1. Tiase, Victoria L. PhD, RN-BC, FAMIA, FNAP, FAAN

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In May 2020, the National Academy of Medicine released its second consensus study report on the nursing profession entitled, "The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity."1 The report was funded by the Robert Wood Johnson Foundation and is the product of a National Academy of Medicine committee of 15 experts in nursing leadership, education, practice, and workforce as well as health policy, economics, medicine, law, and healthcare research. Drs Mary Wakefield and David Williams chaired the committee. It met eight times, including two sessions with the public. Committee members also conducted site visits and town halls in Chicago, Philadelphia, and Seattle.


This new report first and foremost recognizes that promoting health and well-being for all has long been an essential role of nurses. And, as the largest and consistently most trusted segment of the health workforce, nurses are well-suited to help our country advance health equity. The report identifies nurses as bridge builders and collaborators who engage and connect with people, communities, and organizations to ensure people from all backgrounds have what they need to be healthy and well. Through concerted efforts connected to practice, education, and research, the nursing profession is uniquely positioned to lead in health equity over the next decade. However, the report insists that nurses need more support from the systems that educate, pay, employ, and enable them to continue this critical work.


At a high level, the Future of Nursing report lays out four key actions:


Permanently remove barriers



Nurses currently face two types of barriers: those relating to scope of practice, which can be lifted through policy changes; and institutional ones, which affect where nurses are working, learning, and training. These range from restrictions on providing telehealth services to workplace policies that prevent them from providing optimal care. To address these barriers, the report recommends an expanded scope of practice for advance practice RNs, including nurse practitioners, and the removal of institutional barriers, such as telehealth restrictions and restrictive workplace policies.


Value nurses' contributions



The current healthcare payment system prioritizes volume of care and underestimates the value nurses bring in addressing obstacles to good health, such as poverty and discrimination, and in expanding access to care. The work that nurses do-much of which addresses the social determinants of health (SDOHs)-is often unrecognized and undervalued. The report recommends reforming and embracing different payment models and centering performance measures on health equity. The creation of a national nurse identifier can be used to meaningfully quantify the value of nurses.


Prepare nurses to advance equity



Evidence shows that nurses at all levels and in all settings are not yet prepared to advance equity for all. Preparing them to address the evolving health, social, and economic needs of their communities should take many forms. The report recommends steps that educators and employers should take such as expanding the environments where nurses train to prepare nurses to work in and with communities, increasing the capacity of the nursing workforce to respond to public health emergencies and natural disasters, and supporting nurse well-being so nurses can in turn support the well-being of others.


Diversify the workforce



To better serve and understand the changing needs of the nation, it is critical that the nursing workforce reflects that of the country. Moreover, by diversity, the report refers to diversity in all its forms: by race, ethnicity, gender, sexual orientation, gender, geography, and more. The report recommends that in order to diversify the nursing workforce, nursing schools need to intentionally recruit, support, and mentor faculty and students from diverse backgrounds to ensure that the next generation of nurses reflects the communities they serve.


Reflecting on the first report, "The Future of Nursing: Leading Change, Advancing Health," it was mostly centered on building the volume of the nursing workforce. Its messages were to educate more nurses-especially BSN- and PhD-prepared nurses-and promote full practice authority for advance practice nurses.2 There were also themes connected to growing nurse leaders and improving data collection of the nursing workforce. However, the first report had one very small mention of the use of electronic medical records and no mention of the need for informatics. Fortunately, this report calls for the use of data, information, and knowledge to get us to an equitable, healthy future for all. It infuses the importance of leveraging SDOH data, employing nurses with informatics expertise, encouraging innovation, and providing resources to facilitate telehealth delivered by nurses.



Race and ethnicity, income level, sexual orientation, immigration status, access to health insurance, and the conditions of neighborhoods predict whether one will experience preventable, costly medical conditions, live shorter lives, and have a fair and just opportunity to be healthy and well. Understanding the roots of these inequities and the role that housing, transportation, the kind of job one has, the conditions of one's neighborhood, and other social needs data play will help improve everyone's health and well-being.


It is not simply collecting SDOH data but facilitating the sharing of these data across settings, especially with community-based organizations. This includes the technical integration of these data into nursing workflows in a meaningful way, with the proper visualization and contextualization so that nurses can efficiently make use of the data in clinical decision-making. The inclusion of environmental data sharing can aid in responding to public health issues as well as natural disasters or climate change more generally.



The report has a portion of the education chapter dedicated to nursing informatics. Given that the updated American Association of Colleges of Nursing Essentials now includes the informatics and healthcare technologies domain, the report urges its incorporation into curricula. The report also notes that nursing informaticists will be needed to leverage artificial intelligence and advanced visualization methods to summarize and contextualize SDOH data in a way that provides actionable insights while also eliminating bias and not overwhelming nurses with extraneous information. Even nurses who do not specialize in informatics will need to understand how the analysis of massive datasets can impact health. Investments in expanding program offerings, certifications, and overall student enrollment will be needed to meet the demand for nurses with such skills. Essential skills for nurses using these new tools will include the ability to project a caring relationship through technology and to use technology to personalize care based on patient preferences, technology access, and individual needs.



Another focus area of the report is the use of technology to effectively manage patient populations and to increase patient access. The use of information and communication technologies and informatics processes should be used to deliver safe nursing care to diverse populations in a variety of settings. This includes deploying advanced technologies for the analysis of large amounts of data from such sources as sensors, wearables, and other digital devices that can help with detecting and tracking disease trends, identifying disparities, and finding patterns of correlation. Tools for data analytics will become increasingly important for improving patient care and the health of population. The report also emphasizes that nurses can not only use, but also constructively inform the design and deployment of these technologies so they are free of bias and can augment nursing processes rather than create additional burdens.


The role of telehealth and the importance of training nurses in this technology have been recognized for several years, but the urgent need for telehealth services during the COVID-19 pandemic has made it "imperative" to include telehealth training in nursing curricula. Moreover, it is anticipated that the shift to telehealth for some types of care will become a permanent feature of the healthcare system in the future.



The report concludes with 11 recommendations for charting a 10-year path forward. The sixth recommendation, along with five subrecommendations, is crafted specifically for informatics and technology aspects (Table 1). Now it is time for the collective "us" to move forward with action plans and roadmaps to support the recommendations. So please look for ways to stay connected, the Future of Nursing 2020-2030 Web site and Campaign for Action are good places to sign up for updates. At a minimum, align with your nursing specialty organizations and please anticipate future updates from the Alliance for Nursing Informatics.

Table 1 - Click to enlarge in new windowTable 1 Future of Nursing 2020-2030 Report Recommendation 6



1. National Academies of Sciences, Engineering, and Medicine. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press; 2021. [Context Link]


2. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press; 2011.[Context Link]