Redefining The Future

Converging tides are fundamentally changing America’s health care system. The long-predicted wave of baby boomers is reaching Medicare age. As the Affordable Care Act is implemented, 32 million people previously without access to coverage will be seeking primary care—at a time when primary physicians are already in short supply. The health care system is adapting to changes in Medicare reimbursement, with more cuts likely to come in deficit reduction legislation.

At a time of challenge, the Institute of Medicine’s recent report on the future of nursing foresees a transformation in the role of nurses in health care delivery. The nation’s three million nurses—the largest segment in health care—are on the front lines of patient care, poised to play a pivotal part in reshaping the system and dealing with the new realities ahead.

The nation will need more nurses, and nurses will need more education and training to prepare them to take on new responsibilities. However, with the median age of nurses at 46, and more than 900,000 nurses over 50 who will be retiring in the years ahead, the need for new nurses is already growing faster than the capacity of nursing schools to graduate them.

“Everyone is gearing up enrollment, and taking as many students as we can take, but nursing schools are limited by the availability of faculty,” Nena Sanders, RN, DSN, Dean of Nursing at the Ida V. Moffett School of Nursing said. “Fortunately, we have received a grant for a nurse faculty loan program that forgives up to 85% of the loan after four years of teaching. We are graduating more DNPs, who will be teaching more nurses.

“With healthcare reform and an aging population, it is imperative that nurses achieve higher levels of training to respond to the increasing demands placed on them. Our graduates must also be technology competent and trained in critical thinking. A priority is to move toward a nursing pool of 80% or more educated at the baccalaureate level or above by 2020. We are also moving toward nursing internship and residency programs to help graduates gain a depth of understanding as they move into specialty areas such as critical care.”

Alabama has several excellent nursing schools that are offer accelerated programs to move nurses from RN to bacculauate and MSN degrees, and RN second degree programs. The state also has highly regarded advance practice nursing programs—but it is losing a large percentage of its graduates due to what is widely considered the most restrictive practice regulations in the nation.

“There is a brain drain. Alabama is a rural state and in many counties we have no access to physicians and no one who delivers babies,” Joyce Varner, BSN, DNP, president of the Alabama State Nurses Association said. “We graduate many advanced practice nurses, but around 20% of our nursing graduates, mostly in advanced practice, leave the state because they are limited to practicing far below their skills, training and competencies.

“They move to states where they are allowed a full range of practice, earn more and are doing very well. There is a growing body of evidence that their patients are doing very well, too. We will again be supporting legislation in 2012 to remove these outdated restrictions. We also hope to see reimbursement policies brought up to date to match the norm in other states.

The Institute of Medicine’s report also sees advanced practice nurses as the critical link in “bridging the gap between coverage and access” at a time when primary care physicians are already in short supply. The report quotes a growing body of evidence showing excellent outcomes for patients of nurse practitioners, and notes that their competencies can be of great value as the focus of health system moves from acute care toward a greater emphasis on preventive care and wellness.

In the future, the Institute of Medicine report sees a transformation in nursing that will combine career-long education with growing experience to expand the scope of nursing practice to deliver quality care that is patient centered, accessible, evidence-based and sustainable, and to achieve value in health and well being relative to cost.

Recommendations include increasing the role of nurses as coordinators of care teams to facilitate communication and interprofessional collaboration. A greater emphasis on nurses as hospital to home and wellness coaches could improve outcomes and reduce costs from preventable illnesses and recurrences. Nurses are already working in many settings, with a variety of competencies they can use to take care to underserved areas and out into the community.  Workers who postpone checkups because of difficulty getting appointments outside work hours could see nurse practitioners for routine care, screenings and help in preventing illnesses.

To meet the challenges ahead, the report sums up, “we must match the practice of nursing to future needs, not past demands.”