The study makes four global recommendations: (1) Nurses at all levels must work to the fullest extent of their education, licensure, and skill; (2) Nurses must become more educated and there must be improved, progressive access to education; (3) Nurses need to be represented at every level of the healthcare decision-making progress, from the bedside to the boardroom to the legislative chambers; (4) There must be improved access to data that can be translated into information to improve workforce planning.

Either through legislation or organizational bureaucracy, nurses at all levels have been inhibited to practice to the fullest extent of their licensure. State Boards of Nursing, state laws, and hospitals and healthcare organizations have been able to limit the practice of nursing at all levels. Local or regional policies and laws have placed limitations because of political agendas brought forth by interest groups intimidated by the knowledge, skill, and abilities of educated professional nurses. Nurses-who've long been touted as the most trusted profession in the country that includes over 3,000,000 professionals-have failed in their attempts to ensure they can fully practice their skill level at the bedside. We must work to repeal these limitations on practice by clearly articulating and demonstrating the value of nurses' knowledge at all levels.

Although the number of baccalaureate graduates is increasing, greater efforts need to be made to move nurses from the associate or diploma level to the baccalaureate level. The complexity of healthcare and the need to improve its value (lower cost and improved quality) can only be accomplished through the effective and efficient use of evidence-based practices and procedures. Nurses need to be the producers of this evidence, and it can only be accomplished if we have sizeable numbers of individuals educated at the master's and doctoral level to spearhead these initiatives.

A greater emphasis also needs to be placed on creating nurse leaders. The recent passage of the Affordable Care Act will require significant changes in the manner in which we deliver care. Nurses need to be the decision makers and drive the healthcare agenda. In doing so, nurses must become actively involved and engaged in their professional organizations and take calculated risks to ensure their voices are heard.

We need information to be effective leaders. An infrastructure needs to be developed and secured to carefully analyze the data and convert them into information used to make decisions about workforce planning. In what locale do we need nurses? Are there enough educational facilities to meet the growing demand for professional nurses? How many nurses are we educating each year?

The IOM panel did a wonderful job in creating these recommendations. It's now up to us to implement them...and, yes, we can!!

Richard Hader

nursing.management@wolterskluwer.com

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