Three Years After Release of 'The Future of Nursing' Report - What Progress Have We Made?

On December 11, the Institute of Medicine's (IOM) 2013 Richard & Hinda Rosenthal Lecture focused on progress made advancing the recommendations of the IOM report, The Future of Nursing: Leading Change, Advancing Health, released three years ago.

Donna Shalala, president of the University of Miami in Florida, former head of the U.S. Department of Health and Human Services, and chair of the Committee on the Robert Wood Johnson Foundation (RWJF) Initiative on the Future of Nursing, gave the keynote address, urging nurses and their allies to take this opportunity to transform nursing.

Among the victories cited by Shalala, RWJF President and CEO Risa Lavizzo-Mourey, and other speakers  were: the launch of the Future of Nursing: Campaign for Action; the removal of barriers to expanded scope of practice for advanced practice registered nurses in seven states; an increase in the number of streamlined nursing education programs that enable nurses to advance their education; and an increase in the appointment of nurses to decision-making boards.

Watch the webcast here.

INQRI In the News

New guidelines from the Joint Commission highlight the key role of nurses in preventing central line-associated bloodstream infections (CLABSIs), Infection Control Today reports. "Nurses are on the front lines and can take advantage of their constant contact with patients and other caregivers to explain infection control techniques and help health facilities develop and enforce standards of care that have been proven effective against CLABSI," said INQRI grantee Patricia Stone, PhD, MPH, RN.  She is also quoted in Long-Term Living,  Advanced Healthcare Network for Nurses, and Becker’s ASC Review.  

The health care system must ready itself for the influx of newly insured patients resulting from the Affordable Care Act, and advancing the role of nurses may be one way of addressing a potential physician shortage, according to an MSNBC.com article. The Institute of Medicine’s "Future of Nursing Report" is quoted in the article: “Now is the time to eliminate the outdated regulations and organizational and cultural barriers that limit the ability of nurses to practice to the full extent of their education, training, and competence.”

A Reuters Health article profiles the INQRI-funded study "Scope-Of-Practice Laws For Nurse Practitioners Limit Cost Savings That Can Be Achieved In Retail Clinics" and quotes co-lead investigator Joanne Spetz. "It appears there are cost savings when those nurse practitioners are allowed to operate autonomously in the retail clinic settings," Spetz told Reuters Health.

Nursing Economic$ Journal Feature: Leading Nurse Researcher Cites Importance of Transparency in Nurse Staffing Ratios

The September-October 2013 issue of Nursing Economic$ journal features the first in an insightful interview series with Linda H. Aiken PhD, FAAN, FRCN, RN, a member of the INQRI National Advisory Committee and a Research Manager supporting the Future of Nursing: Campaign for Action.

“The Impact of Research on Staffing: an Interview with Linda Aiken” covers numerous areas of nurse staffing, including the viability of public reporting as an alternative to legislatively-mandated nurse staffing ratios.

“If we had more transparent information on what staffing levels are at hospitals, consumers and nurses could exercise more informed choices in selecting a hospital for care or employment,” Aiken told NursingEconomic$. “Also, easily accessible information on staffing would expose hospitals with particularly poor staffing to increased public and professional scrutiny which would be expected to motivate improvements.”

Aiken also praises the 2013 Safe Nurse Staffing Act, introduced in Congress in April 2013, which proposes public reporting of nurse staffing on the Centers for Medicare & Medicaid Services Hospital Compare website.

Other topics covered in the interview include: variations of nurse staffing ratios across the country; inadequate staffing at minority hospitals; the impact of healthcare reform on nurse staffing; and addressing work environment issues. The second part of Aiken’s interview will be featured in the November/December 2013 issue of Nursing Economic$.

Policy Research to Inform Discussion on Scope of Practice

Alex Hoyt, PhD, RN, a Massachusetts General Hospital Institute of Health Professions School of Nursing Assistant Professor is using his recently awarded RWJF grant to bring policy research to the political debate over nurse practitioners’ (NPs') scope of practice. Dr. Hoyt was recently awarded a $250,000 grant via the Future of Nursing National Research Agenda initiative.

Dr. Hoyt plans to study the influence of regulatory changes on the NP workforce over time, how organizations interpret state practice regulations, and how these factors impact cost, quality, and access to care.

Click here to learn more about this impressive work.

New Brief Makes the Case for Baccalaureate-Prepped Nurses

A new policy brief authored by Ann Kutney-Lee and Linda Aiken and distributed by the Leonard Davis Institute of Health Economics at the University of Pennsylvania makes the case for baccalaureate-prepared nurses.

