While nurses are more frequently getting higher degrees and being allowed to practice independently of a physician, the profession still struggles in terms of diversity and leadership, concludes a report released Friday.
A National Academy of Medicine committee evaluated the nation's progress on eight recommendations first outlined in a 2010 Institute of Medicine report called The Future of Nursing. Those recommendations aimed to revamp nursing education, bolster leadership roles and remove the barriers that prevent nurses from practicing to the full extent of their education and training.
While progress has been made in some areas, there is still a ways to go on others, according to the report. It offers new suggestions on how to achieve the recommendations and ensure the nursing profession is equipped to meet the demands of major transformations to U.S. healthcare delivery and payment systems spurred by the Affordable Care Act.
The 2010 IOM report recommended increasing the number of nurses with a bachelor degree 80% by 2020, and doubling the number with a doctorate. That goal is being met. The committee found that between 2010 and 2015, the number of registered nurses enrolling in bachelor of science in nursing programs increased from 77,259 to 130,345, a nearly 70% jump. The number of nurses enrolling in entry-level baccalaureate programs increased from 147,935 to 172,794 during the five-year window.
The committee also found that advanced practice nurses are gaining more responsibilities. Five years ago, for example, only 13 states allowed nurse practitioners to perform tasks such as prescribing certain drugs without an "attestation agreement" from a physician. In May, Maryland became the 21st state to allow such provisions.
Other states have made “incremental improvements” to laws advancing the practice authority for advanced practice nurses, the report found. Modern Healthcare reported in June that the Veterans Affairs Department is considering similar legislation, regardless of laws in individual states, to help mitigate physician shortages and reduce patient wait times that have plagued the VA system.
Still the report found a “substantial barrier” in terms of the number of nurses with a doctorate. That level of education is needed to teach, perform research, and serve as leaders in clinical practice and health policy.
Ethnic and gender diversity has increased. “But not enough,” Stuart Altman, committee chair and a professor of National Health Policy at Brandeis University, said Friday. “We want to make diversity a priority as we go forward,” he said.
The report notes that Hispanics make up 20.3% of the general population ages 20 to 40, but only 5.6% of the RN workforce and 7.0% of baccalaureate graduates. African-Americans, who make up only 13.6% of ages 20 to 40, account for only 10.7% of the RN workforce and 9.3% of baccalaureate graduates. There are approximately 3 million RNs in the U.S. and only 9.2% are men.
Both the previous and recent report were commissioned and funded by the Robert Wood Johnson Foundation, which alongside the AARP launched the Future of Nursing: Campaign for Action in late 2010 to help implement the report's recommendations. An RWJF meeting to discuss the next steps to further the campaign is scheduled for Tuesday, committee members said during a briefing Friday.