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Paving the way for the Future of Nursing 2020 – 2030

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

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.

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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.

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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