1. Kennedy, Maureen Shawn MA, RN


There's a way to move forward, but are we willing?


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Here we are, on the cusp of another new year. In last January's editorial, I wrote that I hoped we were leaving behind "a bad economy, record unemployment rates, the ongoing wars in Iraq and Afghanistan, vitriolic debate over health insurance reform, the H1N1 pandemic flu, and generally hard times for too many people." Unfortunately, about the only thing on my list that we did leave behind was the H1N1 pandemic flu; the rest have persisted through 2010 and give every indication of continuing through 2011.


And we were barely into 2010 when a 7.0-magnitude earthquake struck Haiti on January 12, killing more than 200,000 people. While Haiti seemed to represent the worst such tragedy, there were others. Natural disasters occurred in regions already challenged by poverty or war; these included earthquakes in Chile and Afghanistan; floods or landslides, sometimes both, in Pakistan, the Philippines, Nepal, and parts of Central America and Africa; volcanic eruptions in Indonesia and Guatemala; and cyclones, hurricanes, and tropical storms in India and Myanmar. The images in the news media of misery and suffering were often overwhelming. I marveled at the stamina of the relief workers who responded time after time; always, there were nurses among them.


In the United States, a stalled economy and a political system embroiled in power struggles have led many Americans to wonder where we're heading. Sometimes it seems as if we're going backward-for instance, there are reports that the new Speaker of the House, Republican John Boehner, plans to dismantle the Office of Congressional Ethics. And while politicians continue their turf wars, the people they represent lose sleep worrying about whether they'll be able to pay the mortgage, send their children to college, or ever retire.


Signs of progress are accompanied by uncertainty. The Patient Protection and Affordable Care Act was signed into law last March after months of political wrangling; in the end, the one thing everyone agreed on was that it left much to be desired. As we report in this issue (see In the News and Policy and Politics), the future of the Affordable Care Act remains unclear, as does that of health care reform efforts. After so many months of rancor, I worry that people will settle for anything just to be done with it all, and any chance for significant reform will be lost.

Figure. Maureen Shaw... - Click to enlarge in new windowFigure. Maureen Shawn Kennedy

But I'm heartened by the increased focus on nursing in 2010, and I hope this trend continues. A report released last October by the Institute of Medicine (IOM), The Future of Nursing: Leading Change, Advancing Health, advocates a greater role for nurses in health care. To this end, it recommends removing scope-of-practice barriers, supporting nurses in achieving higher levels of nursing education, ensuring that nurses are full partners in health care planning and reform, and improving data collection to achieve better workforce planning. While such support from the IOM-which has a mandate to provide independent, objective, and evidence-based recommendations on health matters to Congress-certainly carries weight, there's no guarantee that its recommendations will be implemented. Indeed, immediately after this report's publication, physician groups released statements reaffirming the traditional supervisory role of physicians, thereby challenging the IOM's recommendation to give nurses full partnership.


Still, the IOM report marks a first step in moving nursing toward a future in which nurses help to shape health care, rather than simply to deliver what others have planned. All nursing organizations should be planning ahead, communicating and working together to see what each can do to help make this happen. Last month, a national summit brought together a multidisciplinary group of stakeholders to strategize how best to implement the IOM's recommendations. (Watch for AJN's report on the summit in the February issue.) If ever there was a time for nursing groups to put aside parochial concerns and speak with one voice, that time is now. It's going to be an interesting year.