Study urges expanding role of nurses
In a rapidly changing health-care environment, the nation's more than 3 million nurses can and should play a much greater role in delivering care, according to a recently released Institute of Medicine report.According to Dr. David C. Goodman of The Dartmouth Institute for Health Policy and Clinical Practice in Hanover and one of the authors of the report, "nurses already are central to high-quality care. Of any member of the health-care team, they have the most enduring relationship with patients and are the most trusted professionals in health care."Goodman is also a professor of pediatrics and of Community and Family Medicine at Dartmouth Medical School, as well as a practicing physician at the Children's Hospital at Dartmouth-Hitchcock Medical Center.The report, "The Future of Nursing: Leading Change, Advancing Health," was authored by the 18-member Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. Over two years of analysis and deliberation, including five meetings, workshops, three public forums and numerous site visits, the committee considered its charge to "examine the capacity of the nursing workforce to meet the demands of a reformed health care and public health system," according to Goodman.Among its recommendations, the committee concluded that to fully take advantage of the skills and commitment of nurses, they must have expanded educational opportunities and be freed from "scope of practice" regulations that limit the care they can provide. Further, it recommends that nurses be given a greater role in health care redesign and improvement efforts."We believe the search for an expanded workforce to serve the millions who will now have access to health insurance for the first time will require changes in nursing scopes of practice, advances in the education of nurses across all levels, improvements in the practice of nursing across the continuum of care, transformation in the utilization of nurses across settings and leadership at all levels so nurses can be deployed effectively and appropriately as partners in the health care team," write the authors.The nursing population represents the largest portion of the U.S. health-care workforce, according to the report, yet it faces many challenges to being integrated as fully as it could be in the provision of care. Among these are: a lack of diversity in race, ethnicity, gender and age; insufficient education and preparation to adopt new roles; restrictions on scope of practice, limitations by insurance companies, and in some cases "professional tensions" that make it difficult or impossible to practice to their full potential."Producing a health-care system that delivers the right care - quality care that is patient-centered, accessible, evidence based, and sustainable - at the right time will require transforming the work environment, scope of practice, education, and numbers of America's nurses," according to the report.According to Goodman, the report "will advance the nursing profession to the center of leading change and improvement in health care systems as the nation seeks higher value in patient care."