By Jennifer Thew, RN
The year 2010 was monumental in healthcare. Not only was the Affordable Care Act signed into law, but the Institute of Medicine (now the National Academies of Sciences, Engineering, and Medicine) issued its landmark report, The Future of Nursing: Leading Change, Advancing Health.
The report called for significant changes in nurses' roles, responsibilities, and education to meet the increased demand for care and to make improvements to the healthcare system, and made recommendations in the following categories:
- Improving access to care
- Fostering interprofessional collaboration
- Promoting nursing leadership
- Transforming nursing education
- Increasing diversity in nursing
- Collecting workforce data
In response to these recommendations, the Robert Wood Johnson Foundation, AARP, and the AARP Foundation joined forces to create Future of Nursing: Campaign for Action. The campaign is working in each state to catalyze nurses, health providers, consumers, educators, and businesses to strengthen nursing in a variety of areas.
"The important thing to remember about [NAM] reports is the recommendations are generally stretch goals," says Susan Hassmiller, RN, PhD, FAAN, senior adviser for nursing at RWJF and director of the Future of Nursing: Campaign for Action. "We're trying to push the envelope. We were certainly trying to push it on many different fronts."
Some of the recommendations call for achievement by 2020. So just how close is the nursing profession in meeting the improvements outlined in the initial report?
The Campaign for Action's "Dashboard" of seven primary indicators reports how far nursing has come since 2010.
The IOM recommended 80% of nurses be prepared with baccalaureate degrees by 2020. Research by Chenjuan Ma, PhD, associate professor at NYU Rory Meyers College of Nursing, says that goal likely will not be achieved by 2020. However, the number of BSN-prepared nurses has increased according to the Campaign for Action's indicators. In 2010, 49% of employed nurses were BSN-prepared compared to 56% in 2017. Ma projects the 80% goal will likely be attained by 2029.
Some healthcare facilities, particularly those with Magnet designation, may reach the 80% BSN goal says Hassmiller. And some states are closer to the goal than others.
"Hawaii, for example, they're now at 72%," says Hassmiller.
Additionally, in 2018, New York State passed the first-of-its-kind law mandating newly licensed registered nurses obtain a BSN-degree within 10 years of their initial licensure.
2. Doctoral degrees
The IOM recommended that there be double the number of nurses with doctorate degrees by 2020. This goal has already been achieved. In 2010, the total number of employed RNs with doctoral degrees was 10,022. In 2017, it was 28,004.
3. State practice environment
The IOM recommended that APRNs be able to work to the full-extent of their education and training. Since the Campaign for Action began, nine states have removed statutory barriers that prevented nurse practitioners from providing care to their full capacity. That means today, 22 states allow NPs to practice to the fullest extent of their training and education. Additional states have made substantial or incremental improvements toward meeting this goal.
Plus, in 2017, the Department of Veterans Affairs granted APRNs (with the exception of certified registered nurse anesthetists) full practice authority.
4. Interprofessional collaboration
The IOM recommended expansion of opportunities for nurses to lead and disseminate collaborative improvement processes. This can be achieved through a variety of means such as involving nurses in quality improvement initiatives and making interprofessional education more robust.
The Campaign for Action has collected data from nursing schools that outline the number of required clinical courses and/or activities that include RN students and graduate students of other health professions. For example, the University of Pittsburgh went from one required course that allows nurses to collaborate with other health professions in 2011 to four required courses in 2016.
The IOM recommended that healthcare decision-makers ensure leadership positions are available to nurses. The Nurses on Boards Coalition was created to help meet that goal. The coalition set an objective of having 10,000 nurses serving on corporate, health-related, and other boards, panels, and commissions by 2020. Currently, 5,757 nurses who are serving on boards have registered with the coalition.
Nurses are also increasingly moving into the CEO role at major hospitals and health systems.
6. Workforce Data
The IOM recommended building an infrastructure for collection and analysis of interprofessional workforce data to help nurse leaders make decisions for hiring and to address shortages. Twenty-five states collect data on nurse education programs, supply of nurses, and demand for nurses. The other states collect some but not all of this information. The idea behind this initiative is that more thorough data can assist with improved workforce planning and managing healthcare worker supply and demand.
The IOM recommended making diversity in the nursing workforce a priority, and there has been some headway made in this area. While the makeup of the U.S. population is about 50.8% female and 49.2% male, in 2017, pre-licensure RN program graduates were 85.6% female and 14.1% male—up from 12.2% in 2010.
According to the American Association of Colleges of Nursing, in 2017, 68.6% of graduates of entry-level baccalaureate nursing programs where white. The number of total minorities in 2017 was 31.4%, up from 24.6% in 2010.
Editor's note: This is the first installment in a two-part series on the Future of Nursing report and Future of Nursing: Campaign for Action. Part two will focus on Hassmiller's insights on the recommendations' impact, where nurse leaders should focus their efforts running up to 2020, and more about the Future of Nursing.