Mapping the Future of Nursing

We recently marked a historic day for nursing. The meeting “Partnering to Transform Healthcare in Pennsylvania,” part of a national effort, brought together more than 200 nurses and nursing students here at Penn earlier this month to discuss an action plan for the future of healthcare in the state. It is clear that nurses in Pennsylvania have great potential – and responsibility -- to make much-needed changes to the healthcare system.

To this end, the Pennsylvania State Nurses Association, a co-leader of the Pennsylvania Action Coalition, joined a 50-state campaign to advance the recommendations of the Institute of Medicine’s 2010 Future of Nursing report. Leading the campaign are the Robert Wood Johnson Foundation (RWJF), the Center to Champion Nursing in America, and the AARP Foundation.

Chaired by Julie Fairman, PhD, RN, FAAN, the Nightingale Professor at Penn Nursing, the steering committee of the Pennsylvania Action Coalition is developing a mission statement and strategic plan -- or “map” – to meet the IOM’s recommendations in Pennsylvania.

Time is of the essence. Pennsylvania ranks fourth in the nation among states with a population aged 65 and older, after Florida, West Virginia, and Maine, according to the 2010 Census, with similarly high rates of diabetes, hypertension, and asthma. The demand for healthcare providers of course is growing in tandem.
To meet the increasing healthcare needs of the U.S. population, the IOM report recommended:

• Increasing the proportion of nurses with a baccalaureate degree to 80 percent by 2020
• Doubling the number of nurses with a doctoral degree by 2020
• Developing nurse leaders to advance health
• Building an infrastructure for the collection and analysis of interprofessional healthcare workforce data to ensure equitable distribution of resources.
Advancing the education of nurses is particularly important. The national average for nurses with a bachelor’s degree is about 50 percent, and in Pennsylvania it is about 41 percent. Susan Hassmiller, senior adviser for nursing with RWJF, spoke not about a so-called “nursing shortage,” but about a faculty shortage. Estimates show that some 3,000 eligible nursing students are turned away every year by education programs in Pennsylvania for insufficient numbers of faculty to teach them.
As she pointed out, having more highly educated healthcare professionals will lead to safer and more effective care, and having more nurse practitioners and midwives in practice would help create a more cost-effective system.

The Pennsylvania Action Coalition will next establish regional coalitions co-led by a nurse and a non-nurse partner.  This is where the real work will take place. When you are called to participate, I urge you to join.

You have a role in ensuring more equitable care, state-by-state, in a country in increasing need of it.

Initiative on the Future of Nursing

Where do we go from here?

There’s no time to let moss grow under the feet of the medical profession. There are plenty of recommendations in this report that could be instituted with a minimum of delay. Some will cost money. Others will require new models to make them work. But the goal is essential and there is no time to waste.

• Nurses should practice to the full extent of their education and training
• Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression
• Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States.
• Effective workforce planning and policy making require better data collection and an improved information infrastructure.

In its recommendations, the committee suggested that Medicare and Medicaid should reimburse advanced-practice nurses for providing the same care provided by their colleagues. "When you do the same job, you ought to be paid the same,"  said Dr. Donna Shalala, who chaired the committee on the future of nursing.

Increasing access to care and utilizing nurses’ full capacity prompts such recommendations as changing regulatory barriers that prevent advanced practice nurses from admitting patients to the hospital or to a hospice. The reports calls for the Federal Trade Commission and the Department of Justice to review existing scope-of-practice provisions for "anticompetitive" practices.

Is all of this feasible? Yes it is. But it will take dedication and drive to make it happen sooner before the next crisis in health care bursts to the surface. 

-Afaf I. Meleis, Dean University of Pennsylvania School of Nursing


Read more about the Initiative on the Future of Nursing

Initiative on the Future of Nursing

Penn Researchers Role in New Nursing Report

Penn researchers contributed significantly to the 500-page report on The Future of Nursing: Leading Change, Advancing Health. The report draws heavily on practice at Penn Nursing and on research produced by a number of professors and researchers. Among them:

• The benefits of nurse-led teams to manage the discharge of chronically ill adults to avoid revolving-door hospital readmissions in a transitional model of care
• Nurse workforce issues including issues of nurse migration from other countries and turnover
• The contributions of nurses to invent new technology to help care for patients cites the device that measures the ability of vulnerable infants to suck and survive
• The potential for a new practice milieu with integrated teams within a “digital commons”

Dr. Donna Shalala, who chaired the committee on the future of nursing, put it succinctly:

“We cannot get significant improvements in the quality of health care or coverage unless nurses are front and center in the health-care system — in leadership, in education and training, and in the design of the new health-care system," she said.
 
-Afaf I. Meleis, Dean University of Pennsylvania School of Nursing

Read more about the Intiative on the Future of Nursing

Initiative on the Future of Nursing

The Nursing profession is ready
to head in new directions

The nursing profession has been long neglected and often ignored. But that’s about to change as nursing becomes an important piece of delivering better health care.

This new report underscores the importance of nursing as an essential component of the health care profession. Nurses are crucial in preventing medication errors, reducing rates of infection and successfully facilitating a patient’s return to health, not to mention delivering health care that may have been handled in previous times by a physician.

