ASSESSING PROGRESS on the
Institute of Medicine Report
THE FUTURE OF NURSING

Committee for Assessing Progress on Implementing the
Recommendations of the Institute of Medicine Report
The Future of Nursing: Leading Change, Advancing Health

Stuart H. Altman, Adrienne Stith Butler, Lauren Shern, Editors

Institute of Medicine

THE NATIONAL ACADEMIES PRESS

Washington, DC

THE NATIONAL ACADEMIES PRESS    500 Fifth Street, NW    Washington, DC 20001

This study was supported by Contract/Grant No. 72309 from the Robert Wood Johnson Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-38031-7
International Standard Book Number-10: 0-309-38031-6
Library of Congress Control Number: 2016931586
DOI: 10.17226/21838

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Ralph J. Cicerone is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

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COMMITTEE FOR ASSESSING PROGRESS ON
IMPLEMENTING THE RECOMMENDATIONS OF THE
INSTITUTE OF MEDICINE REPORT
THE FUTURE OF NURSING:
LEADING CHANGE, ADVANCING HEALTH

STUART H. ALTMAN (Chair), Sol C. Chaikin Professor of National Health Policy, Heller Graduate School of Social Policy, Brandeis University, Weston, Massachusetts

CARMEN ALVAREZ, Assistant Professor, Department of Community-Public Health, Johns Hopkins University School of Nursing, Baltimore, Maryland

CYNTHIA C. BARGINERE, Senior Vice President and Chief Operating Officer, Rush University Hospital, Chicago, Illinois

RICHARD A. BERMAN, Interim Director, Patel College of Global Sustainability; Visiting Professor of Social Entrepreneurship, Muma College of Business; Professor, Institute for Advanced Discovery and Innovation, University of South Florida, Tampa

KAREN DONELAN, Senior Scientist in Health Policy, Mongan Institute for Health Policy, Massachusetts General Hospital, and Associate Professor of Medicine, Harvard Medical School, Boston, Massachusetts

SUZANNE FFOLKES, Vice President of Communications, Research!America, Alexandria, Virginia

PAULA GUBRUD, Associate Professor, Oregon Health & Science University School of Nursing, Portland

JACK NEEDLEMAN, Professor and Chair, Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles

MICHELE J. ORZA, Senior Advisor to the Executive Director, Patient-Centered Outcomes Research Institute, Washington, DC

ROBERT L. PHILLIPS, JR., Vice President for Research and Policy, American Board of Family Medicine, Washington, DC

EDWARD SALSBERG, Director, Health Workforce Studies, George Washington University Health Workforce Institute and School of Nursing, Washington, DC

GEORGE E. THIBAULT, President, Josiah Macy Jr. Foundation, New York, New York

Study Staff

ADRIENNE STITH BUTLER, Senior Program Officer

LAUREN SHERN, Program Officer

THELMA COX, Administrative Assistant

Consultants

RONA BRIERE, Consultant Editor

ERIN HAMMERS FORSTAG, Consultant Writer

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

David Auerbach, Massachusetts Health Policy Commission

Elizabeth H. Bradley, Yale School of Public Health

Patrick H. DeLeon, Uniformed Services University of the Health Sciences

Catherine Dower, Kaiser Permanente

Kathleen Gallo, North Shore–Long Island Jewish Health System

Ann Hubbard, Indian River State College

Judith R. Kunisch, Yale School of Nursing

Salimah H. Meghani, University of Pennsylvania School of Nursing

Wayne J. Riley, Vanderbilt University

John W. Rowe, Columbia University Mailman School of Public Health

William M. Sage, University of Texas at Austin

Richard Sorian, FleishmanHillard

Antonia M. Villarruel, University of Pennsylvania School of Nursing

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the report’s conclusions or

recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by Bobbie Berkowitz, Columbia University School of Nursing and Columbia University Medical Center, and Mark R. Cullen, Stanford University. They were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Preface

In 2010, the Institute of Medicine (IOM) released a landmark report titled The Future of Nursing: Leading Change, Advancing Health. In the preface to the report, the chair and vice chair of the committee, Donna Shalala and Linda Burnes Bolton, stated that the passage of the Patient Protection and Affordable Care Act, also in 2010, would require that the U.S. health care system expand to accommodate a significant increase in demand for services, particularly those needed to manage patients with chronic conditions or mental health conditions or to provide basic primary care. They noted that nurses were in a unique position to take on a leadership role in helping the nation attain these goals. They stated that “nurses have a key role to play as team members and leaders for a reformed and better integrated patient-centered health care system.”

