1 REPORT BRIEF OCTOBER 2010. Advising the nation / Improving health For more information visit The Future of Nursing Focus on education The 2010 Affordable Care Act represents the broadest health care over- haul since the 1965 creation of the Medicare and Medicaid programs. Trans- forming the health care system to provide safe, quality, patient-centered, accessible, and affordable care will require a comprehensive rethinking of the roles of many health care professionals, nurses chief among them. To realize this vision, Nursing education must be fundamentally improved both before and after nurses receive their licenses. In 2008, the Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) launched a two-year initiative to respond to the need to assess and transform the Nursing profession.
2 The IOM appointed the Com- mittee on the RWJF Initiative on the Future of Nursing , at the IOM, with the purpose of producing a report that would make recommendations for an action-oriented blueprint for the Future of Nursing . As part of its report, The Future of Nursing : Leading Change, Advancing Health, the committee considered many challenges that face the Nursing edu- cation system and some of the solutions that will be required to advance the system. It determined that nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. The Need for Highly-Educated Nurses In the 21st century, the health challenges facing the nation have shifted dra- matically.
3 The American population is older Americans 65 and older will be nearly 20 percent of the population by 2030 as well as more diverse with respect not only to race and ethnicity but also needed to negotiate with the health care team, other cultural and socioeconomic factors. In addi- navigate the regulatory and access stipulations tion to shifts in the nation's demographics, there that determine patients' eligibility for enrollment also have been shifts in that nation's health care in health and social service programs, or under- needs. Most health care today relates to chronic stand how these programs and health policies conditions, such as diabetes, hypertension, arthri- affect patients and health outcomes.
4 Nursing cur- tis, cardiovascular disease, and mental health con- ricula need to be reexamined, updated, and adap- ditions, due in part to the nation's aging popula- tive enough to change with patients' changing tion and compounded by increasing obesity levels. needs and improvements in science and technol- While chronic conditions account for most of the ogy, the IOM committee says. care needed today, the health care system was Many Nursing schools have dealt with the primarily built around treating acute illnesses and rapid growth of health research and knowledge by injuries, the predominant health challenges of the compressing available information into the cur- early 20th century.
5 Riculum and adding layers of content that require The ways in which nurses were educated dur- more instruction. New approaches and educa- ing the 20th century are no longer adequate for tional models must be developed to respond to dealing with the realities of health care in the 21st burgeoning information in the field. For example, century. As patient needs and care environments fundamental concepts that can be applied across have become more complex, nurses need to attain all settings and in different situations need to be requisite competencies to deliver high-quality taught, rather than requiring rote memorization. care. These competencies include leadership, Competencies also must move from task-based health policy, system improvement, research and proficiencies to higher-level competencies that evidence-based practice, and teamwork and col- provide a foundation for care management knowl- laboration, as well as competency in specific con- edge and decision-making skills under a variety of tent areas such as community and public health clinical situations and care settings.
6 Additionally, and geriatrics. Nurses also are being called upon emerging new competencies in decision making, to fill expanding roles and to master technologi- quality improvement, systems thinking, and team cal tools and information management systems leadership must become part of every nurse's pro- while collaborating and coordinating care across fessional formation. teams of health professionals. To respond to these increasing demands, the IOM committee calls for nurses to achieve higher levels of education and Entering the Profession suggests that they be educated in new ways that Nursing is unique among the health care profes- better prepare them to meet the needs of the pop- sions in the United States in that it has multiple ulation.
7 Educational pathways leading to an entry-level license to practice. Nursing students are able to pursue three different educational pathways to An Improved education System become registered nurses (RNs): the bachelor's of Much of Nursing education revolves around acute science in Nursing (BSN), the associate's degree in care rather than community settings that include Nursing (ADN), and the diploma in Nursing . More aspects of primary care, public health, and long- recently, an accelerated, second-degree bachelor's term care. Nursing education frequently does not program for students who possess a baccalaureate incorporate the intricacies of care coordination degree in another field also has become a popular and transitions.
8 Nor does it promote the skills option. These various pathways provide numer- 2. ous opportunities for women and men of modest mation management systems that require skills in means and diverse backgrounds to access careers analysis and synthesis. Care outside the hospital is in an economically stable field. becoming more complex as well. Nurses are being The qualifications and level of education called on to coordinate care among a variety of cli- required for entry into the Nursing profession have nicians and community agencies; to help patients been widely debated by nurses, Nursing organiza- manage chronic illnesses, thereby preventing tions, academics, and a host of other stakeholders acute care episodes and disease progression; and for more than 40 years.
9 Although a BSN education to use a variety of technological tools to improve is not a panacea for all that is expected of nurses the quality and effectiveness of care. A more edu- in the Future , it does, relative to other educational cated Nursing workforce would be better equipped pathways, introduce students to a wider range to meet the demands of an evolving health care of competencies in such arenas as health policy system, and this need could be met by increasing and health care financing, community and public the percentage of nurses with a BSN. An increase health, leadership, quality improvement, and sys- in the proportion of nurses with a BSN also would tems thinking.
10 Care within the hospital continues create a workforce poised to achieve higher lev- to grow more complex, with nurses having to make els of education at the master's and doctoral lev- critical decisions associated with care for sicker, els, required for nurses to serve as primary care frailer patients and having to use more sophisti- providers, nurse researchers, and nurse faculty . cated, life-saving technology coupled with infor- positions currently in great demand across the Distribution of the registered nurse population by highest Nursing or Nursing -related educational preparation, 1980-2008. 3,500. 3,000. Number of RNs (thousands). 2,500 2,000 1,500 1,000 500.