1. Carlson, Elizabeth A.

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All nurses will be influenced in some way by the recommendations of the first book reviewed, Assessing Progress on the Institute of Medicine Report on the Future of Nursing. The second book, Transforming Interprofessional Partnerships: A New Framework for Nursing and Partnership-Based Health Care, offers a vision of what is needed to change healthcare into partnership-based healthcare. The two books dovetail nicely into each other and offer great information in an easily accessed manner.


In 2010, the Institute of Medicine (IOM) published The Future of Nursing: Leading Change, Advancing Health. You have most likely heard of this report and the recommendations. The Future of Nursing (FON) report, sponsored by the Robert Wood Johnson Foundation (RWJF), issued recommendations intended to serve as a guide or blueprint to improvements in nursing. These recommendations clustered around improving nursing education and training, practice, leadership, and workforce planning. This report had four key messages.


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 an improved information infrastructure. (p. B-1)


After FON report was issued in 2010, RWJF supported the creation of the Future of Nursing: Campaign for Action (Campaign) to work with 51 State Action Coalitions. In 2015, RWJF requested that IOM assess the progress made toward implementation of the report's recommendations and identify areas to the Campaign that require emphasis over the next 5 years to help fulfill the recommendations. The prepublication version of this report Assessing Progress on the Institute of Medicine Report on the Future of Nursing was released in December 2015.


National Academies of Science, Engineering and Medicine, 2015. Assessing Progress on the Institute of Medicine Report on the Future of Nursing. Washington, DC: The National Academies Press. 190 pages, $66.00 prepublication hardcover, $59.00 prepublication softcover.


Or, it can be downloaded for free at the following URL:


This report has six chapters and three appendices. It begins with a Summary of 14 pages. The Introduction (Chapter 1) provides the context, study scope, an overview of FON, the Campaign, RWJF Activities outside of the Campaign, organization of the report, and references. The remaining chapters of the report (Chapters 2-6) offer detailed descriptions of the assessments, activity and progress, discussion, findings and conclusions, recommendations, and references for each reviewed recommendation. The appendices include Data Sources and Methods (Appendix A), Recommendations of the Institute of Medicine Report The Future of Nursing: Leading Change, Advancing Health (Appendix B), and Committee Biographies (Appendix C).


So what has this evaluation revealed? As stated in the Summary, overall, the committee conducting the review found that the Campaign has made significant progress in many aspects. First, in a short period of time, the Campaign has galvanized the nursing community to address these recommendations. Most expectations have been met or exceeded; however, it is recommended that the Campaign broaden its network of stakeholders, particularly in light of the importance placed on interprofessional collaboration. A summary of some of the recommendations and the progress made toward the recommendation follows:


The first FON recommendation was the removal of scope of practice barriers. In 2010, 13 states were classified as having full practice authority. Eight states have changed their laws to give nurse practitioners full practice and prescriptive authority. To date, 17 states are categorized as having reduced practice authority and 12 as having restricted authority. Although at the federal level, a final rule issued in 2012 broadens the concept of medical staff, thus allowing other practitioners to perform all functions within their scope of practice, existing state laws, and business preferences remain a barrier to expansion of the advanced practice registered nurse's scope of practice. Therefore, the 2015 committee's first recommendation is to build common ground around scope of practice and other issues in policy and practice specifically to build common ground to remove scope of practice restrictions, increase interprofessional collaboration, and address other issues to improve healthcare practice in the interest of patients.


The second FON recommendation was related to nurses achieving higher levels of education. In 2010, FON recommended that by 2020, the proportion of nurses with baccalaureate degrees be increased to 80%, the number of nurse with a doctorate be doubled, residency programs to assist in transition to practice be established, and that nurses engage in lifelong learning.


To date, both entry-level and accelerated baccalaureate program enrollment has increased substantially in the 5 years as has the number of baccalaureate programs. One concern expressed is the relatively flat level of funding for the past decade that creates logistical problems for students and creates barriers to obtaining a baccalaureate degree. The small number of doctorally prepared nurses remains a substantial barrier to teaching, performing research, and serving as leaders in clinical practice and health policy. In 2010, less than 1% of nurses held a doctoral degree. Because the length of time needed to obtain a doctoral degree typically takes years, the committee was unable to assess progress on this recommendation. However, it was noted that DNP enrollment has more than doubled (a 161% increase) from around 7,000 to more than 18,000 students. PhD enrollment has increased by 15%.


Transitions to practice residency programs are recommended as a way to reduce nurse attrition. Although these residency programs appear to have some positive outcomes, the committee reports that the programs vary widely and lack data on cost and value provided. This lack of outcome data results in barriers to implementation.


