The Future of Nursing is Up for Debate

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It's not very often that one gets a chance to contribute to a nationwide public debate that just might result in changes to your profession. But that's what the Robert Wood Johnson Foundation, in collaboration with the Institute of Medicine, is calling for as part of a major study on the future of nursing. As well as securing the opinion of nursing experts from around the country, the study will also be examining testimony submitted from individuals and organizations in the field.

"In a reformed healthcare delivery system, what would be the future role of nursing?" asks Linda Burnes Bolton, Dr.PH, RN, FAAN, vice president for nursing, chief nursing officer, and director of nursing research at Cedars-Sinai Medical Center in Los Angeles. "That's our charge, so we're looking at acute care, community health, school health, public health, and what we need to reform the education system."

Burnes Bolton is the vice chair of the new Initiative on the Future of Nursing, which was launched earlier this year with a goal of producing a report in 2010 detailing how nursing should evolve so it can meet the demands of an ever-changing health system. The committee is spending the next few months examining evidence from around the country, debating and reviewing that evidence, and then coming up with a blueprint for change. They plan to make broad recommendations about the delivery of nursing services, changes to public and institutional policies, and even ways to solve the nursing shortage.

The committee is officially charged with examining the following areas:

• Reconceptualizing the role of nurses
• Expanding nursing faculty, increasing the capacity of nursing schools, and redesigning nursing education
• Care delivery and health professional education
• Attracting and retaining well-prepared nurses

As part of the committee's evidence collection, Burnes Bolton says they are actively seeking public testimony—including innovations/models and barriers/opportunities—from around the country. Some of the most interesting testimony will become part of the debate at three national forums on the future of nursing, the first of which was held yesterday at Cedars-Sinai Medical Center in Los Angeles.

Yesterday's program concerned the topics of quality and safety, technology, and interdisciplinary collaboration. Marilyn Chow, DNSc, RN, FAAN, vice president, patient care services, program office, at Kaiser Permanente, program director for the RWJF Executive Nurse Fellows Program, and presenter at the first forum, says she hopes the forums provide an opportunity to think about issues in a different way.

"The problem is that nurses are misused and underutilized" in the current system, says Chow. She adds that as information and knowledge grows at warp speed, the acute care environment will be shaped by the intersection of technology, business models, and human needs. As such, now is the time to design new models to meet the needs of the future.

One of the issues being considered is the economic approach to the value of nursing care. "How would you bill for nurses to spend time with patients?" asks Chow. "If we don't do anything, the alternative is to continue in the current model where all human aspects are really done in spare time."

Chow proposes four concepts that will drive change in nursing:

1. Leveraging the power of the electronic health record
2. Balancing technology, business models, and human needs
3. Using rapid translation teams
4. Using rapid design teams

The last two categories concern the need to create new models and ideas for healthcare delivery, and she says they need to include people outside of healthcare, such as engineers and ethnographers, who can provide alternative ways of thinking about how we do things.

"There is technology on the horizon that will change how we do things. There are business models that are changing the way we do things. But what is not changing is the focus on human needs," says Chow. "So we have to design that with an intelligent use of tech and business models."

The focus on human needs was a theme of yesterday's debate. In his opening remarks, Thomas Priselac, president and CEO of Cedars-Sinai and current chair of the American Hospital Association, noted that historically nurses have always been at the forefront of the healthcare system, and will remain at the forefront even as healthcare delivery changes.

"It still comes down to the personal touch of the person providing care," said Priselac at the forum. "For the most part that personal touch comes from a nurse; they are quite simply the face of healthcare today."

The next stage of public discussion takes place on December 3 in Philadelphia and examines primary care, long-term care, community health, and public health. The third forum is on February 22, 2010 in Houston and will look at nursing education.

To be a part of the discussion, you can submit testimony for the committee's consideration—and potential presentation at a future forum—at www.iom.edu/nursing or by e-mailing nursing@nas.edu.