ANA Work Related to IOM Recommendations
ANA was gratified to find that many of the elements and recommendations of the Institute of Medicine (IOM) Report on the Future of Nursing are reflected in our ongoing work to advance the nursing profession. We are in complete agreement with the four “key messages” of the report. ANA and the CMAs have engaged in a wide range of activities over time that support the evidence-based recommendations of the IOM. While not an exhaustive list by any means, some of these efforts are noted in the attached document, keyed to each recommendation. We urge our Constituent Members to add their own efforts to this preliminary list and share it with ANA, so that we may compile in one place a repository of the extensive work that nursing has done -- and is doing -- to advance our profession and patient-centered care in a reformed health care system.
ANA and CMA activities reflected in the IOM recommendations
October 6, 2010
ANA was gratified to find that many of the elements and recommendations of the Institute of Medicine (IOM) Report on the Future of Nursing are reflected in our ongoing work to advance the nursing profession. We are in complete agreement with the four “key messages” of the report. ANA and the CMAs have engaged in a wide range of activities over time that support the evidence-based recommendations of the IOM. While not an exhaustive list by any means, some of these efforts are noted below, keyed to each recommendation. We urge our Constituent Members to add their own efforts to this preliminary list and share it with ANA, so that we may compile in one place a repository of the extensive work that nursing has done -- and is doing -- to advance our profession and patient-centered care in a reformed health care system. [See end of this document for link to send ANA your activities and comments].
KEY MESSAGES
from IOM Report on the Future of Nursing
As a result of its deliberations, the IOM committee formulated four key messages that structure the discussion and recommendations presented in this report:
1. Nurses should practice to the full extent of their education and training.
2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
3. Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States.
4. Effective workforce planning and policy making require better data collection and an improved information infrastructure.
RECOMMENDATIONS
From IOM Report on the Future of Nursing
ANA’s ongoing work pertinent to the recommendations
IOM Recommendation 1: Remove scope-of-practice barriers. Advanced practice registered nurses should be able to practice to the full extent of their education and training.
ANA has committed extensive resources to assure that all registered nurses, including APRNs, are able to practice to the full extent of their education, training and knowledge. ANA addresses the scope of practice for all registered nurses in 2010 Nursing: Scope and Standards of Practice, Second Edition and within the specialty nursing areas published through Nursesbooks.org.
Addressing scope of practice barriers at the national level:
The IOM report contains multiple references to the Consensus Model for APRN Regulation. ANA had a key role in the development of the model, and continues to make significant contributions in its implementation. See: http://www.nursingworld.org/consensusmodeltoolkit.
ANA was a founding member of the Coalition for Patients Rights (CPR) in 2006 and continues to be an active participant. CPR, consisting of more than 35 organizations representing a variety of licensed healthcare professionals. It was formed to address scope of practice barriers and ensure that patients have direct access to the full scope of services offered by the quality health care providers of their choice. http://www.patientsrightscoalition.org/
ANA has been working in collaboration with the associations representing each of the four APRN roles for the past year to identify specific barriers to practice in federal law and regulation. Some of those barriers were successfully reduced or eliminated in the Affordable Care Act. The coalition continues to meet regularly together and with key stakeholders to seek appropriate changes in laws and regulations.
During the 111th Congress:
IOM Recommendation 2: Expand opportunities for nurses to lead and diffuse collaborative improvement efforts. Private and public funders, health care organizations, nursing education programs, and nursing associations should expand opportunities for nurses to lead and manage collaborative efforts with physicians and other members of the health care team to conduct research and to redesign and improve practice environments and health systems. These entities should also provide opportunities for nurses to diffuse successful practices.
ANA’s Nursing: Scope and Standards of Practice, 2nd edition, (2010), speaks to the essential role of the nurse in care coordination, promoting wellness, providing individualized care in nurse-managed health centers, and participation in medical homes. It identifies these and other nursing services as vital to the effort “to alleviate the financial and social costs of treating preventable and chronic diseases.” ( p. 26.)
ANA’s National Database of Nursing Quality Indicators (NDNQI) is the nation’s largest nursing registry. More than 25 percent of hospitals participate in the database, which documents more than 21 measures of hospital performance linked to the availability and quality of nursing services in acute care settings. Participating facilities are able to obtain unit-level comparative data, including patient and staffing outcomes, to use for quality improvement purposes. Comparison data are publicly reported, which provides an incentive to improve the quality of care on a continuous basis. This database is also available to researchers interested in improving health care quality.
