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Viewpoint: Future of Nursing report: Recommendations to transform our healthcare system


In October 2010, the Institute of Medicine (IOM) released a landmark report, The Future of Nursing: Leading Change, Advancing Health. This report is a call to action for anyone who’s passionate about improving health care. It makes recommendations to help transform our healthcare system to provide seamless, affordable, high-quality care accessible to all—care that is patient-centered and evidence-based, and leads to improved health outcomes.

I was among the nurse leaders who participated in the Robert Wood Johnson Foundation (RWJF) Initiative on the Future of Nursing at the IOM. Unlike past committees and reports on nursing, this initiative involved a diverse group of experts and health professionals from a wide range of fields, who worked as an interprofessional team to envision an improved healthcare delivery system and identify the role of nursing in leading change to achieve this vision. We started our work from the premise that this report wouldn’t be about nursing alone. Instead, it would focus on how to better prepare and deploy nurses in partnership with physicians and other professionals to improve health care.

We sought to examine how to achieve a healthier nation by examining what nursing has done and what it could do in a reformed healthcare system. While other nursing reports have addressed specific issues, such as the nursing shortage or nurse staffing ratios, The Future of Nursing report addressed the changes needed to achieve the nation’s health goals.

Many of the recommendations came from the field. We held three public forums where individuals submitted testimony and offered their opinions on how to transform nursing to advance health. Our first public forum, held at Cedars-Sinai Medical Center in Los Angeles, focused on the acute-care setting. The second, held in Philadelphia, focused on care delivery in the community. The last forum, held in Houston, focused on the future of nursing education. These gatherings greatly informed the report, as we observed exemplary practices across the country and explored how they might be replicated elsewhere.

The Future of Nursing report represents a new press for change and starts with staff nurses in hospitals, community clinics, and long-term care facilities. Nurses’ consistent close proximity to patients and scientific understanding of care processes give them a unique ability to partner with other healthcare professionals and lead the charge to improve and redesign our healthcare system. Nurses are poised to coordinate increasingly complex care for a wider range of patients and to manage chronic diseases. They help prevent medication errors, reduce infection rates, and promote patients’ transition from the hospital to the home. Their tremendous role in disease prevention and improving care can’t be overstated.

However, our healthcare system is becoming increasingly complex, and nurses need to be better prepared to make critical decisions associated with caring for older and more diverse patients. That’s why the report calls on the nursing profession to increase the proportion of nurses with a baccalaureate degree to 80% by 2020. It also calls for nursing education to serve as a platform for continued lifelong learning and for nurse residency programs to help ease the transition from nursing school to practice. Cedars-Sinai Medical Center is one of many institutions that offer multiple educational programs for nurses, including a residency program. Our residency program has reduced staff turnover, which costs hospitals $66,000 per nurse—and has improved patient outcomes dramatically.

The report also calls on staff nurses to take on leadership roles, not just in patient-care settings but within organizations’ leadership. In care environments, staff nurses need to assume responsibility for identifying problems and areas of waste and delays and to implement plans for improvement, track improvements over time, and make adjustments to realize established goals.

I urge you to seek leadership opportunities by serving on advisory committees, commissions, and boards where policy decisions are made, toward the goal of advancing health systems and improving patient care. The healthcare system especially needs your expertise now as we embark on a new approach to health care in our country.

The Future of Nursing report calls for all nurses to practice to the full extent of their education and training through the elimination of scope-of-practice restrictions. We need to ensure that nurses with baccalaureate degrees can practice fully in their communities by providing health education and preventive health care to patients.

I strongly urge you to read the report (available at www.thefutureofnursing.org). Talk with your colleagues and the people in your community about the recommendations and what would work best for the patients and families you serve.

The report has also spurred the RWJF and the Center for Championing Nursing in America at AARP to develop Regional Action Coalitions to move key nursing-related issues forward at the local, state, and national levels. The RWJF and AARP are piloting these coalitions in five states—New Jersey, New York, Michigan, Mississippi, and California. The coalitions will capture best practices, track lessons learned, and identify replicable models that other states can study and implement in their systems.

We strongly encourage you to join your state’s Regional Action Coalition. By joining, you’ll be involved in recruiting engaged and committed stakeholders from a variety of sectors; educating policymakers and other decision-makers on key issues; reaching out to philanthropies and funders to seek financial support; gaining visibility through the media; and, above all, moving key recommendations forward. Find out more about the coalitions and how you can get involved at www.thefutureofnursing.org. Please join us today to help nurses lead change and advance health as we usher in the future of nursing and transform patient care.

Linda Burnes Bolton, DrPH, RN, FAAN, is VP and chief nursing officer at Cedars Sinai Medical Center, Los Angeles.

1 Comment.

  • I am very encouraged by the IOM report, especially the recommendation to allow nurse practitioners to practice at the full scope of their education and training. NPs in Florida have big challengers to this evidence that we are prepared to fullfill primary care roles and improve access to care for Floridians.

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