IOM and RWJF Release The Future of Nursing Report
Released October 5, 2010, the much awaited Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, calls for a "transformation" in how nurses are utilized in all sectors of health care. The committee — chaired by Donna Shalala, president, University of Miami and vice chaired by Linda Burnes Bolton, vice president and chief nursing officer, Cedars-Sinai Health System and Research Institute — presented their report as a roadmap for policymakers, health care leaders, and consumers to fully utilize the largest health care profession in the nation. The Robert Wood Johnson Foundation (RWJF) funded the study.
Dr. Burnes Bolton acknowledged that in many ways the report is "more evolutionary than revolutionary" and noted that nurses were well-positioned to lead change at all levels of the health care system; nurses should be at the table and as well as in the boardroom. Acknowledging that it would require a cultural change, IOM president, Dr. Harvey Fineberg, and RWJF president and CEO, Dr. Lisa Lavizzo-Mourey, noted the critical importance of using nurses to the full extent of the scope of practice.
According to the report, for the nursing profession to benefit from this increased opportunity, there must be increased professional responsibility. Nursing must enhance and refine its education and training to prepare this new generation of leaders. Individual nurses must take responsibility to become lifelong learners. As the health care system integrates new technology into patient care environments, nurses will be called on to be expert on these technological tools and information management systems while collaborating and coordinating care across teams of health professionals.
The NLN, which has long championed academic progression in nursing and other report recommendations, endorsed it, joined by fellow organizations in the Tri-Council for Nursing, — the American Association of Colleges of Nursing, the American Nurses Association, and the American Organization of Nurse Executives. See Tri-Council release here.
The report states that nurses must have higher levels of education and training. Reasonable and efficient pathways are needed from LPN/LVN diplomas to the associate's and bachelor's degrees to master's, PhD, and DNP degrees. In addition, a more diverse cadre of nurses is needed. The report recommends an increase in the proportion of nurses with a baccalaureate degree to 80 percent by 2020. The NLN Accrediting Commission (NLNAC) along with the Commission on Collegiate Nursing Education (CCNE) is asked to require all nursing schools "to offer defined academic pathways, beyond articulation agreements, that promote seamless access for nurses to higher levels of education." The committee calls on health care organizations, community leaders, funders, and governmental agencies to assist with this educational change. One example is the call for health care organizations to differentiate the pay for nurses with different educational preparations and to encourage degree advancement within a set time period post graduation.
To meet the demand for faculty as well as nursing leaders in education, research, and practice, the report calls for a doubling in the number of nurses with a doctorate by 2020. In order to assist in the achievement of this goal NLNAC and CCNE are asked to monitor the progress of each accredited nursing school with a goal that at least 10 percent of all baccalaureate graduates matriculate into a master's or doctoral program within five years of graduation.
Hours after IOM released the report, the American Medical Association issued a statement in response, emphasizing the team approach to care — a team that's led by a physician.
"The AMA is committed to expanding the health care workforce so patients have access to the care they need when they need it. With a shortage of both nurses and physicians, increasing the responsibility of nurses is not the answer to the physician shortage," Dr. Rebecca Patchin, AMA board member, said in a statement. "Research shows that in states where nurses can practice independently, physicians and nurses continue to work in the same urban areas, so increasing the independent practice of nurses has not helped solve shortage issues in rural areas. Efforts to get health care professionals in areas where shortages loom must continue in order to increase access to care for all patients."
Many additional recommendations are presented in the report in the areas of data and workforce planning, scope of practice, and leadership development. The full report can be found online here.
HRSA Reports Increase in Nurse Workforce
This past March, the Health Resources and Services Administration (HRSA) released initial findings from the latest in its series of nurse workforce surveys and reports conducted and published every four years by its Bureau of Health Professions (March 2010 Nursing Education Policy). The final report, The Registered Nurse Population: Findings from the 2008 National Sample Survey of Registered Nurses, released in late September, confirms the findings released earlier, i.e., the number of licensed RNs in the United States grew to a new high of 3.1 million between 2004 and 2008, and it adds more details with respect to that growth.
