1. Shalala, Donna E. PhD
  2. Bolton, Linda Burnes DrPH, RN, FAAN


Nurses are transforming American health care.


Article Content

Few health care reform efforts will affect patients as directly as determining how nurses can best work toward ensuring high-quality, affordable care for all Americans. As the chairperson and vice chairperson of the Initiative on the Future of Nursing, a new effort created by the Robert Wood Johnson Foundation and the Institute of Medicine, we are seeking innovative ideas that address important nursing issues, such as the nurse shortage and regulatory and reimbursement barriers to nursing, and which can help transform the way Americans receive care.


Without question, we're joining a very crowded field in the health care reform debate. Participants include health care providers, insurers, policymakers, and consumers. This long-running debate is impassioned and opinionated, with many participants firmly convinced they know the best way to fix our desperately broken system. The initiative provides a means for nurses to join this effort. It will convene three regional town hall-type meetings, and several technical or policy-oriented workshops, to gather information. The initiative's committee will then prepare a consensus report, and the initiative's sponsors will hold a national conference on the issues raised.


As the largest group of health care professionals, nurses hold the key to effective health care system change. We know that efforts to address the challenges facing the system will be in vain without their expertise and leadership. So much of what nurses do directly addresses health care reform goals: better-quality care for more people at a lower cost. Nurses have been shown to reduce the rates of medical error, death, and hospital-acquired infection, and they contribute to shorter hospital stays for patients. Nurses are trained to provide case management in patients with chronic diseases, helping them avoid high-cost acute care. And nurse-led efforts in health promotion and screening for early detection are at the center of preventive care. Along with physicians and other providers, advanced practice nurses provide primary care to patients who might otherwise go without basic health care.


Unfortunately, nursing is facing a crisis that, left unaddressed, will severely hinder health care reform efforts. There simply are not enough nurses. Current estimates put the shortage at a half million by 2025, and it could worsen as the population ages and the need for long-term care and chronic disease management increases. This workforce crisis requires swift and bold action to fix ongoing problems: insufficient faculty to educate the next generation of nurses, inadequate nursing curricula that fail to address 21st-century clinical practice, and regulatory and reimbursement constraints that prevent the health care system from using nurses as effectively as possible.

Figure. Donna E. Sha... - Click to enlarge in new windowFigure. Donna E. Shalala (left) and Linda Burnes Bolton

The Initiative on the Future of Nursing will work over the next year to develop a blueprint for action on these issues and identify ways for nurses to contribute to the design and implementation of health reform. Our nation's leaders must not squander the opportunity to benefit from the insight and experience of nurses as they tackle the daunting task of determining who pays for and delivers health care services. The initiative recognizes that our health care system depends on the involvement and expertise of a vast number of professionals. At the same time, we must acknowledge that no matter the specific outcomes of health care reform, nurses will be on the front lines of the redesigned system, delivering care.


Let us know your thoughts on the initiative at