NURSING PROFESSION REENGINEERED FOR LEADERSHIP IN LANDMARK REPORT

Abstract

Evolutionary. Revolutionary. The missing piece to the puzzle of improving healthcare. These were the reactions to a landmark report announced October 5 at the National Press Club in Washington, DC. The report, "The Future of Nursing: Leading Change, Advancing Health," is the result of a partnership launched in 2008 between the Robert Wood Johnson Foundation and the Institute of Medicine to determine criteria to transform the nursing profession, leading to new roles and leadership positions for nurses in the redesign of the healthcare system. The Alliance for Nursing Informatics (ANI) provided written and in-person testimony about the use of technology and informatics for this milestone publication. Our contributions were used in the development of the audience of 2300 online participants and upward of 100 in-person attendees as a "tipping point in nursing care," calling for the nursing profession to be reengineered. Donna E. Shalala, PhD, former secretary, Department of Health and Human Services (1993-2001) and committee chair for the report, stated that nurses, 3 million strong, represent the largest workforce in healthcare and should be "leading the discussion of care delivery reform." The report provides recommendations for developing a stronger foundation in nursing education and calls for 80% of all nurses to hold a bachelor's degree in the next decade. Additionally, the report points out the need for collaborative efforts from states, federal agencies, and healthcare organizations to remove barriers that limit the full scope of practice for nurses. The ANI applauds the report for recognizing that nursing is the largest healthcare profession and is committed to patient care, safety, and quality and that we should be full partners in shaping the design of healthcare and the systems to support care delivery. The report outlines several "Opportunities to Transform Nursing Practice Through Technology" that ANI members should be aware of. These are as follows: (1) Implications of technology's impact on the design of health care delivery. Given the nature of patient data collection, nurses will be integral to proper collection of meaningful use data. As electronic health records (EHRs) become more refined and integrated, nurses will have the opportunity to help define additional meaningful use objectives. (2) Implications for time and place of care. Care supported by interoperable digital networks will shift in the importance of time and place. It is likely that a significant subset of care might be independent of physical location when health information technology (HIT) is fully implemented. Nurses provide care in every setting, particularly the community and need to be involved in shaping the effective use of information technology across settings. (3) Implications for nursing practice. While HIT will have its greatest influence on how RNs plan and document their care, all facets of care will be mediated increasingly by digital workflow, computerized knowledge management, and decision support. (4) Implications of technology's impact on quality, efficiency, and outcomes. Adoption of HIT is expected to increase the efficiency and effectiveness of clinician interactions with each patient and the target population. (5) Technology's role in transforming the practice of nursing. Interoperable electronic health records linked with personal health records and shared support systems will influence how collaborative care teams work and share clinical activities. (6) Involving nurses in technology design and implementation. The TIGER Initiative goal of engaging more nurses in leading both the development of national healthcare information technology infrastructure and healthcare reform is referenced, as well as the goal to "accelerate adoption of smart, standards-based, interoperable technology that will make healthcare delivery safer, more efficient, timely, accessible, and patient-centered, while also reducing the burden of nurses." CALL TO ACTION FOR ALL ANI MEMBERS (1) Share this publication and the report findings with each member of your organizations. (2) Have a discussion with ANI members and other nursing informatics colleagues about how to use this report to support nursing. (3) For more information on The Future of Nursing: Leading Change, Advancing Health IOM/RWJ Report, the PDF summary and the Executive Brief have been made available for download on the ANI Web site (www.allianceni.org) or visit the National Academies Press Web site (www.nap.edu/catalog.php?record_id=12956). ANI (www.allianceni.org), cosponsored by the American Medical Informatics Association and HIMSS, represents more than 5000 nurse informaticists and brings together more than 27 distinct nursing informatics groups globally. ANI crosses academia, practice, industry, and nursing specialty boundaries and works in collaboration with the nearly 3.1 million nurses in practice today.