On October 5, 2010 a landmark report on “The Future of Nursing“ was published by the Institute of Medicine, sponsored by the Robert Wood Johnson Foundation. This report is the most comprehensive and data based analysis of the various issues facing the profession and the discipline, written by a committee of experts from within and outside of nursing.

All nurses in leadership positions should read the 600 page report you can access via the web link provided here. The report provides a framework for the work to be done by all of us to maximize the contributions of the nursing profession to improving the health and well-being of citizens in this country and so many others.

I have asked several members of the IOM committee to share their thoughts about questions I posed. I highly recommend to you their valuable answers and insights —and WELCOME your thoughts in response!! Please do sign on and tell us what you are thinking…..
Marion E Broome, editor, Nursing Outlook: The Official Journal of The American Academy of Nursing

http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx

Question: What do you think is the single most important issue that nursing must address in the next 2 years?

Response from: Linda Burnes Bolton, DrPH, RN, FAAN
Vice President and Chief Nursing Officer,
Cedars-Sinai Health System and Research Institute, Los Angeles, CA

Nurses and nursing organizations must assume professional and leadership responsibility to adopt the committee’s recommendations on improving the professional nurses’ capacity to participate in the transformation of our health care system. As stated in the committee’s report we need nurses across all settings to be better educated and to work within and outside of their organizations for safer, patient centered, equitable, effective and efficient health care for the American public.

Question: Based on the work of the committee what advice would you give nurses newly entering the field who want to maximize their contributions to the field over the course of their career?

Response from: Linda Burnes Bolton, DrPH, RN, FAAN
Vice President and Chief Nursing Officer,
Cedars-Sinai Health System and Research Institute, Los Angeles, CA

New nurses entering the field should seek opportunities to participate in transitional programs that will facilitate their adoption of evidenced based, effective health care. Nurses must adopt a commitment to life-long learning that includes working with consumers, physicians and other health professionals as full partners in the promotion of health , prevention of adverse events and the fostering of health system renovation across the continuum of care. The greatest demand for nursing care remains outside of acute care settings. Individuals entering the field should seek to acquire knowledge, skills and experience to provide care across the life span and settings.

Response from: Liana Orsolini-Hain, PhD, RN
Nursing Instructor, City College of San Francisco, CA

Stay in school. I am hearing from chief nursing officers that they will become further financially strapped due to healthcare reform and probably won’t have the financial resources to train new graduates. They are being selective and are hiring BSN prepared nurses over AD prepared nurses in many parts of the country. Some hospitals in California are advertising that they prefer new graduates to have a master’s degree in nursing to make up for their lack of experience. Healthcare Reform will provide many new opportunities for nurses who get their NP and can practice primary care, especially collaboratively within medical homes and other chronic care management entities. A certification in geriatrics will go a long way as 78 million baby boomers continue to age. Also, consider a trajectory that will enable you to become a nursing educator. We have a serious nursing faculty shortage that will worsen as older faculty retire. We desperately need more doctorally prepared nurses to teach in universities and in community colleges offering the BSN degree. Lastly, join a few nursing, political, and leadership professional organizations. All of us should be active members of our specialty organization to help us stay up to date in our practice. We need more nurses to lead the implementation of health care reform, and we need to learn to lead at the national level.

Question: What strategies should leaders in nurse education employ most effectively to lead their faculty to respond to the mandates in the IOM report on the Future of Nursing?

Response from: Linda Burnes Bolton, DrPH, RN, FAAN
Vice President and Chief Nursing Officer,
Cedars-Sinai Health System and Research Institute, Los Angeles, CA

Presidents of universities and colleges must work with deans of nursing and other health professional schools to promote interdisciplinary education at the undergraduate and graduate level. It is essential that faculty actively lead efforts to prepare nurses to work within complex systems, engage consumers and patients at the community and point of care level, to identify opportunities to work environments so that they are beneficial to patients and less burdensome to health professionals through the use of technology and the creation of innovative systems of care.

Response from: Liana Orsolini-Hain, PhD, RN
Nursing Instructor, City College of San Francisco, CA

Every university that offers a BSN or higher degree in nursing should reach out to community college nursing programs and employers of RNs to form education consortiums which provide seamless co-enrollment of Associate Degree (AD) students, the automatic transfer of financial aid, joint-teaching appointments, shared staff RN clinical faculty in dedicated education units, elimination of curriculum redundancy and a streamlined process of earning a BSN degree in no more than 3 semesters. Universities should also streamline AD and diploma to MSN education for working RNs who wish to make a contribution to nursing that requires a minimum of a master’s in nursing degree. Community colleges that wish to offer the BSN degree should incentivize their faculty to return to school for a doctoral level degree and obtain and those colleges should maintain CCNE or NLNAC accreditation. We should also tap into our LVNs and incentivize them to return to school for higher degrees. Our LVN population has a level of diversity that is more reflective of the population of the US so recruiting them to return to school will probably increase the diversity of RNs.

Question: How do we best prepare and mentor dynamic leaders for the future of health care practice?

Response from: Linda Burnes Bolton, DrPH, RN, FAAN
Vice President and Chief Nursing Officer,
Cedars-Sinai Health System and Research Institute, Los Angeles, CA

Leaders of the future should be prepared by today’s leaders through the deployment of mentors from across health care settings and the implementation of programs where individuals have the opportunity to lead projects in diverse environs. Leadership is a practiced art and to create the leaders of the future we must provide individuals with the education and willingness to lead with opportunities to do so.

