Paving the way for the Future of Nursing 2020 – 2030

This story was published in the Fall 2021 issue of The Washington Nurse magazine.

Behind the scenes of the Future of Nursing 2020 Report Card #

Since 2010, the Washington Center for Nursing (WCN) has collab­o­rated with organi­za­tions repre­senting the nursing commu­nity (including WSNA) and partners in health care, workforce devel­op­ment and policy to imple­ment action­able and impactful initia­tives recom­mended in Future of Nursing: Leading Change, Advancing Health,” published in 2010 (FON: Leading Change).

FON: Leading Change was published soon after the passage of the Patient Protec­tion and Afford­able Care Act in 2010. In the report, the Insti­tute of Medicine, since renamed the National Academy of Medicine, asserted that there needed to be a trans­for­ma­tional change in the nursing profes­sion to success­fully imple­ment the Afford­able Care Act — and achieve its primary goal of increasing access to health care in the United States.

An excerpt of FON: Leading Change reads:

“[The report] explores how nurses’ roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to advance improvements in America’s increasingly complex health system. At more than 3 million in number, nurses make up the single largest segment of the health care work force. They also spend the greatest amount of time in delivering patient care as a profession. Nurses therefore have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care as envisioned in the Affordable Care Act (ACA) enacted this year [2010].”
— “Future of Nursing: Leading Change, Advancing Health”

The report presented four key recommendations:

  • Effec­tive workforce planning and policy making require better data collec­tion and an improved infor­ma­tion infrastructure.
  • Nurses should achieve higher levels of educa­tion and training through an improved educa­tion system that promotes seamless academic progression.
  • Nurses should be full partners, with physi­cians and other health profes­sionals, in redesigning health care in the United States.
  • Nurses should practice to the full extent of their educa­tion and training.

A summary of key indicators of success for Future of Nursing: Leading Change, Advancing Health” goals #

WCN put together the Future of Nursing 2020 Report Card for Washington State to provide highlights of progress made toward FON: Leading Change’s recom­men­da­tions in graphic form.

Effective workforce planning and policy making require better data collection and an improved information infrastructure. #

Nursing workforce data is used to inform policy. There are three major types of nursing workforce data that every nursing workforce center and state aim to provide: supply, demand and nursing educa­tion. In 2006, WCN contracted with the Univer­sity of Washington Center for Health Workforce Studies and worked with the Nursing Care Quality Assur­ance Commis­sion to gather data on the state’s LPNs, RNs and ARNPs based on a nation­ally estab­lished survey called the Nursing Minimum Data Set. This data gave us more infor­ma­tion on the supply (or charac­ter­is­tics) of these nursing categories in Washington. Examples include educa­tional attain­ment, race, ethnicity, places of residence and employ­ment, area of practice, age and gender. The FON 2020 Report Card on the WCN website highlights the increased amount of data collected. Washington went from only knowing four attrib­utes about nurses to 16. This data is reported in the aggre­gate, and no infor­ma­tion about any individual nurse is shared.

Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. #

Data shows that more nurses in Washington state are earning a BSN, with younger nurses leading the way. In 2019, while only 58.9% of all RNs had a BSN (compared to 53.5% in 2007), nearly 75% of nurses under age 30 held a BSN or higher. The creation of Direct Transfer Agree­ments between commu­nity colleges and four-year colleges and univer­si­ties helped to stream­line require­ments for entry into BSN programs and likely facil­i­tated this growth. The FON 2020 Report Card shows the expan­sion of 1 to 18 commu­nity colleges adopting Direct Transfer Agree­ments between 2007 and 2020.

Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States. #

The Leader­ship Washington Nursing Action Coali­tion (Leader­ship WNAC), housed at WCN, works to redesign health care to improve health outcomes by increasing nurses’ aware­ness and appli­ca­tion to practice the social deter­mi­nants of health (SDOH). In 2016, Leader­ship WNAC surveyed nurses about their aware­ness of SDOH. Responses among a sample of about 300 nurses indicated that only 29% were aware of SDOH, with the majority identi­fied as public health nurses. Using feedback from the survey to publish articles, provide presen­ta­tions at confer­ences and produce an educa­tional video in collab­o­ra­tion with the Washington State Health Care Authority called A Healthier Washington State Starts With Nurses, a post-test in 2017 showed aware­ness rose to 48% among nurses in Washington.

Leader­ship WNAC also aligned with the Nurses on Boards Coali­tion (NOBC). Nation­ally, the NOBC goal has been to get 10,000 nurses on nonnursing organi­za­tion boards by 2020. Leader­ship WNAC used its networks to provide infor­ma­tion on how to apply for board service while also publi­cizing oppor­tu­ni­ties on nonprofit boards and the Washington State Office of the Governor. With an NOBC goal of 158 Washington nurses serving on boards by 2020, Washington success­fully surpassed this number in August 2020 with 164 Washington nurses serving on boards.

Nurses should practice to the full extent of their education and training. #

Washington state led in this area, and nurses here have had full practice authority since 2005. Nation­ally, 13 additional states removed practice barriers for advanced practice nurses from 2010 – 2019.

Paving the way to Future of Nursing 2020 – 2030: Nursing workforce diversity and advancing health equity through nursing #

Diver­sity was implied throughout FON: Leading Change, recog­nizing the critical inter­sec­tion between the health needs of diverse popula­tions across the lifespan and the actions of the nursing workforce.

Included in the FON 2020 Report Card is additional infor­ma­tion on efforts to increase the diver­sity of the nursing workforce. Examples include:

  • Data showing nurses of color are just as likely to earn a BSN as white nurses, with the excep­tion of Hispanic and Native American nurses.
  • A video based on WCN’s Student Diver­sity Survey informing diverse families about ways they can support their students through nursing education.
  • Outcomes from the So You Want to Be a Professor Workshops, which seek to increase the diver­sity of nurse faculty. Nurse faculty are one of the least diverse nursing practice popula­tions. In addition, nursing faculty tend to be older and are at higher risk for shortage compared to other practice areas.

The diver­sity of the nursing profes­sion is central to the mission and work of WCN. The Future of Nursing 2020 – 2030: Charting a Path to Achieve Health Equity, the National Academy of Medicine’s new report released in May 2021, empha­sizes the nurse’s role in promoting health equity and continued work to diver­sify the profession.

The WCN report card acknowl­edges the many organi­za­tions that contributed to Washington state’s progress on FON: Leading Change recom­men­da­tions. WCN thanks WSNA for being a strong partner in the state’s success and commit­ment towards continued success to reach Future of Nursing 2020 – 2030 recommendations