The increase of more than 5 percent represents a net growth of 153,806 nurses, and it also reflects important gains in age and diversity of the workforce. In regard to age, for the first time in three decades, the youngest population of nurses grew. An estimated 444,668 RNs received their first US license from 2004 through 2008. This rise, the report asserts, has helped "restock the pool" of RNs. At the same time, despite the fact that about 291,000 RNs allowed their licenses to lapse, possibly indicating the substantial number of retirements that have begun to take place, the older population of nurses continued to grow as well. This growth may be a result of the growing demand for RNs and the respondent growth in enrollment. But, the final report also highlights the fact that one of the principle barriers to restocking the pool of RNs is a shortage of nursing faculty to meet the growing need, and it predicts that, with 50 percent of faculty 50 years of age or older, the shortage of nursing faculty will grow significantly in the near future.
As for diversity gains, the percentage of minority RNs (Asian, Black/African-American, American Indian/Alaska Native, and/or Hispanic) grew to 16.8 percent in 2008 from 12.2 percent in 2004. "The growth in the numbers and diversity of registered nurses is a positive sign of moving in the right direction, and HRSA remains committed to ensuring an adequate supply and distribution of nurses in the future," HRSA administrator Mary Wakefield said. She added, "HRSA has distributed a significant increase of funds over the past year to recruit, educate and retain nurses."
In addition to those reported in March, other findings include:
- The AD was the most commonly reported initial nursing education level of RNs (45.4 percent). Bachelor's or graduate degrees were received by 34.2 percent of RNs, and 20.4 percent received their initial education in hospital-based diploma programs. Nearly two-thirds of RNs reported working in a health occupation prior to their initial nursing education.
- In 2008, an estimated 2,596,399 RNs were employed in nursing — 84.8 percent of licensed RNs. This was the highest rate of nursing employment since the national survey started in 1977, and the first increase reported in full-time employment since 1996 — a rise from 58.4 percent of RNs in 2004 to 63.2 percent in 2008.
- Among nurses under age 50, 90 percent or more are employed in nursing positions. For RNs over age 65, this percentage drops to less than 50 percent.
- Hospitals remain the most common employer for RNs — increasing from 57.4 percent in 2004 to 62.2 percent of employed RNs in 2008. This percentage increase is the first since 1984. Nearly 90 percent of RNs under age 25 work in hospitals, while less than 53 percent of RNs age 55 and older work in hospitals. As for nurses with master's degrees, fewer than half work in hospitals, more than 18 percent are in ambulatory care settings, and nearly 12 percent are in academia.
- The average annual salary for RNs employed full-time in 2008 was $66,973 — a 15.9 percent increase from the 2004 average of $57,785. The highest earnings were reported by nurse anesthetists who averaged $135,776 per year. Staff nurses on average earned $61,706 per year. RNs with graduate degrees earned an average of at least $20,000 more than RNs with other levels of education.
- Only 11.1 percent were dissatisfied with their education in 2008, compared with 13.8 percent in 2004. The highest rates of being moderately or extremely satisfied were reported by RNs working in academia (86.6 percent), while the lowest rate of moderate or extreme satisfaction was reported by nurses working in nursing homes/extended care (74.5 percent).
- Nurse practitioners (NPs) represent the largest group of APRNs. In 2008, an estimated 158,348 nurses were prepared as NPs (10.3 percent as clinical). About 35 percent of the NPs were under age 45, nearly 85 percent reported holding a master's degree, and 3.9 percent reported holding a doctorate degree.
FROM THE STATES . . .
Governor Signs Bill Tackling California's
On September 28, 2010, Governor Arnold Schwarzenegger (R) signed into law a bill aimed at addressing the state's severe nursing shortage. Sponsored by Assembly members Pedro Nava (D-Santa Barbara) and Juan Arambula (D-Fresno), AB 867 enables California State University (CSU) to: independently award a doctor of nursing practice (DNP) degree; train its own nursing faculty and the faculty of the California Community College; and train nurses for advanced practice. Previously, the CSU system could train nurses, but were unable to offer DNP degrees.
According to estimates by the California Board of Registered Nursing, the state's RN shortage is between 10,294 and 59,027 full-time positions, and the shortage of nursing faculty is central to this issue. Arambula explains the situation as follows: "The Central Valley has about 20 percent fewer nurses per capita than the national average . . . and the lack of faculty . . . worsens the problem. AB 867 will ensure nursing programs have the faculty needed to meet the rising demand for registered nurses in the state."