Response from: Michael R. Bleich, PhD, RN, FAAN
Dean and Dr. Carol A. Lindeman Distinguished Professor
Oregon Health & Science University School of Nursing

First, we need to embed clarity around the idea that every nurse is a leader, manager, and follower and improve conceptual clarity that leading requires innovation and risk, managing is both a set of personal attributes and an ability to persist in goal achievement, and that following is not a “less than” function, but is an act of acquiescence and energy given willingly to the “team.” If we can embrace a non-hierarchical perspective on this, then we look for traits in those entering the profession who are risk-takers, who believe that they can influence and engage with a range of stakeholders in the health system (beyond the expectation of roles with patients/families/communities), and who will bring forward their best game to work to outcomes. In basic nursing education, all students are given feedback on leadership skills in every course, strengthening the sense of self purpose and awareness in context with others.

Next, we need to create environments for leaders to flourish. This includes creating informational and transformational knowledge experiences of organizations, systems and work design, quality improvement, complexity science approaches to change to complement programmatic approaches to change management and the use of conflict engagement strategies.

Role models and mentoring should become part of a career and life experience, with individual and organizational strategies to “match” individuals both from within and outside of nursing and health care circles. Having a career plan that is developed for short and long term development is an imperative and employing and regulating/certifying organizations should encourage an articulation of this development plan.

Senior level nurses and stakeholders close to nursing must create opportunities and formal programs for leadership development, preferably staged to align with critical times in a professional trajectory. For example, the Veterans Administration as a system is a model for promoting continuous growth and aligning programs at sensitive times over the course of a career, engendering loyalty and an infusion of perspective to advance the health needs of veterans. Other programs that are examples of leadership development include programs sponsored by the Robert Wood Johnson Foundation, the Wharton School of Business at the University of Pennsylvania, Sigma Theta Tau, the American Organization of Nurse Executives, and the Cockcroft Fellows program at the University of South Carolina, and the University of California Center for the Health Professions. All of these programs – and others – have a history of producing effective leaders and can serve as a basis for expanded opportunities.

Question: What role should nurse scientists play in helping shape the future of nursing and how do they expand their capacity to do so? 

Response from: Linda Burnes Bolton, DrPH, RN, FAAN
Vice President and Chief Nursing Officer,
Cedars-Sinai Health System and Research Institute, Los Angeles, CA

Nurse scientists have made significant contributions to health care delivery, health policy and the design of effective programs that have facilitated the provision of safe, effective, efficient, equitable, patient centered care across the continuum of services. However, as stated in the report there are insufficient numbers of nurse scientists and nurses with earned doctorates to fulfill the needs for nursing faculty, nurse researchers, nurse executives and public health leaders. The committee’s recommendation on the increase in the number of nurses with BSNs from 50% to 80% of the workforce by 2020 is foundational to increasing the pool of applicants that will enter graduate and doctoral education. Our recommendation on the doubling of nurses with earned doctorates to teach nurses, to expand the number of nurse scientists actively engaged in comparative effectiveness research, translational research, health services research, community participatory research as well as basic and clinical research. The report also identifies the need for more data and nurse researchers are best positioned to lead and disseminated studies that will provide the profession with the requisite evidence to move forward in so many areas.

Response from: Michael R. Bleich, PhD, RN, FAAN
Dean and Dr. Carol A. Lindeman Distinguished Professor
Oregon Health & Science University, School of Nursing

First, nurse scientists must continue to play the critical role they already play in generating clinical knowledge through a nursing lens. From my vantage point, knowledge generation around symptom management, health promotion and maintenance, and discovery to expand knowledge around disease and disability can only strengthen our contributions to the public, inter-professional team performance, and our own discipline. The report reframes the importance of bending the cost curve of health care expenditures by placing added relevance to those areas which are within nursing’s purview of promotion and disease management and curtailment. We must prevail in these areas.

Second, it is my sense that this report challenges nurse scientists to expand our presence at other “systems” tables. As new models of care develop, the efficacy, efficiency, and scalability of these models will require nurses to gain and incorporate comparative effectiveness skills to test and advance new approaches to care. As the public grapples with the acceptance of nursing roles in expanded capacities, we will need nursing science to test and monitor how the nurses who contribute to care can assure safe and effective outcomes in contrast to or when combined with other disciplines, including physicians. The need for additional knowledge generation around nursing and inter-professional education is yet another critical area that nurse educators lament as lacking (and for which there is limited funding) and this report shines a light on the paucity of research to advance teaching, learning, and competency attainment. Finally, as a discipline, we cannot discount that nurse scientists will play expanded roles on inter-professional teams which may include research that is conducted outside of traditional academic settings.

Putting these needs together and in context, expanding our capacity to produce and engage scientists in research is no small task. The first fundamental question is “How do we enlist those nurses with current doctoral research preparation who have never substantively used their education for the purpose of research?” Are there non-research intensive environments where we could enlist these individuals in areas of workforce, educational, or organizational research that does not require an academic health science center setting, but may require linking them with each other and alternate settings, such as workforce centers? The second question is, “How do we enliven the experience of obtaining a research degree, such that it is more appealing and achievable than current perceptions?” Although ideal, not every nurse wants or even needs the same level of preparation for a purist science-based role. Are we able to address variability in learning styles and career trajectories within our doctoral education programs to address those who might want a blended role(s)? If so, how can we market the delivery of those programs and ensure that there is a research “return on investment” in all who graduate. Third, “How do we engage doctoral research educators – within and outside nursing – to augment our perspectives on research careers and expanded content consciousness?” Is there room in nursing education for organizational, econometric, environmental, and other scientists to expand our capacity similar to what was done in the pre-nursing PhD years?

If we can address these issues, then funding options for career development could expand beyond traditional federal funding. Organizations, including accountable care organizations, hospitals and health systems, professional societies, and philanthropy can step forward to play an added role in support.