Making Room, Being Ready, and Expecting More: A Response to "The Future of Nursing" Report
Just 3 years ago, 2 trendsetters in health care, The Robert Wood Johnson Foundation and the Institute of Medicine (IOM), created a project led by carefully selected nurses and nonnurses to examine the present and the potential future roles of the largest licensed group of health care professionals in America: nurses. The project was initiated because of the shocking consensus that the health care system in America is unable in its current structure to fully meet the health care needs of its citizens. More is needed from nurses and not just because of the sheer numbers in the profession; nurses practice in settings that range from the homes of individual patients to the helms of entire health care systems and are thus positioned to affect all levels of care. Oncology nurses populate these very diverse settings and do so to provide direct care, create new knowledge, develop practice guidelines, prepare the next generation of nursing and nonnursing providers, and garner human and technological resources to advance and sustain premier health care systems. What is true about nursing in 2011 in America has meaning for nurses in the world's nations: we are all challenged to meet the health needs of our citizens.
A final report from this project, "The Future of Nursing: Leading Change, Advancing Health," has now been issued (http://www.iom.edu/nursing). Four themes are central to the overall report: (1) nurses should practice to the full extent of their education and training; (2) nurses should achieve higher levels of education and training in seamless academic progression; (3) nurses should be full partners with physicians and other health care professionals to redesign health care in America; and (4) improved data collection and information infrastructures are essential for workplace planning and policy making to fully educate and deploy the nursing workforce. Past and current barriers to achieving the end points described in each theme were boldly identified in the report including systems and disciplines that, by design or oversight, prevent the nursing workforce from being the contributor that it could and should be.
Bluntly translated, these organizing themes mean that (1) government and private payers as well as policy makers, physicians, and others in decision-making positions could advance efforts to meet the health care needs of a nation's citizenry by making room for nurses and actively welcoming them into decision-making roles and situations; (2) the nursing workforce needs to be well prepared through education and experience to step into decision roles and opportunities and to perform well; and (3) nurses and nonnurses need to have higher expectations of nursing and the contributions that can and will come from nurses. As stated in the IOM report, if we are to transform health care systems, we need to transform nursing.
Multiple nursing organizations have responded favorably to the report. The American Medical Association (AMA) also issued a response that included an acknowledgement of how important nurses are to a health care team and a statement of commitment to expanding the health care workforce (http://www.ama-assn.org/ama/pub/news/news/nursing-future-workforce.shtml). Regrettably, the focus of the AMA response was on the difference between the number of years of education between physicians and nurse practitioners. Furthermore, commentary included statements about the expectation of patients to be seen by physicians in a particular care setting (emergency department) and that preparing advanced practice nurses has not solved physician and nursing shortages in certain areas. No statements in the AMA response addressed the central themes or greater majority of the IOM report. This narrowly focused response from our trusted and valued colleagues is disappointing.
We as oncology nurses have steps to take to move the themes of the report into reality. This is our chance to be part of a nation's response to the care of its people-let us all respond. What we do here could and should serve others around the globe. We need to be well educated, well grounded in our practice, and well prepared experientially and ready to responsibly collaborate on or to lead decision-making opportunities to improve health care. We each need to support education of nurses at all levels (the IOM report calls for associate degree nurses to become baccalaureate prepared and for the doubling of doctorally prepared nurses by 2020); we need to critically examine curricula and clinical experiences for how well they prepare us to provide safe and high-quality care and to advocate effectively for such care with regulatory agencies, third-party payers, and administrators; we need to know our science and that of other disciplines to directly address the unknowns in health care; we need to document our care and its outcomes and seek relentlessly to make the outcomes better; and we need to engage our colleagues in discussion about the themes of this report. The AMA response highlights the need for nurses to be well informed about the report and to engage in discussions about the report with our valued physician colleagues. Advancing nursing's responsibility for a nation's health care is not meant to be at the costs of opportunities or income losses for physicians. We need to help them and others make room for the nursing perspective, and we need to fill the opening with prepared, ready, and willing nurses. We and others need to expect more of nurses and together do more for a nation.
Pamela S. Hinds, PhD, RN, FAAN
Editor-in-Chief, Cancer Nursing(TM)