a comprehensive, regularly updated database will provide information that can be used to predict the timing and magnitude of nursing shortages, allocate resources accordingly, establish responsive recruitment initiatives, and make needed changes to preparation programs. A current barrier to establishing a complete database is that participation in the data collection survey administered by the State Board of Nursing is presently voluntary. The coalition is working to ensure that participation becomes mandatory and that it extends to all healthcare providers, including specialists such as physicians, physical therapists, social workers, and psychologists.
Inroads into this effort are anticipated through the establishment of ongoing and ad hoc cross-disciplinary meetings, forums, and networking, as well as through data access incentives offered to participants. Specifically, healthcare institutions with programs that incentivize employees to participate in the national survey will receive complimentary access to periodic reports and research on the nursing workforce. These measures reflect the broader commitment of the action coalitions to transform the data landscape and ensure that workforce planning keeps pace with the evolving demands of the American healthcare system.
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