“At 3.6 million strong, nurses are by far the largest sector of the health profession and also the profession the public most trusts year after year,” (The Future of Nursing: Campaign for Action.)
In 2010, The National Academy of Medicine, then known as the Institute of Medicine, approved a groundbreaking report on the “Future of Nursing.” The central point was and is that we need nurses to have a leadership role in meeting the demands of our changing health care system. NAM offered up an action-oriented blueprint, calling on nurses to serve a greater role in America’s increasingly complex health care system in four key ways:
Practice “to the full extent of their education and training.”
Achieve “higher levels of education and training through an improved education system.”
Be “full partners, with physicians and other health care professionals, in redesigning health care.”
Assure “better data collection infrastructure for effective workforce planning and policy.”
Where are we and where do we need to be?
Data and workforce planning: For our state of Wisconsin, this is a good news/bad news story. The good: Among all the healthcare professions in Wisconsin, nursing has good workforce data collection and forecasting through a partnership of the Wisconsin Center of Nursing and the Wisconsin Department of Workforce Development. Also, we have seen that the RN workforce can grow in Wisconsin by 10,000 from 2010 to 2016. The bad: The most recent forecast shows Wisconsin will be nearly 17,000 registered nurses short by 2030, just as the “baby boomer” generation fully enters the retirement years and presents with a greater need for health care.
We also need nursing’s leadership to help us all focus on the forecast for family caregivers, 44 million nationwide, who offer critical support to nursing and other health care professionals. According to AARP, “in 2010, the family caregiver support ratio was more than seven potential caregivers for every person in the high-risk years of 80-plus. In 2030, the ratio is projected to decline sharply to four to one. Rising demand and shrinking families to provide long term services and support call for new solutions to the financing and delivery of LTSS.” Nursing can lead by expanding its focus on this rapidly diminishing resource.
Redesigning health care: As noted in the “Future of Nursing,” “efforts to cultivate and promote leaders within the nursing profession − from the front lines of care to the boardroom − will prepare nurses with the skills needed to help improve health care and advance their profession. As leaders, nurses must act as full partners in redesign efforts, be accountable for their own contributions to delivering high-quality care and work collaboratively with leaders from other health professions.” The Future of Nursing: Campaign for Action is sponsored by the Robert Wood Johnson Foundation, the country’s largest philanthropy devoted to health and AARP, the nation’s largest nonprofit, nonpartisan organization dedicated to empowering Americans 50 and older. As of July 2017, the campaign reports over 3,200 nurses serving on corporate boards. This represents a significant improvement, but the holistic perspective a nurse leader brings is still underutilized by healthcare and related sectors.
In these roles, nursing can significantly strengthen statewide and local efforts to address the determinants of health, including how and where we live, work and play. In Wisconsin, a significant new opportunity will soon be available through the Healthy Community Designation initiative sponsored by the University of Wisconsin Population Health Initiative https://uwphi.pophealth.wisc.edu. While I may be speaking from my own self-interest, all aspects of the impact of Wisconsin’s baby boomer demographic shift need to be considered in the preparation and deployment of our nursing students; the unique health care needs of our elders are no longer on the edge of the population served but at its core.
Improved education system: As called for by Competitive Wisconsin (competitivewi.com), nursing needs to be part of a multi-sector collaborative effort to “define challenges and proposing outcome and cost-effective systemic proposals on how best to address Wisconsin’s short- and long-term physician and nurse shortages.” Current efforts to expand enrollment and shorten the time in school without sacrificing quality must continue to be pursued. If schools of nursing and providers further partnered to improve nurse engagement and retention rates, we would reduce the need for additional graduates and the forecast nursing shortages. Developing a diverse workforce, in every sense of the word (including rural and inner city), must continue to be a priority.
The high average age of nursing faculty is a significant threat to meeting our long-term nursing shortage. Schools when hiring faculty should have additional flexibility to substitute experience for a terminal degree. We need new models to support community-based clinical instructors as downward cost pressure on providers means fewer potential student placements without remuneration.
We must retain two-year degree programs as a door into the profession. Many or most healthcare facilities encourage, if not require, that the nurses they employ hold or complete a BSN. While the importance of nursing’s shift to focus on BS-prepared practitioners is widely recognized, associate degree nurses are held in high respect and will continue to be needed, particularly in our rural communities.
Practice environment: According to the American Association of Nurse Practitioners, the practice environment in 22 states is “full,” “reduced” in 16 states (including Wisconsin) and “restricted” in the remaining 12. Full is defined as “state practice and licensure law provides for all nurse practitioners to evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments–including prescribe medications.”
Substantial progress is needed for nurse practitioners in Wisconsin and many other states to practice “to the full extent of their education and training.” A truly collaborative team recognizes and respects the full contributions of what each member can do for the patient that expands on what anyone can do alone. We have entered an era when the shortage of health care professionals across the country is creating institutional and market forces in support of truly collaborative practice. We accelerate the development of true team-based care when we all spend more time talking and learning across our own disciplines’ boundaries.
As noted by NAM, “The United States has the opportunity to transform its health care system, and nurses can and should play a fundamental role in this transformation. Working together, with many diverse parties, nursing can help ensure that the health care system provides seamless, affordable, quality care that is accessible to all and leads to improved health outcomes.”