Future of nursing report: Where are we now, what's to come

In October 2010, the Institute of Medicine released the first "The Future of Nursing: Leading Change, Advancing Health" report with recommendations "for an action-oriented blueprint for the future of nursing," the single largest segment of the health care workforce.

“Working on the front lines of patient care, nurses can play a vital role in helping realize the objectives set forth in the 2010 Affordable Care Act, legislation that represents the broadest health care overhaul since the 1965 creation of the Medicare and Medicaid programs,” according to a statement from the National Academies of Science, Engineering and Medicine.

However, the agency noted that a number of barriers exist preventing nurses from offering the most effective, rapid response to the changing health care settings and an evolving health care system.

For the Future of Nursing report, a two-year IOM initiative launched in 2008 with the help of the Robert Wood Johnson Foundation, researchers focused on six major categories for recommendations to be met by 2020. These suggestions included improving access to health care; fostering inter-professional collaboration; promoting nurse leaders; transforming nurse education; increasing diversity in the profession and collecting workforce data.

The report also led to the Future of Nursing: Campaign for Action, backed by the RWJF and the AARP, which encouraged state-specific implementation.

In February, the campaign published a progress dashboard to examine how far we've come between 2010 and 2017. The short version: We've got a long way to go, especially when it comes to diversity, valid data collection and leadership enhancement.

In an interview with HealthLeaders, Susan Hassmiller, RWJF senior adviser for nursing and director of the aforementioned campaign, said she "has worked tirelessly to ensure that the report and its recommendations didn't just 'sit on a shelf.'"

As for where progress has been made, Hassmiller noted that at the time of the report, only 49 percent of U.S. nurses had bachelor’s degrees, and “there’s been a cultural shift,” thanks in part to the fact that the campaign “put the infrastructure in place” to move forward.

She noted that community colleges and universities now “have memorandums of understanding” between them, and while the country might not reach the 80 percent goal by 2020, some institutions will. In fact, in Hawaii, Hassmiller said, “they are at 72 percent BSN-prepared nurses.”

As for the next report, Hassmiller told HealthLeaders there'll be a larger emphasis on a nurse's role "addressing social detriments and health inequities in our country," such as employment, housing, transportation, food access and social isolation. In the meantime, she wants nurses to focus on meeting on specific goal: getting 10,000 nurses on boards by 2020.

Here’s a breakdown on how far the nursing profession has advanced, and what’s ahead:

Which goals have been achieved so far?

IOM recommended the number of employed nurses with a doctoral degree should double by 2020. In 2010, that number was 10,022. By 2017, 28,004 nurses had a doctoral degree.
Since the campaign began, states North Dakota, South Dakota, Minnesota, Nebraska, Nevada, Vermont, Rhode Island and Maryland have all met the IOM recommendation that advanced practice registered nurses should be able to practice to the full extent of their training and education. Eleven others, plus Washington, D.C., achieved this goal before the campaign launched.
States California, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Louisiana, Mississippi, Missouri, Nevada, New Mexico, New York, North Dakota, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Texas, Utah, Vermont and Wisconsin all collect data on nurse education programs, supply of nurses and demand for nurses, part of an IOM recommendation to build infrastructure and collect workforce data.

Which goals still need work?

Recommendation: Increase proportion of nurses with baccalaureate degree to 80 percent by 2020

2017: Only 56 percent of nursing workforce has a baccalaureate degree

Recommendation: Advanced practice registered nurses should be able to practice to the full extent of their training and education

2017: Goal has not been achieved in all states.

Recommendation: Expand opportunities for nurses to lead and disseminate collaborative improvement efforts

2017: Many of the top schools don’t have required clinical courses or activities that include registered nursing students and graduate students of other health professionals, according to the campaign.

Recommendation: Health- care decision-makers should ensure leadership positions are available to and filled by nurses, starting with 10,000 nurses serving on boards

2019: As of Feb. 14, 5,670 nurses have reported serving on boards to the Nurses on Boards Coalition.

Recommendation: Build infrastructure for collection and analysis of inter-professional health care workforce data

2019: Not all states collect data on nurse education programs, supply of nurses and demand for nurses.

Recommendation: Make diversity in the nursing workforce a priority

2017: While the U.S. female/male population ratio was 50.8 percent female to 49.2 percent male in 2017, graduates of pre-licensure registered nursing programs were 85.6 percent female and 14.1 percent male. Here’s a screenshot of the racial disparities, pulled from the campaign dashboard: