I had the opportunity recently to attend a webinar about the coming update of the Future of Nursing: Leading Change, Advancing Health document that was published 10 years ago by the Institute of Medicine (now the National Academy of Medicine). For those not familiar with the Future of Nursing: Campaign for Action, it is a national initiative of the American Association of Retired Persons (AARP), the AARP Foundation, and the Robert Wood Johnson Foundation that is working to build a healthier America through nursing. The Campaign for Action was established in 2010 to implement recommendations from the Future of Nursing (FON) report, and to harness the power of nursing to help all people live longer and healthier lives. Through action coalitions in each state, the campaign works with policymakers, health care professionals, educators, and business leaders to respond to the country's increasing demand for safe, high-quality, and effective health care for all (National Academy of Medicine, 2021).

The stated purpose of the webinar was to honor the contributions made by nurses during recent times, recognize a decade of nursing progress by the FON Campaign, and to prepare for the second "Future of Nursing 2020-2030" report, expected in May of 2021. Throughout the webinar, nurse practitioners were mentioned numerous times including the barriers that have been removed within the past 10 years. Much progress has been made but more freedom to practice is needed. Related to this, the novel coronavirus (COVID-19) pandemic was discussed, including both negative effects such as understaffing and positive effects such as temporary easement of nurse practitioner (NP) barriers in several states.

The first FON publication explored nurses' roles, responsibilities, and education with several recommendations for changes in each. Nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States. The report promoted residency training for nurses, an increase in the percentage of nurses who attain a bachelor's degree to 80% by 2020, and doubling the number who pursue doctorates. This last goal was achieved through the massive expansion in doctor of nursing practice education. Further, there were recommendations for the removal of regulatory and institutional obstacles, including limits on nurses' scope of practice, so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care. The report also recognizes that nurses spend the greatest amount of time in delivering patient care as a profession. Nurses therefore have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care. Although the FON campaign addresses all nurses, there are many specific references to nurse practitioners and the need to eliminate barriers to achieving full scope of practice in the first FON report. At the time of the first report, there were about 154,000 NPs in the United States. Since then, our numbers have almost doubled.

A substantial part of the webinar was spent on presentations and discussion of diversity, inclusion, and equity in the clinical and educational setting. The nurse's role in ensuring health equity, in particular, was highlighted as a major focus of the upcoming Future of Nursing 2020-2030 initiative. At the conclusion of the presentation, the current chair of the FON campaign, former Health and Human Services (HHS) secretary Dr. Donna Shalala, passed the baton to Dr. Mary Wakefield, also a former HHS appointee with a long and distinguished career in academics and public service.

Two take-home messages related to nurse practitioner science from the presentation are:

1. We need to continue studying and publishing evidence related to our impact. Refer to the nurse practitioner research agenda that was first developed in 2010 and most recently updated and featured in the December 2018 issue of JAANP. This can serve as the focus for contributing to further research that will meaningfully document the ongoing real and potential impact of NPs.

2. To study and document NP contributions, we must define the words we use. There is a tendency to assume that we have shared definitions of key words and phrases. For example, after listening to several discussions in the webinar on the concept of equity, I searched for a broadly agreed on, measurable definition of the word and was unable to locate one. Although there may be no universally agreed on definition, and in fact a narrower term such as "health equity" may be preferable, it still must be defined. Individual researchers and those discussing goals and outcomes must define terms, describe how they will be measured, and be prepared to defend the definition and measurement plan. Without that we will never know whether or to what extent we have achieved anything.

It was inspiring to hear so much support and recognition for nursing writ large and for the many references to advanced nursing practice in the Future of Nursing presentation. It was also helpful to be reminded of some of our ongoing barriers. An example was the acknowledgment that only 25% of states allow NPs to practice to the full extent of their abilities. I hope my colleagues will consider involvement in their state action coalitions and further the work of the Future of Nursing campaign.

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