Researchers found that increases in the percentage of nurses with baccalaureate degrees were associated with significant reductions in surgical mortality rates and failure-to-rescue rates.  They also found that a ten-point increase in a hospital’s percentage of baccalaureate-prepared nurses was associated with an average reduction of 2.12 deaths for every 1,000 patients. (The average reduction was 7.47 deaths per 1,000 patients in the subset of patients with complications.)

These results suggest that if all the hospitals in the study had increased their percentage of baccalaureate nurses by ten points, about 500 deaths might have been prevented.  This is an incredibly important finding, given the recommendation made in the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health to increase the number of nurses holding a baccalaureate degree to 80% by the year 2020.

The brief also explains that in addition to improving patient outcomes, higher numbers of baccalaureate-prepared nurses could also lead to an increased number of graduate-level nurses prepared to either become nurse faculty or accept advanced-practice positions in primary care.  Aiken found that nurses with initial associate's degrees were less likely than those with an initial baccalaureate degree to earn a master's degree.

This brief is based on the following articles: 

1. A. Kutney-Lee, D.M. Sloane, L.H. Aiken. An increase in the number of nurses with baccalaureate degrees is linked to lower rates of post-surgery mortality, Health Affairs, March 2013, vol. 32, pp. 579-586;
2. L.H. Aiken. Nurses for the future. New England Journal of Medicine, January 20, 2011, vol. 364, pp. 196-198.

Sharing Nursing's Knowledge... with Lots of INQRI News

Check out the June edition of the Robert Wood Johnson Foundation's Sharing Nursing's Knowledge newsletter.  We were pleased to see that INQRI was heavily featured in this month's collection of stories... Read on!

Highlights:

• The Future of Nursing national research agenda announces four new grantees supported by the INQRI program.
• The section on recent nursing research features an INQRI study on heart failure.
• Last week, RWJF announced a $20M grant to support nurse PhD scientists.

Of course, this is just a sampling of the exciting news shared in the newsletter.  Check it out!

Research Grants Awarded to Study Nurse Residency Programs, Scope of Practice, Primary Care Workforce

The Robert Wood Johnson Foundation and INQRI today announced the recipients of four new grants from the Future of Nursing National Research Agenda. The grants will support research into key issues being addressed by the Future of Nursing: Campaign for Action: nursing education and scope of practice regulations.

A fifth study funded last year, to determine the how emerging models of primary care will affect future primary care workforce needs, is nearing completion.That study was co-funded by the Donaghue Foundation. It's being conducted by David Auerbach of the RAND Corporation.

The other four studies are:

• A team from the University of Pennsylvania will examine the impact of the provision of the Prescription for Pennsylvania law that removed practice barriers for APRNs. The research team will evaluate the development and architecture of the bill, and the success of the provision in expanding access to health care, particularly in medically underserved communities.
  

The Case for Nurse Residency Programs

The Institute of Medicine Report, The Future of Nursing: Leading Change, Advancing Care, includes several recommendations for strengthening nursing education. Nurse residency programs are one avenue for doing that, while also boosting nurse staffing at hospitals and helping those hospitals retain new nurses.

An article in the Anchorage Daily News looks at one nursing residency program at Alaska Regional Hospital and how it's preparing nursing school graduates and increasing nurse staffing. In addition to classroom instruction, Alaska Regional's program includes nurse-to-nurse mentoring, daily debriefing and frequent testing and evaluation.

The Future of Nursing: Campaign for Action includes several Action Coalitions working to develop or expand nurse residency programs. Most recently, the Rhode Island Action Coalition launched a statewide clinical nurse residency and mentoring program with a State Implementation Program grant from the Robert Wood Johnson Foundation. The Rhode Island program will place nursing school graduates in a range of settings from nursing homes to community clinics, as well as hospitals.

Transition-to-Practice Programs: Can They Improve Patient Safety and Quality of Care?

An article in Nurse.com looks at several pioneering transition-to-practice programs that are helping new RNs get the skills and experience they need to more easily make the transition from nursing student to practicing RN.

According to the National Council of State Board of Nursing (NCSBN), more than 40 percent of new graduate nurses report making medication errors and 50 percent do not believe they would recognize life-threatening complications that would require intervention. Moreover, the NCSBN reported that average turnover rates for nurses in their first year are 35 to 60 percent.

To address these issues, leading educators, hospitals and health systems have developed nurse residency and other transition programs that help nurses develop and practice the critical thinking and clinical judgement skills needed, as well as the clinical experience they need to feel more confident and less stressed when they take on their first nursing job.

Results of these early efforts are promising, including lower turnover rates. NCSBN is currently conducting a study into the effect of a transition-to-practice program model on patient safety and and quality outcomes.

The IOM report, The Future of Nursing: Leading Change, Advancing Care, calls for strengthening nursing education, and many of the Action Coalitions that are part of Campaign for Action to implement the IOM report recommendations are working to develop or expand nurse residency programs.