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December marks the end of another year and is a time for reflection on past events that have shaped our lives and will hopefully guide us toward a healthier future. On October 5, 2010, the Robert Wood Johnson Foundation (RWJF) at the Institute of Medicine (IOM) released the results of a 2-year initiative in which individuals selected for their expertise in a certain area studied the current nursing dilemma; the book is appropriately titled The Future of Nursing: Leading Change, Advancing Health.1 The full report of this collaborative effort, almost 600 pages, is available online, free of charge. An easier read, however, is the summary, which succinctly highlights the four main messages that form the basis of the committee's final recommendations:
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
If these four points sound familiar, it is because they echo the voice of nursing, and particularly the voice of advanced practice nurses (APNs). Over the years, our voices have been consistent and persistent about our qualifications and ability to independently provide comprehensive healthcare services to diverse populations. We have boldly advocated for advancing the educational preparation for basic and advanced nursing practice to produce a more highly skilled nursing workforce with the additional competencies necessary for a complex healthcare environment. Our voices have become increasingly louder and more visible with each new challenge as we demonstrate and document the high-quality care we deliver, validated by high patient satisfaction and public trust in nurses. Finally, our voices will not be quieted in the legislative halls as more and more nurses become politically active, "sit at the table," and hold elected offices. This past year will be marked in the history books as the beginning of healthcare reform in the United States.
The passage of the Affordable Care Act of 2010, the shortage of nursing clinicians and educators, and the projected increasing shortage of primary care providers, have given nursing, and APNs in particular, an opportunity to "grab the bull by the horns and run with it." Future practice for APNs is strongly linked to actions we take now during these changing times and planning to meet the future healthcare needs of Americans. The intensity with which Americans continue to react to healthcare reform is reflective of individual and collective frustrations with our present healthcare system.
My December editorial usually carries a theme of change within its message. People want change. Even those opposed to healthcare reform want change. We nurses want change. Consider the recommendations in the RWJF/IOM report: remove scope-of-practice barriers, expand opportunities for nurses to lead collaborative efforts, implement nurse residency programs, increase baccalaureate-prepared nurses to 80% and double the number with doctorates by 2020, foster lifelong learning for nurses, prepare and enable nurse leaders, and build systems to collect and analyze interprofessional healthcare workforce data.1 We nurses are going to be even busier as we move into 2011!! So get ready to be a part of history and I wish you all a peaceful holiday season!!
Jamesetta Newland, PhD, RN, FNP-BC, FAANP, FNAP
1. Committee on the Robert Wood Johnson Foundation Initiative at the Institute of Medicine. The future of nursing: leading change, advancing health. Washington, DC: The National Academies Press; 2011. http://books.nap.edu/openbook.php?record_id=12956&page=3. [Context Link]
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