On November 30 and December 1 about 500 nurses and health care leaders convened in Washington, DC, to launch the Robert Wood Johnson (RWJ)-funded Institute of Medicine (IOM) "Future of Nursing: Leading Change, Advancing Health" report.
This 562-page report offers eight recommendations—many ambitious (Recommendation #4: Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020), some contentious (Recommendation #1: Remove scope of practice barriers), and others just necessary (Recommendation #8: Build an infrastructure for the collection and analysis of interprofessional health care workforce data). The recommendations cluster around themes of nurse practice, education, and leadership.
The purpose of this day and a half-long meeting was to develop meaningful ways to translate this IOM report into a blueprint for action. According to Sue Hassmiller, Senior Advisor for Nursing at RWJ and the IOM Future of Nursing Study Director, “This launch event is just the beginning. We have much work to do, and we are learning as we go. We are building the plane at the same time we are flying it.”
The meeting was productive: attendees discussed and dissected recommendations, identified stakeholders, summarized next steps, and offered thoughts on leading large-scale change. But what does all this mean? Why is this IOM report important to Hartford, geriatric nursing, and older adults?
First, Chapter 2 of the report sets the context by defining the patients of the future as older, diverse, and with more chronic conditions. Speakers at this launch meeting reinforced this message. IOM Future of Nursing Committee member Jack Rowe stated this report “is not about doctors, is not about nurses, but is about the patients.” Furthermore, in his keynote, Don Berwick, Administrator of the Centers for Medicare & Medicaid Services, noted that he routinely visits senior centers across the country.
Don Berwick knows that older adults are the major consumers of health care in this country—that starting in January 2011, the first wave of boomers will turn 65. IOM Future of Nursing Committee member Bill Novelli, in a panel discussion on implementation, cited our aging population as a national trend that should serve as a driver of change. Couple the aging of our society with the fact that our country’s three million nurses represent the largest and most trusted segment of the health care workforce, and you soon realize that nurses serve as principal care providers for older adults across a variety of settings.
We know from the 2008 IOM Retooling for an Aging America report that all health care professionals should work at the top of their "license," meaning that they should take on the most sophisticated responsibilities within their scope of training. Otherwise, as a nation, we can’t get the work done in an affordable way. And in addition to containing costs, we need to improve care. For example, 70% of ACOVE indicators for geriatric conditions are simply not provided, such as screening and treating incontinence, falls, and cognitive impairment. We must do this work, and it is most efficient and effective to have RNs do a lot more by serving as full partners in primary care as both independent practitioners and as members of health care teams.
Secondly, this report and launch are important to our aging network because implementation dictates that a diverse group of stakeholders from policy, business, philanthropy, government sectors, and care providers are required to bring these recommendations to life.
Other disciplinary organizations attended the launch meeting. Of note, there were at least four geriatricians present (leading to a running joke that 75% of the nation’s geriatricians were in attendance). This speaks to interdisciplinary interest in the report. We know that health care is a team sport. For implementation to have any legs, it needs to be endorsed and adopted by other health care providers.
Despite all the good work of this launch, I am compelled to issue a caution. During the Q & A sessions, nurses pushing their specific organizations, specific agendas, and specific projects dominated the microphones. Nurses and nursing organizations must coalesce as a unified voice with a united message focused on the patient. If we do not, we will dilute the power of this report. I applaud Beverly Malone, chief executive officer of the National League for Nursing, who during a panel threw down the gauntlet: “Nurses need to stop acting up and act together to look to the patient and the consumer.”
The future of the "Future of Nursing" report depends on it.