Web 191216 10 years

In 2010, the National Acade­mies of Sciences, Engineering, and Medicine (formally known as the Insti­tute of Medicine), put out a report calling for drastic changes to the respon­si­bil­i­ties and educa­tion of nurses to improve health care nation­ally. The report, The Future of Nursing: Leading Change, Advancing Health, made specific recom­men­da­tions addressing nursing educa­tion, state practice environ­ments, inter­pro­fes­sional collab­o­ra­tion, the engage­ment of nurses in leader­ship roles, workforce data collec­tion and diversity. 

To put these recom­men­da­tions into action, the Robert Wood Johnson Founda­tion, AARP and the AARP Founda­tion created the Future of Nursing: Campaign for Action, with Action Coali­tions in every state and Washington, D.C., carrying out the work of the Campaign. The Washington Nursing Action Coali­tion (WNAC) leads the collab­o­ra­tive work in our state to trans­form health and health care through nursing, with the goal of a healthier popula­tion supported by a nursing workforce with advanced education.

The Future of Nursing report gave states a set of goals to aim for as they devel­oped their nursing workforce. Now, almost a decade later, how is the state of Washington measuring up to the recom­men­da­tions outlined in the report? Let’s take a look. 

Nursing Education #

The IOM recom­mended that by 2020, 80% of nurses be prepared with a baccalau­reate degree.

Younger RNs are leading in this recom­men­da­tion. Based on weighted survey responses, 81.4% in the 19 – 24 age group, 74.9% in the 25 – 29 age group and 68.7% in the 30 – 34 age group had a baccalau­reate in nursing or higher. In contrast, each of the age groups for nurses 35 or older had approx­i­mately 60% or lower completing at least a baccalau­reate degree. 

According to a 2018 WA State RN workforce survey conducted by the Washington Center for Nursing (WCN) and the Univer­sity of Washington’s Center for Health Workforce Studies, in Washington state, 63% of surveyed nurses have a baccalau­reate or higher nursing degree. 

The study also found that the associate degree was the initial degree received for 43.2% of RNs with a Washington state license. This number has seen little change since 2007, the last time this survey was conducted, when the number stood at 43.1%. The percentage of licensed Washington RNs receiving a baccalau­reate degree as their initial degree stands at 42.5%, up from 39.7% in 2007. 

The IOM goes on to recom­mend that the number of nurses pursuing doctorate degrees double by 2020. According to a report from the Washington State Depart­ment of Health, Nursing Educa­tion Programs 2016 – 2017 Annual School Report, this has been accom­plished in the state of Washington. The report shows that there were 161 gradu­ates with a nursing doctorate in 2016 – 2017, compared with only 33 in 2009 – 2010. 

State Practice Environments #

The IOM recom­mended that sates, federal agencies and health care organi­za­tions remove scope of practice barriers.

The report states that nurses are the primary care providers for patients, make up most of the health care workforce, and contribute valuable acumen to improving health care quality and safety. The report goes on to recom­mend that, States, federal agencies, and health care organi­za­tions should remove scope of practice barriers that hinder nurses from practicing to the full extent of their educa­tion and training.” The report points out that this is partic­u­larly problem­atic for APRNs. 

Washington state leads the nation in this recom­men­da­tion and is currently one of 21 states plus the District of Columbia where APRNs have full practice authority. 

Interprofessional Collaboration #

The IOM recom­mended the expan­sion of oppor­tu­ni­ties for nurses to lead and dissem­i­nate collab­o­ra­tive improve­ment processes.

This can be achieved through a variety of means such as involving nurses in quality improve­ment initia­tives and making inter­pro­fes­sional educa­tion more robust. 

In 2015, WNAC set its focus on the IOM recom­men­da­tion to prepare nurses to lead change and advance health. To do this, WNAC partnered with the Health Care Authority to appoint nurses to each of the five accel­er­ator commit­tees that would advise the imple­men­ta­tion of the Healthier Washington Initia­tive to promote whole-person care in the state. These commit­tees were created to inform the Health Innova­tion Leader­ship Network (HILN) in the following priority areas: collec­tive respon­si­bility, clinical engage­ment, commu­ni­ties and equity, integrated physical and behav­ioral health, and rural health innovation.

At the begin­ning of 2019, and with funding from a Robert Wood Johnson Founda­tion grant, WNAC launched a campaign to improve aware­ness of social deter­mi­nants of health, and subse­quently surveyed nearly 400 nurses around the state to see if and how they were addressing these deter­mi­nants where they work.

Leadership #

To accel­erate nurses’ influ­ence on commu­nity health, the IOM recom­mended that health care decision-makers ensure leader­ship positions are avail­able to nurses.

Nurses on Boards is a national campaign aimed at increasing the number of nurses serving on boards to 10,000 by 2020. The mission of the campaign is twofold; first, to connect the unique perspec­tive of nurses to the commu­ni­ties where they live and work; and second, to give nurses oppor­tu­ni­ties to develop valuable leader­ship skills. 

To reach the goal number of nurses serving on boards across the country, each state was given a target number to support the success of the campaign. The goal for WA was 158 board seats. As we approached the end of 2019, WA was at 79% of our goal with 125 nurses serving on boards. 

To get involved in Nurses on Boards and the Be Counted initia­tive, go to nurseson​board​scoali​tion​.org.

Workforce Data #

The IOM recom­mended that each state build an infra­struc­ture for the collec­tion and analysis of inter­pro­fes­sional workforce data to help nurse leaders make informed hiring decisions and to address short­ages in the nursing workforce. 

WCN is working with the Nursing Commis­sion to gather data on LPNs, RNs, and ARNPs based on the minimum nursing dataset. This data will enable us to have more infor­ma­tion on the supply (or charac­ter­is­tics) of these nursing categories in Washington. Examples are educa­tional attain­ment, ethnicity, place of residence as well as place of employ­ment, area of practice, age and gender.

Diversity #

The IOM recom­mended making diver­sity in the nursing workforce a priority. 

Members of ethnic groups that are under­rep­re­sented in nursing typically face multiple obsta­cles to entering the profes­sion. These can include inade­quate prepa­ra­tion in science and math, the high cost of college, limited exposure to the health profes­sions and lack of profes­sional role models.

To encourage diver­sity and inclu­sion in the state’s nursing workforce the focus has been on identi­fying and removing barriers to nursing educa­tion in the state. 

In 2013 the WCN devel­oped a nursing mentor­ship program to help connect minority nursing students with a working nurse mentor to help support profes­sional devel­op­ment. In both 2015 and 2017, WCN put together several implicit bias train­ings to educate working nurses, nursing students, nurse educa­tors and health­care providers about the impacts of biases in nursing – including delivery of care. 

In 2019, WCN’s Diver­sity Advisory Committee imple­mented a pilot program entitled So You Want to be a Professor. This program aims to encourage under­rep­re­sented nurses and nursing students to pursue a career in nursing educa­tion. The program was well-received, and a grant has been awarded to continue the program for two years with the poten­tial for an additional two-year exten­sion beyond that. 

What’s next #

Given the WCN and WNAC’s work to move the 2010 Future of Nursing goals forward, efforts have already been underway to shape goals for the 2030 Future of Nursing report. A likely theme is nursing’s poten­tial to promote health equity, address health dispar­i­ties, and to grow a more robust and diverse nursing workforce. This means continued data collec­tion and analysis of the nursing workforce, improved strate­gies to move nursing educa­tion forward, and a focus on where diver­sity in nursing is most challenging.