"I think one's feelings waste themselves in words; they ought to be distilled into actions which bring results." - Florence Nightingale
Florence Nightingale's prescient words explain the urgency behind nurse leaders' efforts to implement the recommendations from the Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health (IOM, 2011). Released in 2010, this landmark report galvanized the nursing field to take the necessary steps to provide exceptional care in an increasingly complex and rapidly changing health system. The report offered eight evidence-based recommendations in the areas of education, practice, leadership, interprofessional collaboration, and diversity. The Robert Wood Johnson Foundation, the nation's largest health philanthropy, and AARP, the nation's largest consumer organization, believed that implementing these recommendations could significantly improve health and heath care. They formed the Future of Nursing: Campaign for Action, a nationwide initiative to advance the IOM recommendations. The Campaign is composed of many partners within and outside health and healthcare settings. Nursing professional development (NPD) practitioners have been pivotal to advancing the recommendations within their organizations. Their expertise will be critical to further success and sustaining hard-won gains.
PROGRESS
Education
The IOM report placed substantial emphasis on strengthening nursing education. Specifically, the report recommended that 80% of nurses earn a baccalaureate degree or higher by 2020 and that all nurses keep current of the latest trends. The report also called for the field to double the number of doctorates and to implement nurse residency programs. Community colleges, universities, and hospitals responded by forming partnerships to make it easier for nurses to continue with their education, and as a result, more nurses with associate degrees are obtaining their baccalaureate degree. RN-to-BSN degrees have increased from 23,000 to 56,000, due to initiatives that reduced the financial, distance, and time constraints that prevented nurses from returning to school. Although the proportion of nurses with a baccalaureate degree is unlikely to reach 80% by 2020, nursing forecasters believe that the goal may be within reach by 2025 (Boivin, 2017). Continuing education and lifelong learning programs that focus on the competencies needed to provide care in the 21st century have flourished since the report's release.
The Campaign in 2015 met its goal of doubling the number of nurses with doctorate degrees, and nurse residency programs are on the rise. A report released in 2015 by the National Academy of Medicine-the new name for the IOM-evaluated the progress made in advancing the Future of Nursing recommendations. It found that residency programs have "positive effects on retention and job satisfaction" (Altman, Butler, & Shern, 2016, p. 90), but that further evaluation is needed to determine their effect on patient outcomes. Several studies, including the National Council of State Boards of Nursing Transition-to-Practice Study (Spector, 2015) and the New Jersey Action Coalition residency program in long-term care settings (Cadmus, Salmond, Hassler, Black, & Bohnarczyk, 2016), are building the evidence base to support nurse residencies.
NPD practitioners who keep the passion for education alive in their organizations have been key contributors to advancing the education recommendations. They base content on the best available evidence and advocate for and initiate new practice models in their organizations. They encourage nurses to return to school for their baccalaureate and doctoral degrees by touting the benefits of further education; offering financial incentives, flex time, and employee benefits; and forming partnerships with colleges and universities to make it easier for nurses to return to school. NPD practitioners are building the evidence base for nurse residency programs and demonstrating the return on investment to their organizations.
Practice Since the Campaign began, nine states (Connecticut, Maryland, Rhode Island, Minnesota, Nebraska, Nevada, North Dakota, South Dakota, and Vermont) have removed statutory barriers that prevent nurse practitioners from providing care to the full extent of their education and training. These victories expanded access to high-quality health care and increased choice for consumers. NPD practitioners can work within their organizations to promote policies that enable nurses to work to the full extent of their education and training. If they live in 1 of the 28 states that limit practice authority, they can connect with the Campaign to advocate for legislative changes to expand scope of practice.
Leadership
The Campaign has sought to increase the number of nurses on boards, with a goal of placing 10,000 nurses on boards by 2020. As of September 2017, 3,384 nurses have joined boards (Nurses on Boards Coalition, n.d.). Other Campaign goals include encouraging all nurses to see themselves as leaders who (a) advocate for their patients, (b) join committees and take advantage of shared governance opportunities, and (c) seek to mentor new nurses and be mentored by more experienced nurses. NPD practitioners can advance leadership opportunities by identifying nurses with nascent leadership capabilities and creating learning opportunities to buttress their skills, as well as offering programs to nurses in leadership roles. They can also start mentoring programs.
Interprofessional Collaboration Since the Campaign began, top nursing schools have increased the number of interprofessional courses offered. The National Academy of Medicine report urged the Campaign to continue to expand opportunities for interprofessional collaboration (Altman et al., 2016). NPD practitioners can foster interprofessional collaboration by promoting interprofessional continuing education and leadership learning opportunities.
Diversity Nearly all 50 states that comprise the Campaign have implemented diversity strategies to increase the number of nurses from diverse backgrounds and to ensure that all nurses provide culturally competent care. The National Academy of Medicine report called for a continued focus on diversity and key strategies to promote it (Altman et al., 2016). NPD practitioners can promote diversity by offering continuing education opportunities that address the needs of the diverse populations served by their organizations and promoting cultural sensitivity within their organizations.
CALL TO ACTION: KEY TAKEAWAYS
The Campaign has accomplished much, but more remains to be done. NPD practitioners can take the following steps to continue to advance the recommendations:
* Be familiar with the evidence surrounding the recommendations to successfully promote the recommendations to the C-suite.
* Promote policies that enable nurses to return to school for their baccalaureate degrees and higher. Devise programs to ensure flexibility with staffing and scholarships to aid nurses in returning to school.
* Set up mentoring programs so nurses can support each other.
* Advocate for an institutional and unit culture that empowers all nurses to use their voices to promote health and a culture of safety.
* Collect and use data that demonstrate high-quality outcomes in nurse residency programs.
* Establish learning opportunities that keep on top of the latest medical advances, foster interprofessional collaboration and culturally competent care, and build leadership skills for nurses at all career levels.
* Promote learning opportunities that address the needs of diverse populations served by their organizations.
* Advocate for policies within their organizations that enable nurses to practice to the full extent of their education and training.
* Join the Campaign for Action. Click on "Get Involved."
As Florence Nightingale advocated, let's act together to fully implement the IOM recommendations and improve care for people, families, and communities.
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