Nurses are in an ideal position to propagate changing within the health care workforce, with three millions nurses to effectuate change, and the objectives within the Affordable Care Act (ACA) providing the largest overhaul within medical care since the inception of Centers for Medicare and Medicaid (CMS) in 1965 (Institute of Medicine [IOM], 2010). The intent of this paper is to discuss the Institute of Medicine (IOM) report regarding the future of nursing as it pertains to nursing practice, nursing education and nursing workforce development. Next, a review of Nevada’s state-based action coalitions and how Nevada advances the goals of the IOM report. Lastly, two Nevada coalition initiatives will be outlined, discussing the advancements and barriers that need to be overcome.
Future of Nursing
In 2008, the Robert Wood Johnson Foundation (RWJF) committee was formed to conduct a two-year research project that commenced with the formation of the IOM Future of Nursing report discussing a number of key objectives. Several barriers were identified preventing nurses from practicing to the full extent of their licensure and education, largely due to the overhaul of the health care system with the introduction of the ACA (IOM, 2010). In addition, the rapidly evolving health care system to include adoption of electronic health records (EHRs), computerized provider order entry (CPOE), electronic medication administration (eMAR), and bar code medication administration (BCMA), to name a few. This paper will focus specifically on the nursing practice, nursing education, and nursing workforce development as a whole, specifically within the state of Nevada.
Licensure and nursing practice rules vary state by state, specifically when it comes to the nurse practice act, which defines the actions and interventions a nurse may perform within the scope of their practice. Therefore, these variations allow opportunity for patient care to vary state-to-state (IOM, 2010). For example, one state may allow advanced practice registered nurses (APRNs) to independently treat patients without a supervising physician, while others do not. Recent changes in Nevada legislation allows new APRNs, to prescribe Schedule II medication independently without collaborative agreement once the APRN has completed two years or 2000 hours of practice; however a facilities by-laws may contradict the independent practice of an APN’s, requiring them to be supervised by a physician (Robert Wood Johnson Foundation [RWJF], 2014). All the more reason that policy changes need to be made based on the IOM report recommendations, which state, nurses should practice to the full extent of education and training. For this to be fully accomplished, the federal government is well positioned to promote reform within this area to ensure nursing practice is similar across the country while ensuring best practices are followed (IOM, 2010).
Technology changes specifically with the adoption of Meaningful Use requires nurses to be more educated than 20 years ago when documentation was done in a simplistic way with the use of pen and paper. Currently, nurses need to know more than ever how medicine and technology meet, as well as the nurse bridging the technology gap in knowledge. EHR technology, for most nurses, wasn’t something learned or even taught within nursing school, but is a growing specialized field of nurse informatics. The gap in medical technology must be improved for nurses to continue to deliver safe, competent, patient-centered, high-quality care with positive patient outcomes. Nurse competencies today “ include leadership, health policy, system improvement, research evidence-based practice, and teamwork and collaboration” (IOM, 2010, p. 2). In order for this to become reality, nurses must achieve increased training and education to meet the demands.
The IOM’s philosophy of nurses to become life-long learners has been realized by the ever changing demands of technology, and the need for nurses to become technologically proficient to ensure their patient reaches goal directed positive outcomes (IOM, 2010). According to the American Association of Colleges of Nursing (2010), key nursing competencies include “ an understanding of evidenced-based health care and critical appraisal, familiarity with informatics and literature search and retrieval strategies, practice-based learning and improvement methods, self-reflection and assessment, and other skill sets related to knowledge management” (American Association of Colleges of Nursing [AACN], 2010, p. 6). Most undergraduate nursing programs are geared toward problem-based learning, relying a didactic, lecture-based approach with clinical rotations placing emphasis on acquired knowledge and applying the knowledge within the clinical setting (AACN, 2010).
“ The 2010 Affordable Care Act mandates the creation of both a National Health Care Workforce Commission to help gauge the demand for health care workers and a National Center for Workforce Analysis to support workforce data collection and analysis” (IOM, 2010, p. 3). The demand or lack of qualified nursing staff certainly can be situational depending on the area of the country; therefore a detailed gap analysis of the workforce is need to help identify and create a plan to adequately provide a qualified nurse workforce throughout the country. Nevada Action Coalition / Initiatives
“ The Nevada Action Coalition serves as the driving force for transforming health care through nursing in our state” (RWJF, 2014, para. 1). Nevada’s long term goal is to achieve sustainable change to better the health of the population. Nevada and California Coalitions have teamed up to share successes, strategies, and barriers to reach the best practices (RWJF, 2014). Building a coalition takes time and planning; however, partnering with another state can assist in accomplishment of goals. Nevada Action Coalition initiatives include education, leadership, diversity, practice and care. Nevada’s education goals are in line with the IOM report recommendations by increasing the number of nurses with higher education. In order to do so, Nevada is removing barriers that could impede progress towards this goal. One strategy is accessibility to online education to further your education and/or degree. Other avenues to accomplish the education goal include nursing residencies, leadership training, legislation to remove barriers to scope of practice, and new ADN graduates to obtain their BSN within ten years (RWJF, 2014).
The second Nevada initiative to be discussed is leadership. Nurses provide a unique and critical perspective to patient care, since nurses represent the largest number of clinicians within health care delivery; however, leadership opportunities exist within the state of Nevada. “ There is no concerted effort to place nurses in key leadership positions; moreover, Nevada has no nurse legislators” (RWJF, 2014, para. 1). Nevada for the most part is a rural state with only two major metropolitan cities, Reno and Las Vegas. “ In order for the Action Coalition to be successful, stakeholders in all areas of the state are being recruited and their opinions valued. Nurse leaders in regulation, education, and clinical practice have embraced the charge to transform health care through nursing and have committed to working together to achieve our shared goals” (RWJF, 2014, para. 2). In addition, Nevada has an opportunity to improve their tracking of those appointed to the Nevada Action Coalition. Currently, Nevada does not have a mechanism to track board appointments (RWJF, 2014).
Nurses are well-positioned to transform health care, but need support from key stakeholders such as regulatory bodies, governmental bodies, hospital organizations, managed care organizations, health care researchers, the Nevada Board of Nursing, educational institutions, and consumer advocacy organizations. If all of organizations worked together with the common goal of improving the patient care delivery to provide positive outcomes, the health care system would be better positioned to provide affordable, quality, positive goal directed care while improving the health of our patients.
American Association of Colleges of Nursing. (2010). Lifelong learning in medicine and nursing final conference report. Retrieved from http://www. aacn. nche. edu/education-resources/MacyReport. pdf Institute of Medicine. (2010). The future of nursing leading change, advancing health. Retrieved from http://thefutureofnursing. org/sites/default/files/FutureofNursing2010ReportBrief. pdf Robert Wood Johnson Foundation. (2014). Future of nursing campaign for action Nevada Action Coalition status report November 2013 – January 2014. Retrieved from http://campaignforaction. org/state/Nevada