As the leader of a philanthropy whose founder recognized early on the value of nurses to his own medical care and to healthcare writ large, I welcomed last year's Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, with great expectation. In the coming years, our nation's healthcare system will serve 32 million newly insured Americans as well as rapidly increasing numbers of seniors and people with chronic conditions. And it will do so in the context of changing models and settings for care delivery.
Greater teamwork among clinicians, foundations to improve nursing profession
Our foundation has long believed that a highly capable nursing workforce is critical to providing accessible, quality care. To meet the healthcare needs of all Americans, we must strengthen the nursing profession at all levels, from the front lines to the executive ranks. That is precisely why we partnered with the institute on this report, which quickly joined other institute studies on the quality of care, medical errors and public health as a landmark document.
We knew when The Future of Nursing was released that it held immense potential to illuminate the ways in which nurses could help to address the healthcare challenges we confront. It concluded that the full capacity of the nursing workforce had to be tapped. To effect that, it recommended changes within nursing education, scope of practice, interprofessional collaboration and leadership.
A year later, we are witnessing the report's impact through initiatives across the country. Yet truly realizing the report's promise—for nursing, for the healthcare system and for patients—will require sustained action. I am talking about new, even visionary ways of educating, training and utilizing nurses and other providers that put patients front and center.
This will demand a national, collaborative movement, and it will not come about unless stakeholders and leaders together commit to transforming healthcare as we know it into healthcare as we know it can and should be. Collaboration will indeed be a linchpin—across professions and sectors—as will recognition of nurses' roles as partners and leaders in the continuing push for improvement.
Interprofessional dialogue and work already is taking place through the Future of Nursing: Campaign for Action. The campaign is coordinated by the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation and the Robert Wood Johnson Foundation. It has helped unite nursing and other health professions' leaders, even as broad-based groups have coalesced in nearly every state to push ahead.
Nationally, more than 70 organizations are working through the center to craft strategies to carry out the report's recommendations. There also are now 36 campaign-designated state action coalitions, made up of nurses and other healthcare professionals, business leaders, consumers and others, that have convened to implement the report's recommendations in the most promising ways in their states.
In response to the specific recommendation that private and public funders should collaborate to advance research on models of care and innovative solutions, the Robert Wood Johnson Foundation has joined with other major philanthropies to form a community of funders. This venture (thefutureofnursing.org/research) will focus national attention on a common research agenda related to the report recommendations, from interprofessional education and nursing residency programs to the diffusion of effective practices across healthcare settings and models.
There is growing evidence that collaboration contributes to improving the quality of care. For example, to provide the best possible care to the medically vulnerable children it serves, Children's Medical Services of Southeast Florida approaches each case through teams that integrate the work of physicians, nurses, social workers and others. In addition to bringing clinical expertise, the nurse members of the team provide real insight into patients' day-to-day experiences by virtue of having the greatest degree of contact with them and their families.
What results have the teams seen? As Mary Hooshmand, regional nursing director for the Florida Department of Health, notes, the program achieves strong performance measurements on the Healthcare Effectiveness Data and Information Set and is a top-ranked provider despite the difficult cases it handles.
These efforts represent a strong start, but the road is long. As it is at Children's Medical Services, healthcare should always be a highly collaborative enterprise. To deliver the best care, each profession should perform its respective job at the highest level and in concert with others. The future of America's healthcare system clearly lies in even greater levels of teamwork as we look to more cost-effective models of care across settings. It is time to leave our silos and our comfort zones behind.
The time to find a common purpose is now. Making our healthcare system better must be our rallying point. The challenge is substantial but the reward is great. After all, providing the very best care for each of our patients speaks to the very reason we chose our profession.
Dr. Risa Lavizzo-Mourey is president and CEO of the Robert Wood Johnson Foundation, Princeton, N.J.
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