But it will take planning to bring nursing into this new age. It will require an emphasis on higher levels of education and more training. Physicians must embrace the idea that nurses are their full partners in a redesigned health care system in the United States.

Among the problems to fix:

• The federal government needs to develop a nationwide best practices model.
• Scope-of-practice barriers must be eliminated
• Better training for nurses must be provided so they can have a key role in a patient-centered health care system.
• A high turnover rates among newly graduated nurses means learning how to manage the transition from school to practice.

Along with the urgency to retool the profession, the need for a diverse workforce for a diverse society is acute and most urgent.

-Afaf I. Meleis, Dean University of Pennsylvania School of Nursing

Read more about the Initiative on the Future of Nursing 

Initiative on the Future of Nursing

Time to Remodel Nursing

A new report on 21st century nursing gives us plenty to digest and a big task to transform nursing, the largest segment of the health care workforce.

It offers recommendations that serve as a blueprint for the nursing profession to grow to a pivotal role in delivering quality health care. It means improving nursing education and providing new opportunities for nurses to assume leadership roles.

There is no time to sit still and just think about it. The recommendations come with a call to action. Some of them:

• Expand the nursing faculty, increase the capacity of nursing schools and redesign nursing education to make sure there will be an adequate number of well-prepared nurses for the new model of medicine now emerging.
• Attract and retain well-qualified nurses who can handle multiple care settings, including acute, ambulatory, primary care, long term care, community and public care.
• Find innovative solutions relating to delivery of care and develop new kinds of nurse education.

This report provides a thoughtful in-depth analysis of best practices, challenges and opportunities. We now have the directions. The question is how quickly can we get there?


-Afaf I. Meleis, Dean University of Pennsylvania School of Nursing

Read more about the Initiative on the Future of Nursing including past blogs:



Afaf I. Meleis, PhD, DrPS(hon), FAAN
Margaret Bond Simon Dean of Nursing
Professor of Nursing and Sociology
University of Pennsylvania
School of Nursing
Claire M. Fagin Hall
http://www.nursing.upenn.edu/

Initiative on the Future of Nursing

Nurses Can Deliver Better Health Care

Nurses hold the key to the future, according to the new report on the future of nursing by the Robert Wood Johnson Foundation and the Institute of Medicine.

However, nurses alone cannot make the changes so desperately needed to provide quality health care for the 21st century.

The power to improve the current regulatory, business, and organizational conditions does not rest solely with nurses; government, businesses, health care organizations, professional associations, and the insurance industry all must play a role.

Working together, these many diverse parties can help ensure that the health care system provides seamless, affordable, quality care that is accessible to all and leads to improved health outcomes.

But we don’t have the time to wait.

It’s essential to have a sea change in regulations because the United States has the opportunity to transform its health care system, and nurses can and should play a fundamental role in this transformation.

Nurses have the education, the expertise, and the capacity to meet the increasing demands for health care, but first they must be allowed to practice to their full capacity. Nurses’ roles, responsibilities, and education should change significantly to meet the increased demand for health care and to provide quality care through innovative models of care.

-Afaf I. Meleis, Dean University of Pennsylvania School of Nursing

Read more about the Initiative on the Future of Nursing 


Afaf I. Meleis, PhD, DrPS(hon), FAAN
Margaret Bond Simon Dean of Nursing
Professor of Nursing and Sociology
University of Pennsylvania
School of Nursing
Claire M. Fagin Hall
http://www.nursing.upenn.edu/

Initiative on the Future of Nursing

Nursing at a critical juncture: Time for change

A new report outlines a road map for nursing in the 21st century. The role of nurses will grow in the coming decades as more people are covered by health insurance, the report says, but there are significant challenges to making it happen and doing it right.

The recommendations of the report by the National Academy of Sciences' Institute of Medicine and the Robert Wood Johnson Foundation will be discussed at a symposium on Oct. 14 at the University of Pennsylvania’s School of Nursing.

Here are some highlights:

• There are more than 3 million nurses in the U.S. And they will be taking on new responsibilities with changes in the health care system as a result of the Obama administration’s new health care law. It will mean coverage for millions of Americans and expanded work for the health care field. Nurses will be at the forefront of these changes.
• In 10 years, 80 percent of nurses should have bachelor's degrees. Twice as many nurses should get PhDs, and all nurses should do residencies, the sort of practical training that new doctors do, the report recommends.
• But that’s not all. The report calls for the elimination of regulations and institutional limits on what nurses are allowed to do, including so-call "scope of practice" rules that define what sorts of care about they can and can't provide.

This report is a rich resource of integrated information. It is instructive on how nurses can effectively deliver quality health care and be prepared to meet the demands of a reformed health care system. Implementing this report’s recommendations will offer greater access, higher quality and more cost-effective care to the American public.

-Afaf I. Meleis, Dean University of Pennsylvania School of Nursing

Read more about the Initiative on the Future of Nursing


Afaf I. Meleis, PhD, DrPS(hon), FAAN
Margaret Bond Simon Dean of Nursing
Professor of Nursing and Sociology
University of Pennsylvania
School of Nursing
Claire M. Fagin Hall
http://www.nursing.upenn.edu/