The Future of Nursing was sponsored by the Robert Wood Johnson Foundation (RWJF), and senior staff of RWJF helped the IOM gather material for the 2-year study. Following the publication of the report, RWJF supported the creation of the Future of Nursing: Campaign for Action (the Campaign) and its 51 state Action Coalitions. The efforts of outside groups devoted to the implementation of the IOM report’s recommendations have been extraordinary.

It has now been 5 years since The Future of Nursing was issued, and RWJF asked the IOM to assess the progress made toward implementing the report’s recommendations and to identify areas that should be emphasized over the next 5 years to help the Campaign fulfill the recommendations. The committee convened to carry out this study was not asked to reexamine the merits of or amend the recommendations of The Future of Nursing. I was delighted when the new president of the now National Academy of Medicine, Dr. Victor Dzau, asked me

to chair the committee and take on this task. The field of nursing has been of special interest to me since I published my first book—Present and Future Supply of Registered Nurses—in the early 1970s. After reviewing The Future of Nursing and analyzing the information collected as part of the present study, it is clear to me that the nursing profession is a far more important component of the U.S. health care system than it was 45 years ago.

The committee conducted three public workshops and met as a group four times. In addition, it held three full-committee and several smaller subcommittee phone meetings. I am especially appreciative of the time commitment and pursuit of excellence of the 11 other members of our committee. Without their expertise, their experience, and their knowledge of the information that could be used to assess the changes that have occurred in the health care system, this report could not have been completed. We also are indebted to the staff of RWJF for their help in assembling this information. We appreciate as well the efforts of the three IOM staff members and the consultant writer who guided us through the study and the writing of this report. In particular, the dedication and drive of our study director, Adrienne Stith Butler, were irreplaceable.

Clearly much has been accomplished by the Campaign and other stakeholders, and it is readily apparent that The Future of Nursing was a catalyst for a number of new activities and accelerated several trends that had begun before the report was completed. The present report is timely in that it allows for reflection on the progress that has been achieved over the past 5 years in implementing the recommendations of The Future of Nursing, while leaving time for the Campaign and others to adjust to the many changes occurring in nursing and the health care system. The committee worked diligently over a short period of time to assemble and review the available data and evidence to help in understanding the changes that have occurred in the field of nursing—the structure of its education system, who is entering the field and in which programs, where nurses are employed, the attitudes of others about the appropriate role of nurses, and, where possible, how the expanded use of nurses has impacted the quality of patient care. With the help of this assessment, the committee generated a number of recommendations, which we hope will assist the Campaign, its state Action Coalitions, and other groups and stakeholders in positively impacting the field of nursing and improving the U.S. health care system.

Stuart H. Altman, Chair
Committee for Assessing Progress on
Implementing the Recommendations of the
Institute of Medicine Report
The Future of Nursing: Leading Change, Advancing Health

Acknowledgments

Many individuals and organizations made important contributions to the study committee’s process and to this report. The committee wishes to thank these individuals, but recognizes that attempts to identify all of them and to acknowledge their contributions would require more space than is available in this brief section.

the National League for Nursing (NLN), the Robert Wood Johnson Foundation (RWJF), and TCC Group.

Finally, many within the National Academies of Sciences, Engineering, and Medicine were helpful to the study staff. We would like to thank Clyde Behney, Laura DeStefano, Chelsea Frakes, Greta Gorman, Nicole Joy, Ellen Kimmel, Fariha Mahmud, Rebecca Morgan, Bettina Ritter, Jennifer Walsh, and Colleen Willis for their invaluable assistance.

Contents

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