As editor-in-chief of JHPN, I have the privilege of representing HPNA and our journal in the International Academy of Nursing Editors (INANE), an organization with many nursing journals. In August 2011, I attended my first annual meeting of this group as JHPN editor, and I came away from that meeting so very proud of our journal and also inspired by the many opportunities to expand and improve JHPN as the official journal of our professional organization.
One of the activities of INANE is a joint effort of nursing editors to have all journals devote an editorial, article, or some other content in their April 2012 issue to the Institute of Medicine (IOM) Report from the Robert Wood Johnson Foundation1-4 (RWJF) on the Future of Nursing; thus, we are participating through this editorial in this community effort by INANE.
The Future of Nursing report is a collaboration between the RWJF and the IOM. The goal of the project was to assess and transform the nursing profession during the time of healthcare system change. You are invited to visit the INANE Web site (http://www.nursingeditors-inane.org) and click on the Resources tab to find "2012 Future of Nursing Initiative" for a bibliography of editorials and articles already published on the topic. Four key messages and eight recommendations resulted from the committee's deliberations:
(1) Nurses should practice to the full extent of their education and training.
(2) Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
(3) Nurses should be full partners, with physicians and other healthcare professionals, in redesigning healthcare in the United States.
(4) Effective workforce planning and policy making require better data collection and information infrastructure.
(1) Remove scope-of-practice barriers.
(2) Expand opportunities for nurses to lead and diffuse collaborative improvement efforts.
(3) Implement nurse residency programs.
(4) Increase the proportion of nurses with a baccalaureate degree to 80% by 2020.
(5) Double the number of nurses with a doctorate by 2020.
(6) Ensure that nurses engage in lifelong learning.
(7) Prepare and enable nurses to lead change to advance health.
(8) Build an infrastructure for the collection and analysis of interprofessional healthcare workforce data.
The IOM report speaks directly to many aspects of palliative nursing. Recommendations include advocacy for expanded roles and reimbursement for advanced practice nurses in home care, hospice and long-term care, expansion of nursing privileges in hospital settings, and expansion of reimbursement by payers for nursing services. The report promotes the need for more models of care and performance measures to capture the contributions of nursing practice.
The IOM report rightly acknowledges that nurses are a vital force in healthcare as we are 3-million-members strong. Yet there are numerous regulatory, political, and economic constraints that limit the power of nursing to meet the healthcare needs of society. Limitations to nursing practice, prescribing, and availability of nurse residency programs to strengthen new practitioners ultimately are limitations to patient care. The report also strongly advocates for enhanced nursing education to prepare nurses for expanded roles, new technology, and information systems and to prepare nurses as leaders and change agents.
The report includes many individual recommendations, strategies, goals, and issues. But what ultimately is the big picture in thinking of the future of healthcare and the future of nursing? How and why did the IOM and RWJF come together to issue a report on the Future of Nursing? Why does healthcare need reformation?
The big-picture issues of the future of healthcare and nursing are issues of palliative care. We have a vastly overwhelmed healthcare system and a population of chronic, aging, and seriously ill people. We have built a healthcare system that has evolved into advanced critical care settings, life-sustaining therapies, treatments that have converted terminal illnesses to long-term chronic illnesses, and a patient population size that far exceeds the workforce. We also have a society now awakening to the need to a more humanistic system of care that values patient comfort, quality of life, and compassionate care. The future of nursing, and of healthcare, is palliative nursing. Palliative care nurses have the ability to address each of the recommendations from the IOM report. We can expand our scope of practice, expand our education, and truly be full partners in the redesign of healthcare. To borrow from the motto of HPNA-"leading the way in hospice and palliative care," we in palliative nursing should lead the way in responding to the recommendations of the IOM report on the Future of Nursing.
Palliative nursing is sometimes envisioned as simple, basic, "low-tech," and "high-touch." But palliative nursing is also innovative and visionary. We are poised for more innovative and independent practice and as strong agents of change because we have challenged the basic tenets of healthcare delivery in order to create our field of palliative care. The Future of Nursing is indeed palliative care nursing.
Betty Ferrell, PhD, MA, FAAN, FPCN, CHPN
The author has no conflict of interest to disclose.