In November 2010, the Robert Wood Johnson Foundation, in collaboration with the Institute of Medicine, published its report, The Future of Nursing: Leading Change, Advancing Health.1 This report focused on 4 major issues: (1) extending nurses the right to practice independently as they were educated particularly in advanced practice roles; (2) improving the educational system to encourage progression to advanced levels; (3) partnering with physicians and other professionals to redesign the US health care system; and (4) collecting and mining data to more effectively inform health policy and workforce development.
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On the face of it, the report appears to be a rehash of what many health care leaders have said about the importance of the nursing profession in the transformation of health care. Delve deeper, and the report is a revolutionary call to action, an evidence-based road map on how nurses can catalyze the change that will improve the health of the nation. Included in the report are data from The Pearson Report2, indicating that credentialed advanced practice nurses can practice independently, without the "collaborative" blessing of a physician in more than one-third of states in the United States. There is ample evidence to support the continued movement to independent advanced nursing practice to promote access to quality, holistic primary care in the United States.
The report emphasizes the importance of a highly educated nurse workforce and a rigorous nursing education system that facilitates academic progression to higher levels of education. Higher education for nurses means rigor and relevancy as nurses work as "full partners" with physicians and other health care professionals in transforming the health of the nation and in redesigning the health care system to emphasize health promotion and early intervention. Promoting the health of the nation will increasingly mean the inclusion of complementary and integrative therapies as a regular component of the armamentarium of primary care interventions.
The aging of the nation, the opening of access to care, and the rise of chronic illness related to unhealthy lifestyles will place increasing demands on the health care system. And knowing what works to improve the situation will depend on how well we interpret outcomes data as a function of care, even self-care.
Health is a complex phenomenon; it is highly individual but has definite patterns, and it is influenced not only by genetic variance but also by environment and behavior. The work of improving health care through experimentation and evidence-based practice is complex and curiously nonlinear. It will take strong nurse leaders in both practice and education to generate the changes that will ultimately lead to a healthier nation. The Future of Nursing report is filled with exemplars of nurse-led initiatives that are changing not only the health of communities but also the manner in which primary care is delivered. If you need a road map for your own future in health care, read the Robert Wood Johnson report, The Future of Nursing, and make your own unique contribution to the transformation of health care.
-Gloria F. Donnelly, PhD, RN, FAAN