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Main Message Points:
(1) Nurses are the key to quality care in a transformed healthcare system. Healthcare experts and patients alike are calling on our profession to optimize its contributions to better meet the needs of all patients for quality healthcare. Informatics nurses are uniquely positioned to assist in the development and implementation of enabling technologies to support high-quality and evidence-based care.
(2) Nurses' knowledge and expertise are in demand. It's time for all nurses to step up and meet the challenge. This is a once-in-a-lifetime opportunity for every nurse to seize the opportunity and "become the change you want to see." Among other things, nursing informatics professionals are experts at individual and organizational change management and can contribute greatly to transitioning the profession of nursing to our future state.
(3) What we do today will influence how our healthcare system looks in 10 years. The public values and trusts nurses. Policy makers are calling on nursing to shape the future of healthcare. If our profession doesn't answer the call, others will.
(4) Every nurse, from the bedside to the boardroom, has a role in transforming nursing. The environment is ripe for nurses to get engaged in charting our future-the future of our nation's healthcare.
(5) Your professional association is your partner on this journey to maximize this opportunity-advocating for leadership roles for nurses in patient-centered care, encouraging your involvement in shaping the future, and providing tools and resources to support your success. The door is open. Will we step through to embrace the full value and power of our profession?
Healthcare at a Turning Point
* We are at a turning point for healthcare delivery in this country. A number of factors have converged to spotlight the importance of maximizing nurses' contributions to quality, patient-centered care. The enactment of the Affordable Care Act (March 2010), followed by release of the Institute of Medicine's report on the Future of Nursing (October 2010), underscores nurses' unique contributions and untapped capacity to transform the quality of care.
* The Affordable Care Act calls for a larger role for nurses in healthcare delivery. It provides for major investments in improving the quality of care and nursing workforce and education and emphasizes new models of care that feature nurses in prominent roles.
* The Institute of Medicine released its report, The Future of Nursing: Leading Change, Advancing Health, in October 2010, following 2 years of study. The initiative was sponsored by the Robert Wood Johnson Foundation and led by a committee of nationally renowned experts from nursing, medicine, and other disciplines, who reviewed the body of scientific evidence and concluded that nurses must take a greater leadership role in the delivery and development of care. The ultimate goal of the initiative on the Future of Nursing is to improve how healthcare is delivered to better meet the needs of all patients.
The Future of Nursing report includes eight key recommendations. These recommendations are in three categories including leadership, education, and practice. The following matrix describes the eight recommendations in the context of nursing informatics:
You can find the report and its full recommendations, as well as a growing list of activities currently going on in the nursing community that are congruent with these recommendations at http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/.
The public's high regard for the profession, coupled with nurses' education and skills, makes us well positioned to meet this challenge to take a major role in the transformation of the nation's healthcare system.
The public trusts us. For the 11th year, nurses were voted the most trusted profession in America in Gallup's annual survey that ranks professions for their honesty and ethical standards. Eighty-one percent of Americans believe nurses' honesty and ethical standards are either "high" or "very high" (http://www.gallup.com/poll/145043/Nurses-Top-Honesty-Ethics-List-11-Year.aspx).
The public recognizes our care quality. In another Gallup survey, Americans rated nurses the best of eight different healthcare providers in the United States, with 88% saying the care nurses provide is excellent or good (http://www.gallup.com/poll/145214/Rate-Nurses-Doctors-Highly.aspx).
* Think about where you want to be in your practice in 5 years-set career goals and identify what you will need to get there.
* Commit yourself to lifelong learning process. Pursue advanced education through continuing education, certification, and academic education.
* Stay informed and apply for grants, scholarships, and other programs that can enhance your opportunities and support a larger role for nurses.
* Don't let policy happen "to you"-get involved in the policy committees at work.
* Your experience and expertise are needed to help design and implement improved care environments and new ways to provide patient-centered care at your facility, organization, or in your own work. No one knows what patients want and need better than nurses.
* Participate in workforce planning surveys and data collection opportunities within your practice setting. Data collection is imperative to reform the current healthcare system. As nurses, we must measure the value of what we do. Nurses are counted on, yet if we don't count what nurses do, nurses don't count.
* Stay informed about and participate in the activities of your professional associations. A few hours of your time can make a big difference; remember there is strength in numbers.
* Share information about this project with your friends and colleagues; invite them to engage in the discussion.
* Embrace your power!
To help illustrate what the future will look like, it is helpful to cite examples of nurses engaged in innovative practice in your specialty. A good place to find samples of nurse-led creativity among the specialties is in the "Edge Runners" program, sponsored by the American Academy of Nursing. These are "practical innovators who have led the way in bringing new thinking and new methods to a wide range of healthcare challenges. Edge Runners have developed care models and interventions that demonstrate significant clinical and financial outcomes. Many of the stories underscore the courage and fighting spirit of nurse leaders who have persevered despite institutional inertia or resistance" (see http://www.aannet.org/custom/edgeRunner/index.cfm?viewAll=1).
Here are illustrations of pediatric nurses providing home-based, well-baby care; certified nurse midwives offering patient-friendly prenatal and birthing care; psychiatric-mental health nurses providing group counseling; and geriatric nurses caring for the elderly in their homes. The list goes on, and you can think of examples from your own specialty to demonstrate the power of nurse-led and managed care.
A campaign for action to implement the Future of Nursing report is underway, following a kickoff meeting held in late 2010 that was attended by more than 600 health leaders from nursing, the government, business, public health, academia, and other sectors. Five states (California, New Jersey, New York, Michigan, and Mississippi) have been selected for pilot programs, and regional action coalitions have been set up to move the recommendations forward. Your state nurses' association and specialty organizations have a vital role in the implementation of the Future of Nursing recommendations in your state and localities.
What is the Institute of Medicine?
The Institute of Medicine (IOM) is an interdisciplinary advisory body to the nation on issues impacting health. Established in 1970 under the charter of the National Academy of Sciences, the IOM provides independent, objective, evidence-based advice to policy makers, health professionals, the private sector, and the public. While expert committees play an important role in guiding report development, the IOM also convenes public forums, roundtables, and other activities to facilitate discussion, discovery, and cross-discipline thinking.
The IOM has a history of making recommendations for improving healthcare and reforming health profession education that have had profound impact on stimulating positive change. Past reports include the landmark To Err Is Human: Building a Safer Health System (1999), Health Professions Education: A Bridge to Quality (2003), and Keeping Patients Safe: Transforming the Work Environment of Nurses (2004). This last study, in particular, linked with the Future of Nursing report, provides a powerhouse of evidence-based information to make nursing's case stronger than ever. To reference the IOM's full portfolio of studies, see http://www.iom.edu/Reports.aspx.
The Future of Nursing Initiative has a dedicated Web site. Background and updates on the initiative are available at http://thefutureofnursing.org/
Mark D. Sugrue, RN, BC,is director of PricewaterhouseCoopers.
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