Healthcare is one of the ever present national challenges in the United States. For years, the nation has grappled with poor health outcomes and runaway healthcare costs. Ironically, with time, the country’s healthcare system has proven to be one of the most expensive in the world, but still with some of the worst recorded health outcomes. Increased healthcare spending could not be matched with quality of care among other health parameters. In 2010, the nation’s congress made a huge step towards improving general health through the enactment of the Affordable Care Act, christened Obama Care (Fitzpatrick, 2010). This brought about the promise for more equitable, accessible, safer and high quality care for all albeit with a number of challenges. Some of the solutions to such challenges were to be found in the institute of medicine (IOM) and the Robert Wood Johnson Foundation Committee Initiative (RWJF) on the future of nursing. The latter was premised on the fact that nurses encompassed around 3 million of the total healthcare workforce in the United States, and in essence were the largest number (Sochalski & Weiner, 2011). Therefore, to transform the healthcare system, there was need to redefine and leverage on the highest output delivery by nurses. The combined work of the RWJF and IOM led to the report “Future of Nursing: Leading Change, Advancing Health” which explained various thematic areas for transforming the nursing profession. This paper discusses the work of the RWJF and IOM leading to the above report, the importance of the report in various respects and the role of state-based action coalitions in advancing the future of nursing.
There was lots of preliminary work done by both the RWJF and IOM in the run up to the development of the report; Future of Nursing: Leading Change, Advancing Health. Prior to the enactment of the Affordable Care Act, the RWJF can up with a vision for transformed healthcare in the US. The gist of this vision was to make high quality care available for diverse people, promote wellness and disease prevention as well as provide compassionate care (Sochalski & Weiner, 2011). In the end improved health outcomes were to be experienced across board. As it emerges, this vision for transformed healthcare centered on improvement of primary care and disease prevention. Other facets of the vision entailed interdisciplinary approaches to care and rewarding quality rather than volumes in payment for health services which further needed to be affordable for both the society and the individual. When the ACA came in force, it was a huge step towards realizing the above vision but could not adequately meet the mark without further intervention (Puetz, 2013). There was need to remodel and reexamine the nursing profession to ensure that it set the pace for healthcare transformation having the largest chunk of healthcare works in the industry. This led to the RWJF approaching the IOM with a proposal for the reassessment and response to the need to transform the nursing profession. What followed was the RWJF committee initiative in conjunction with the IOM which was to work for two years and prepare an actionable report addressing the future of nursing. A number of knowledge dissemination events including conferences have since been held in the aftermath of the report’s release.
The report was significantly important with respect to the development of nursing practice, nursing education and nursing workforce development. One of the key messages in the report was that nurses should practice to the full scope of their education and training (Puetz, 2013). In this respect, the report outlined the various impediments to comprehensive nursing practice in the past including high rates of turnover in the profession, fragmentation of care, and regulatory barriers (Fitzpatrick, 2010). It was particularly of concern that nurses had been restricted in most states in their scope of practice, disallowed to see patients in the absence of a physician. In some states, practice guidelines were quite vague impeding nurses from taking full advantage of their training and education. The report therefore highlighted the need to unchain nurses to allow them to practice to their full potential without institutional and normative barriers. Elsewhere, the report also highlighted the need for nurses to attain higher education through an improved education system that encouraged career progression. Nurses needed a better education system that aided licensing while also setting up the pathway for advanced degrees and certifications. There were various impediments that were to be addressed in this respect including but not limited to lack of enough nursing educators, un-standardized training and high cost of education (Sochalski & Weiner, 2011). In regards to nursing workforce development, the report recommended that nurses were to be taken as full partners alongside physicians and other stakeholders in the transformation of US healthcare. Nurses needed to go beyond clinical practice and provide strong leadership that would allow them to be a force in the transformation of healthcare. In seeking leadership, they needed to develop various skills and competencies that would allow for dispensation of leadership functions.
State based coalitions play an essential role in advancing the goals of Future of Nursing: Campaign for Action.There are several initiatives currently in play at the state level aiming at reaching the various goals set out such as leadership, nursing education, increasing diversity and collaboration between professionals. One of those initiatives is the Nurse Leaders’ Institute which aims at training and equipping the next generation of nurse leaders. These shall in turn play a major role in leading change in healthcare as well as developing the capacity of nurses to act as equal stakeholders in interdisciplinary care teams (Sochalski & Weiner, 2011). Yet another initiative is on increasing the number of BSN nurses through various educational pathways at the state level. This has been pursued through setting of targets and working out plans to pursue those targets through stakeholder engagement in the education sector. Issues of funding, curriculum and rewards have been explored in the search for sustaining solutions. Various barriers currently exist including shortage of nursing workforce and high attrition rates. These barriers can be overcome by working in various mechanisms to motivate nurses and increase their job satisfaction (Fitzpatrick, 2010). In the end, there shall be progress in retaining the nursing workforce and furthering their education.
In conclusion, it is apparent that the future of nursing is an item of great interest. Nurses are the largest number of healthcare staff in the US and therefore any hope of transforming the healthcare system lies in transforming the nature and practice of nursing. The RWJF and IOM set out a good foundation for the same in their report, the Future of Nursing: Leading Change, Advancing Health. Drawing on this report and other allied initiatives, nursing can be transformed to the extent of realizing the vision of a transformed healthcare.
Fitzpatrick, J. J. (2010). The future of nursing: Leading change, advancing health. Nursing Education Perspectives, 31(6), 347-348.
Puetz, B. E. (2013). The future of nursing: leading change, advancing health. Journal for nurses in professional development, 29(2), 51-51.
Sochalski, J., & Weiner, J. (2011). Health care system reform and the nursing workforce: Matching nursing practice and skills to future needs, not past demands. The future of nursing: Leading change, advancing health, 375-398.
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