ANA has advocated aggressively, in coordination with other nursing groups, for increased funding for nursing education initiatives. Nursing successfully lobbied for a new grant program in the Accountable Care Act that will permit HHS to make awards to nursing schools or health facilities that can demonstrate enhanced collaboration and communication among nurses and other health care professionals. (Section 5308, ACA)
ANA also lobbied successfully, in collaboration with other nursing groups, for a new program in the Accountable Care Act that supports nurse-managed health centers. These are multi-disciplinary centers operated by APRNs that provide comprehensive primary care and wellness services to underserved or vulnerable populations.
Also see information on the Coalition for Patients Rights (CPR), under Recommendation #1 above, describing collaborative activity among the licensed health care professional community.
IOM Recommendation 3: Implement nurse residency programs. State boards of nursing, accrediting bodies, the federal government, and health care organizations should take actions to support nurses’ completion of a transition-to-practice program (nurse residency) after they have completed a prelicensure or advanced practice degree program or when they are transitioning into new clinical practice areas.
ANA recognizes that well designed mentoring programs support the growth and development of novice nurses in their transition to professional practice and provide opportunities for leadership development. ANA’s 2010 House of Delegates adopted a resolution on mentoring programs for novice nurses. The ANA will partner with CMAs, IMD and other nursing organizations to develop mentoring program demonstration projects and to disseminate their findings.
ANA worked collaboratively with other nursing groups to include in the Accountable Care Act education grants programs specifically for nurse retention, authorizing HHS to award grants to accredited nursing schools or health care facilities (or partnerships among both) to promote career advancement among nurses. (Section 5309, ACA)
IOM Recommendation 4: Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020. Academic nurse leaders across all schools of nursing should work together to increase the proportion of nurses with a baccalaureate degree from 50 to 80 percent by 2020.
These leaders should partner with education accrediting bodies, private and public funders, and employers to ensure funding, monitor progress, and increase the diversity of students to create a workforce prepared to meet the demands of diverse populations across the lifespan.
The 2008 ANA House of Delegates adopted a resolution supporting initiatives to require registered nurses (RNs) to obtain a baccalaureate degree in nursing within ten years after initial licensure. It exempts (or “grand-parents”) those individuals who are licensed or are enrolled as a student in a nursing program at the time state legislation is enacted. The 2008 House of Delegates further directed the ANA to promote legislative and educational activities that support enhanced nursing education. As this issue must be resolved at the state level, a number of constituent member associations have been working to advance this initiative. ANA has provided a tool kit to facilitate the work.
IOM Recommendation 5: Double the number of nurses with a doctorate by 2020. Schools of nursing, with support from private and public funders, academic administrators and university trustees, and accrediting bodies, should double the number of nurses with a doctorate by 2020 to add to the cadre of nurse faculty and researchers, with attention to increasing diversity.
In 2009, the ANA adopted a policy to support the Doctor of Nursing Practice as a terminal practice-focused degree in nursing offered to educate RNs in advanced levels of clinical judgment, systems thinking, and leadership to the profession of nursing. The Doctor of Nursing Practice graduate provides leadership, mentorship, and support to colleagues to improve patient outcomes and achieve excellence in nursing practice. (ANA’s position statement can be viewed at http://www.nursingworld.org/drpractice.aspx)
Many of the CMAs actively lobby for additional state resources to create the capacity necessary to prepare doctorate prepared nursing faculty, as well as baccalaureate prepared nurses, in their state.
A provision in the Accountable Care Act (ACA), supported by the ANA, expands the Nurse Repayment Loan and Scholarship Programs to provide loan repayment for students who serve at least two years as a faculty member at an accredited school of nursing.
Another ACA provision ANA successfully lobbied in support of increases Nurse Faculty Loan Program amounts, with funding priority to doctoral nursing students. (Section 5311, ACA)
IOM Recommendation 6: Ensure that nurses engage in lifelong learning. Accrediting bodies, schools of nursing, health care organizations, and continuing competency educators from multiple health professions should collaborate to ensure that nurses and nursing students and faculty continue their education and engage in lifelong learning to gain the competencies needed to provide care for diverse populations across the lifespan.
ANA’s Nursing: Scope and Standards of Practice describes nursing’s “continued commitment to the nursing profession [which] requires a nurse to remain involved in continuous learning and strengthening individual practice within varied practice settings.” (p.26) Furthermore, Standard 8 of professional nursing practice (“Education”) enumerates the competencies for nurses regarding their education. Among these is a “commitment to lifelong learning.”
