The Future of Nursing...Leading Change, Advancing Health. Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. 2011. Washington, DC. The National Academies Press. Hardcover, 671 pages with CD ROM, $49.95, can be ordered from The National Academy Press at http://www.nap.edu.

There is hardly a presentation in the last year that has not referred to the Institute of Medicine (IOM) report on the future of nursing. How many of us have seen or heard the 4 key messages of this report?

* Nurses should practice to the full extent of their education and training (p. 29)

* Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression (p. 30)

* Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States (p. 32)

* Effective workplace planning and policy making require better data collection and an improved information infrastructure (p. 33)

These are powerful messages that are evidence based. The book (or the IOM report in book form, hereafter referred to as the report) provides the full work and thinking of the committee to substantiate these messages. As nurse leaders participate and/or lead in the redesign of health systems, this report will be a necessary reference for those from the bedside to the boardroom. True patient-centered care demands a full understanding of the contribution of Nursing and other health professionals if we are to achieve an increase in quality while decreasing costs.

The committee that produced the report was composed of 18 members, led by Donna Shalala (Chair) and Linda Burnes Bolton (Vice Chair). Also identified are 16 reviewers, an equally impressive list. The report is divided into 3 parts:

Part 1: Key Messages and Study Context

Part 2: A Fundamental Transformation of the Nursing Profession

Part 3: A Blueprint for Action

The report includes Appendices A through E. Appendices F-J can be found in the CD-ROM. The findings and recommendation of the committee are supported with 18 tables, 29 figures, and 40 boxes.

The work of the committee was a complex and inclusive process with feedback from a broad range of sources. As with all good committee work, they began with a vision:

"The committee envisions a future system that makes quality care accessible to the diverse populations of the United States, intentionally promotes wellness and disease prevention, reliably improves health outcomes, and provides compassionate care across the lifespan." (p. 2)

Without this vision, the key messages and recommendations cannot be fully understood. The newly enacted and historical Affordable Care Act (is currently under review in the Supreme Court of the United States). Whether the legislation is held to be constitutional, the work done by this prestigious Institute of Medicine committee, funded by the Robert Wood Johnson Foundation, has important implications beyond what the legislative, executive, and judicial branches of our government argue. This is about the health of our nation, something that has always been a core element of nursing's vision. Whether 32 million uninsured receive health care through the front door as part of a comprehensive health system or through the back door via emergency rooms and hospitals, the system as we currently know it, needs to be redesigned. With 3 million nurses--the largest segment of the health care workforces--nursing is poised to bridge the gap between coverage and access.

The committee examined closely issues of interprofessional collaboration, value versus volume, quality care at an affordable price, diversity of the nation and the providers serving them, education of nurses, the profession of nursing scope and practice, and nursing expertise across the broad continuum of care, with a particular focus on coordination of care to palliative care in the absence of cure. These are only a few of the issues they addressed. Equally important, they did not shy away from the difficult political realities. They address straight on the American Medical Association's position on the independent practice of nurse practitioners.^{(pg 110)}

This is an excellent report. My only recommendation would be to create a short companion piece or reference guide on how to access the wealth of information in this book. This addition would be particularly useful for students. Because the committee believes in evidence-based practice, they use real data to support their analyses and recommendations. I randomly chose one topic, diversity, to see how I could find the data that back their recommendation that nursing needed to be more diversified. I am not a nursing researcher; so my apologies to all researchers out there in explaining my approach. It took me awhile. It was not until I put together Figure 3-9 (p. 129) and Table E-1 (p. 370) that I could fully understand the health care challenges posed by a more diverse population discussed on page 48. Currently, minorities make up about one-third of our US population. By 2041, they will be in the majority and by 2050 minorities will make up 54%. Compare and contrast that data with a profile of the current nursing profession, which is 83% white, non-Hispanic. We have some work to do to more closely match population with professional profile. I make this recommendation for a reference or study guide because I think the work of this committee is important enough that it needs to be easily accessible not only to students but to all members of the nursing profession.

I have no doubt our Nursing leaders, both in education and service, will have a great many dialogues about the IOM recommendations on the future of nursing. I look forward to them. My hope is those in health care, outside of nursing, will use this report to help redesign new systems. Fortunately, with an increasing number of hospital and hospital system CEOs emerging from the ranks of the nursing profession, it is likely that this will occur.