On October 5, 2010, the Institute of Medicine (IOM, 2010) released a lengthy document entitled The Future of Nursing: Leading Change, Advancing Health. This document is the culmination of 2 years of work by the Robert Wood Johnson Foundation Committee on the Initiative on the Future of Nursing, an 18member Committee that included nurses, physicians, public health experts, researcher, educators, administrators, and consultants. This 620-page evidence-based publication details ways in which the nursing profession should be transformed and describes how harnessing the full potential of the profession can improve healthcare in the United States.

Predictably, the American Medical Association (AMA) immediately responded endorsing a "physician-led team approach to care" and further stated that "increasing the responsibility of nurses is not the answer to the physician shortage" (AMA Press Release, 10/6/2010). The AMA seems to have missed the point. The report does not purport to be addressing the "physician shortage"-instead it speaks to the big picture, transforming our health care system and the role nurses should play in that transformation.

Fortunately, not all physicians agree with the AMA. In a November 18th editorial in the New York Times, Pauline W. Chen (2010), M.D., applauds the document and states that nurses have been "conspicuously absent" from the process of strategizing currently taking place to plan how our already overburdened healthcare system will cope with increased demands in the future.

The recommendations in The Future of Nursing center around four key messages:

1. Nurses should practice to the full extent of their education and training. (pg. 3-1)

2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. (pg. 4-1)

3. Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States. (pg. 5-1)

4. Effective workforce planning and policy making require better data collection and an improved information infrastructure. (pg. 6-1)

Here are a few examples of issues addressed in the recommendations. We encourage you to read more of the details for yourself. The entire report is available online and at no charge: http://books.nap.edu/catalog.php?record_id=12956

PRACTICE TO FULL EXTENT OF TRAINING AND EDUCATION

Currently many advanced practice nurses are limited in their practice by their state boards of nursing and institutional policies and credentialing. For example, nurse practitioners do not have prescriptive authority in all states. However, this recommendation does not just address advanced practice nurses. It also points out systems and inefficiencies in design that lead to nurses spending less and less time caring for patients and more time documenting, interacting with technology, or dealing with poorly designed systems that lead to wasted time (e.g., walking to retrieve supplies in inconvenient locations, etc.).

HIGHER LEVELS OF TRAINING WITH SEAMLESS ACADEMIC PROGRESSION

While the report does not specifically state that the Bachelor's of Science in Nursing (BSN) should be the entry level for practice, it does say that we need more nurses to enter with a baccalaureate or to progress to that level early in their career. The report also argues for more nurses with advanced degrees, specifically doctoral preparation. The recommendations about nursing education include curricula changes to help establish a foundation for lifelong learning, cross-disciplinary education with physicians and other health care providers, improved opportunities for transitioning to a higher degree, and more diversity in the nursing workforce.

Nursing has been arguing about entry to practice for decades. It is the time to stop arguing and just do it!! What other profession can enter practice with two, three, or four years of preparation? Nurses make life-saving decisions on a daily basis, our patients deserve well-educated practitioners, and we deserve the professional recognition that comes with the requirement for collegiate education as a standard.

FULL PARTNERS IN REDESIGNING HEALTH CARE

The timing of this report is fortuitous. Changes mandated by the 2010 Affordable Care Act will place significant demands on the U.S. system within the next few years. These demands will require new roles and structures for healthcare delivery. All nurses will need leadership skills and competencies in addition the political skills necessary to work together and with other members of the healthcare team in policy development. The public trusts nurses (Gallup, 2009); nurses need to trust themselves to be involved in policy development from stretcher-side to boardroom to the legislature and beyond. Nurses have traditionally implemented plans made by others; now nurses need to participate in making and implementing the plans for the transformation of health care.

BETTER DATA COLLECTION AND IMPROVED INFORMATION INFRASTRUCTURE

The Affordable Care Act mandates the collection and analysis of workforce data so that future needs can be predicted and enable proactive planning to make sure that those needs are met. Currently, there are many gaps in information about numbers and distribution of various types of practitioners as well as the cost-effectiveness of different team configurations and educational programs. These data are essential to plan for the resources necessary to meet future needs.

As editors of AENJ, we salute the IOM and RWJF for recognizing the contributions that nurses do and can make to health care. They have invited us to the table in a very public fashion and we now have a golden opportunity to help improve the system for patients' sake. Perhaps it is time for an even more visible paradigm shift. Let us rename the IOM and make it the Institute of Health Care to acknowledge that high-quality health care requires a team. It is not all about "medicine."

Jean A. Proehl, RN, MN, CEN, CPEN, FAEN

Emergency Clinical Nurse Specialist & Consultant, Cornish, NH Dartmouth-Hitchcock Medical Center, Lebanon, NH, Gifford Medical Center, Randolph, VT, Colby Sawyer College, New London, NH

K. Sue Hoyt, PhD, RN, FNP-BC, CEN, FAEN, FAANP

Emergency Nurse Practitioner St. Mary Medical Center Long Beach, CA

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