ANA’s Continuing Education activities, as well as the vigorous work of the American Nurses Credentialing Center (ANCC), also speak to ANA’s efforts to encourage lifelong learning in all practice settings.
Many of ANA’s Constituent Member associations have worked collaboratively with the state boards of nursing to develop continuing competency requirements. These programs often include continuing education and practice requirements for registered nurses.
IOM Recommendation 7: Prepare and enable nurses to lead change to advance health. Nurses, nursing education programs, and nursing associations should prepare the nursing workforce to assume leadership positions across all levels, while public, private, and governmental health care decision makers should ensure that leadership positions are available to and filled by nurses.
ANA empowers nurses to be competent professional leaders in health care. Leadership is intrinsic to the profession and has been a formal professional standard of nursing practice in both the professional practice setting and within the profession for nearly two decades. (Nursing: Scope and Standards of Practice, 2nd Ed., Standard 12. Leadership, p.55).
ANA policy is member driven. ANA and CMAs provide leadership development and mentoring programs for all our members. Some examples are the member participation on ANA’s Congress on Nursing Practice and Economics, ANA’s Advocacy Institute, and our PAC committee. ANA is nothing without our members/volunteer leaders. This tenet is also articulated in ANA’s Nursing: Scope and Standards of Practice, describing advocacy as a “fundamental aspect of nursing.” (p. 20)
ANA launched the first American Nurses Advocacy Institute (ANAI) in 2009. ANAI is a program designed to increase the political competence of nurses, thus promoting stronger advocacy on nursing related issues at the state and federal levels. The three day event, culminating in visits with members of Congress, is the beginning of a year-long mentored journey.
ANA has long worked to identify nurse leaders to serve on a wide variety of public and private boards and advisory bodies. ANA supported the appointment of Mary Wakefield, PhD, RN, FAAN, as Administrator of HRSA, as well as the appointment of Marilyn Tavenner, Principal Deputy Administrator and Chief Operating Officer of HRSA. ANA also successfully advocated, with other nursing groups, for Mary Naylor, PhD, RN, FAAN to be appointed to MedPAC, and Judith J. Warren, PhD, RN, BC, FAAN, FACMI, to be seated on National Committee on Vital and Health Statistics (NCVHS) of HHS.
ANA spearheaded a successful effort to obtain a permanent seat on the CDC Advisory Committee for Immunization Practices, and has also sponsored a soon-to-be named member of the National Vaccine Advisory Committee.
ANA is advocating for several highly qualified nurses to serve as candidates for a variety of committees and advisory groups created by the Accountable Care Act (ACA). For example, ANA supported appointments for two individuals who were named to the new National Health Workforce Commission. Peter Buerhaus, PhD, RN, was appointed chair and Sheldon Retchin, MD, MSPH, was appointed vice-chair of the commission.
IOM Recommendation 8: Build an infrastructure for the collection and analysis of
interprofessional health care workforce data. The National Health Care Workforce
Commission, with oversight from the Government Accountability Office and the Health
Resources and Services Administration, should lead a collaborative effort to improve research and the collection and analysis of data on health care workforce requirements. The Workforce
Commission and the Health Resources and Services Administration should collaborate with state licensing boards, state nursing workforce centers, and the Department of Labor in this effort to ensure that the data are timely and publicly accessible.
Many CMAs participate in the Forum of State Nursing Workforce Centers, which is a group of nurse workforce entities who focus on addressing the nursing shortage within their state. Twenty nine states are known to have created health care or nursing workforce centers, which vary in their resources and subsequent approaches and outcomes. Many are non-profit and have as a primary goal nursing recruitment. ANA constituent member associations have been instrumental in this endeavor. They contribute to the global effort to assure an adequate supply of qualified nurses to meet the health needs of US residents. The FSNWC has developed National Nursing Workforce Minimum Datasets in the areas of nursing supply, nursing demand, and nursing education programs. See also www.nursingworkforcecenters.org.
With respect to better collection of health workforce data, ANA has advocated for the federal collection of nursing and other health professionals’ data in lieu of a simple proposed expansion sample size of the physician oriented National Ambulatory Medical Care Survey. ANA has pointedly reminded NCHS and HHS that their statutory charge is to collect data on the ambulatory utilization of health professionals—not just physicians. Currently, there is no federal data collection on RN ambulatory utilization, despite the requirement in the Public Health Service Act (42 U.S.C. §242k).