The recommendations in The Future of Nursing center around four key messages:

1. Nurses should practice to the full extent of their education and training. (pg. 3-1)

2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. (pg. 4-1)

3. Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States. (pg. 5-1)

4. Effective workforce planning and policy making require better data collection and an improved information infrastructure. (pg. 6-1)

Currently many advanced practice nurses are limited in their practice by their state boards of nursing and institutional policies and credentialing. For example, nurse practitioners do not have prescriptive authority in all states. However, this recommendation does not just address advanced practice nurses. It also points out systems and inefficiencies in design that lead to nurses spending less and less time caring for patients and more time documenting, interacting with technology, or dealing with poorly designed systems that lead to wasted time (e.g., walking to retrieve supplies in inconvenient locations, etc.).

HIGHER LEVELS OF TRAINING WITH SEAMLESS ACADEMIC PROGRESSION

While the report does not specifically state that the Bachelor's of Science in Nursing (BSN) should be the entry level for practice, it does say that we need more nurses to enter with a baccalaureate or to progress to that level early in their career. The report also argues for more nurses with advanced degrees, specifically doctoral preparation. The recommendations about nursing education include curricula changes to help establish a foundation for lifelong learning, cross-disciplinary education with physicians and other health care providers, improved opportunities for transitioning to a higher degree, and more diversity in the nursing workforce.

Nursing has been arguing about entry to practice for decades. It is the time to stop arguing and just do it!! What other profession can enter practice with two, three, or four years of preparation? Nurses make life-saving decisions on a daily basis, our patients deserve well-educated practitioners, and we deserve the professional recognition that comes with the requirement for collegiate education as a standard.

FULL PARTNERS IN REDESIGNING HEALTH CARE

The Affordable Care Act mandates the collection and analysis of workforce data so that future needs can be predicted and enable proactive planning to make sure that those needs are met. Currently, there are many gaps in information about numbers and distribution of various types of practitioners as well as the cost-effectiveness of different team configurations and educational programs. These data are essential to plan for the resources necessary to meet future needs.

As editors of AENJ, we salute the IOM and RWJF for recognizing the contributions that nurses do and can make to health care. They have invited us to the table in a very public fashion and we now have a golden opportunity to help improve the system for patients' sake. Perhaps it is time for an even more visible paradigm shift. Let us rename the IOM and make it the Institute of Health Care to acknowledge that high-quality health care requires a team. It is not all about "medicine."

Jean A. Proehl, RN, MN, CEN, CPEN, FAEN

Emergency Clinical Nurse Specialist & Consultant, Cornish, NH Dartmouth-Hitchcock Medical Center, Lebanon, NH, Gifford Medical Center, Randolph, VT, Colby Sawyer College, New London, NH

K. Sue Hoyt, PhD, RN, FNP-BC, CEN, FAEN, FAANP

Emergency Nurse Practitioner St. Mary Medical Center Long Beach, CA

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