Lifelong learning is necessary to provide quality care. The committee reports that continuing education and competence has not kept pace with the needs of the increasingly complex healthcare system. The lack of data on what impact continuing education and nurse certification and credentialing have on patient outcomes serves as an obstacle to evaluation of this recommendation.


Thus, the 2015 report recommends the following: The continuation of pathways toward increasing the percentage of nurses with a baccalaureate degree through partnerships with community colleges and 4-year universities, promotion of educational progression by employers, and the provision of logistical and financial assistance. Also, as the number of programs increases, the quality of new programs must be monitored to ensure consistency in educational practices and outcomes. It is recommended that the Campaign promote nurses' pursuit of doctoral degrees, both DNP and PhD, particularly early in their careers to promote maximum value of the additional education. Incentives and expansion of programs are cited as other ways to promote doctoral education. Similarly, the Campaign encourages nursing organizations, education programs, professional societies, and individual nurses themselves to make lifelong learning a priority.


Another recommendation focuses on making diversity in the nursing workforce a priority through continued emphasis on recruitment and retention of a diverse workforce. The Campaign should work with diverse stakeholders to assess progress and exchange information about strategies that are effective in increasing diversity of the workforce. An extensive list of suggested actions is given. Expansion of efforts and opportunities for interprofessional collaboration and leadership development for nurses are recommended and suggested programs and activities detailed. Nursing involvement in the redesign of care delivery and payment systems is Recommendation 7. The need for the development of metrics to measure progress in these areas is encouraged. Finally, it is recommended that workforce data collection improvement is needed. The Campaign should serve as convener, supporter, and promoter of collaboration among a broad range of organizations to assist in creating more robust data sets that can be available to researchers, policy makers, and planners.


I expect that Assessing Progress on the Institute of Medicine Report on the Future of Nursing will be referenced regularly over the coming years as the basis for changes throughout nursing and healthcare. I strongly suggest that you read this report so you are familiar with its content and the suggested actions. Remember, it can be accessed for free at the following URL:


The second book, Transforming Interprofessional Partnerships: A New Framework for Nursing and Partnership-Based Health Care, by R. Eisler and T. M. Potter offers "the framework to shift health care relationships from hierarchies of domination and isolate professions to high-functioning interprofessional teams ready to be full partners with patients, families, communities, and one another" (p. Xxvii). The book has 354 pages, including an index, costs $54.95, and was published by Sigma Theta Tau International, Indianapolis, IN. It has three parts and 14 chapters and is written in an engaging style that makes the more conceptual material accessible to the reader. Each chapter has an extensive reference list.


Part 1 lays a foundation and expands the definition of medicine by returning to its Latin definition of "the art of healing or making whole." With this as the foundation, nursing and medicine are interprofessional equals. In Table 1.1 (pp. 19-22), the authors detail "Nursing's Unique Medicine" and compare it with nurse and physician areas of shared medicine. Potter's BASE of Nursing as a framework for the medicine of nursing is presented. Chapter 2 presents the history, theory, language, and principles of interprofessional education and collaboration practice.


Part 2, encompassing Chapters 3, 4, and 5, is titled "Reconstructing a Partnership-Based Cultural Narrative." Chapter 3 describes Eisler's Cultural Transformation theory, whereas Chapter 4 describes Potter's use of Eisler's theory to reexamine the history of nursing and how the domination narrative has been perpetuated. Chapter 5 contains autobiographies of historical nurses who chose an alternative to domination. This chapter presents eight nursing pioneers, such as Mary Seacole, Walt Whitman, Lillian Wald, Mamie Odessa Hale, and others, and what they viewed as important to their care. Table 5.1 "Historic Nurse and What Their Stories Tell Us" (pp. 132-134) is worth review.


The third part of the book is "A Systems Approach to Partnership-Based Nursing." Its seven chapters present what must be addressed to shift all relationships in healthcare to partnerships. The last chapter of this part questions assumptions under which we have functioned and offers partnership alternatives to the "old conquest-of-nature perspective" (p. xxix).


Part 4 discusses how a shift to partnership will require a shift in our economic models, with Chapter 13 introducing Eisler's Caring Economics model. Chapter 14 discusses leading the change and the role all nurses have in making partnership-based healthcare a reality.


I highly recommend this book to any nurse. The last chapter details what nurses, regardless of their practice site, can do to move the healthcare system to a partnership-based system. I encourage you to spend time rereading and thinking about the concept of definition of medicine and how this will impact the approach you take to partnership-based care.


These two books complement one another in their messages and offer direction for nursing in the future. Either or both of these books would serve as a great starting point for discussion of how the report will influence your nursing future and whether the new framework offered is a workable approach.