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SOLUTION AT Academic Writers Bay THE NATIONAL ACADEMIES PRESS This PDF is available at http://www.nap.edu/21838 SHARE    Assessing Progress on the Institute of Medicine Report The Future of Nursing DETAILS 190 pages | 6 x 9 | PAPERBACK ISBN 978-0-309-38031-7 | DOI: 10.17226/21838 AUTHORS BUY THIS BOOK FIND RELATED TITLES Stuart H. Altman, Adrienne Stith Butler, and Lauren Shern, Editors; Committee for Assessing Progress on Implementing the Recommendations of the Institute of Medicine Report The Future of Nursing: Leading Change, Advancing Health; Institute of Medicine; National Academies of Sciences, Engineering, and Medicine Visit the National Academies Press at NAP.edu and login or register to get: – Access to free PDF downloads of thousands of scientiﬁc reports – 10% off the price of print titles – Email or social media notiﬁcations of new titles related to your interests – Special offers and discounts   Distribution, posting, or copying of this PDF is strictly prohibited without written permission of the National Academies Press. (Request Permission) Unless otherwise indicated, all materials in this PDF are copyrighted by the National Academy of Sciences. Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing 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 PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing 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: International Standard Book Number-10: Library of Congress Control Number: Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2015 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering and Medicine. 2015. Assessing Progress on the Institute of Medicine Report The Future of Nursing. Washington, DC: The National Academies Press. PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing 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. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.national-academies.org. PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing Copyright © National Academy of Sciences. All rights reserved. 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 (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 Innovation & Advanced Discovery, 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 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, 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, NY Study Staff ADRIENNE STITH BUTLER, Senior Program Officer LAUREN SHERN, Program Officer THELMA COX, Administrative Assistant Consultants ERIN HAMMERS FORSTAG, Consultant Writer RONA BRIERE, Consultant Editor PREPUBLICATION COPY: UNCORRECTED PROOFS v Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing 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 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 have provided many constructive comments and suggestions, they were not asked to endorse the 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. PREPUBLICATION COPY: UNCORRECTED PROOFS vii Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing 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 illnesses or for 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 report 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 report. 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 report 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, was irreplaceable. Clearly much has been accomplished by the Campaign and other stakeholders, and it is readily apparent that The Future of Nursing report 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 last 5 years in implementing the recommendations of The Future of Nursing report, 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 PREPUBLICATION COPY: UNCORRECTED PROOFS ix Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing 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 PREPUBLICATION COPY: UNCORRECTED PROOFS x Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing 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 and acknowledge their contributions would require more space than is available in this brief section. To begin, the committee would like to thank the sponsor of this study; funds for the committee’s work were provided by the Robert Wood Johnson Foundation. The committee also gratefully acknowledges the contributions of the many individuals and organizations that assisted in the conduct of the study. Their perspectives were valuable in understanding the work undertaken to implement the recommendations from the 2010 Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health. The committee thanks those individuals who provided important presentations and oral testimony at its open workshops. Appendix A lists these individuals and their affiliations. Written testimony received from nearly 100 individuals and organizations also helped the committee understand the status of implementation of the recommendations. The committee is grateful for the time, effort, and valuable information provided by all of these dedicated individuals and organizations. We are immensely grateful for the organizations that provided the committee with data and other inputs: the Accreditation Commission for Education in Nursing (ACEN), American Association of Colleges of Nursing (AACN), Commission on Collegiate Nursing Education (CCNE), the National League for Nursing (NLN), the Center to Champion Nursing in America and Robert Wood Johnson Foundation, 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, Jennifer Walsh, and Colleen Willis for their invaluable assistance. PREPUBLICATION COPY: UNCORRECTED PROOFS xi Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing Contents SUMMARY S-1 1 INTRODUCTION Context Study Scope Overview of The Future of Nursing: Leading Change, Advancing Health The Future of Nursing: Campaign for Action RWJF Activities Outside of the Campaign Organization of the Report References 1-1 1-1 1-3 1-5 1-7 1-15 1-17 1-17 2 REMOVING BARRRIERS TO PRACTICE AND CARE Activity and Progress Discussion Findings and Conclusions Recommendation References 2-1 2-3 2-5 2-10 2-11 2-11 3 ACHIEVING HIGHER LEVELS OF EDUCATION Increase the Proportion of Nurses with a Baccalaureate Degree to 80 Percent by 2020 Implement Nurse Residency Programs Double the Number of Nurses with a Doctorate by 2020 Ensure that Nurses Engage in Lifelong Learning Recommendations References 3-15 3-23 3-30 3-34 3-36 PROMOTING DIVERSITY Introduction Activity Progress Discussion Findings and Conclusions Recommendation References 4-1 4-1 4-3 4-6 4-15 4-17 4-18 4-19 4 PREPUBLICATION COPY: UNCORRECTED PROOFS xiii Copyright © National Academy of Sciences. All rights reserved. 3-1 3-1 Assessing Progress on the Institute of Medicine Report The Future of Nursing xiv 5 6 CONTENTS COLLABORATING AND LEADING IN CARE DELIVERY AND REDESIGN Interprofessional Collaboration Preparing Nurses to Lead Nurses in Leadership Positions The Campaign for Action’s Communication Efforts to Support Collaboration and Leadership Recommendations References IMPROVING WORKFORCE DATA INFRASTRUCTURE Activity and Progress Discussion Findings and Conclusions Recommendation References 5-1 5-1 5-9 5-12 5-14 5-18 5-19 6-1 6-1 6-5 6-9 6-10 6-11 APPENDIXES A B C Data Sources and Methods Recommendations of the Institute of Medicine Reports The Future of Nursing: Leading Change, Advancing Health Committee Biographies PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. A-1 B-1 C-1 Assessing Progress on the Institute of Medicine Report The Future of Nursing Acronyms AACN AAMC AAN AANP ACA ACCME ACEN ACP ACPE ACS ADN AMA ANA ANCC AONE APIN APRN American Association of Colleges of Nursing Association of American Medical Colleges American Academy of Nursing American Association of Nurse Practitioners Patient Protection and Affordable Care Act Accreditation Council for Continuing Medical Education Accreditation Commission for Education in Nursing American College of Physicians Accreditation Council for Pharmacy Education American Community Survey associate’s degree in nursing American Medical Association American Nurses Association American Nurses Credentialing Center American Organization of Nurse Executives Academic Progression in Nursing advanced practice registered nurse BSN bachelor’s of science in nursing Campaign CCNA CCNE CDC CHC CMA CMMI CMS CNO CPS Future of Nursing: Campaign for Action Center to Champion Nursing in America Commission on Collegiate Nursing Education Centers for Disease Control and Prevention Community Health Center, Inc. California Medical Association Center for Medicare and Medicaid Innovation Centers for Medicaid & Medicare Services chief nursing officer Current Population Survey DNP doctor of nursing practice FON FQHC FTC The Future of Nursing: Leading Change, Advancing Health (IOM, 2011) federally qualified health center Federal Trade Commission GNE Graduate Nursing Education PREPUBLICATION COPY: UNCORRECTED PROOFS xv Copyright © National Academy of Sciences.

All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing xvi ACRONYMS HRSA Health Resources and Services Administration INQRI IPE IPEC IPEDS Interdisciplinary Nursing Quality Research Initative interprofessional education Interprofessional Education Collaborative Integrated Postsecondary Education Data System MDS MSN Minimum Data Set master’s of science in nursing NAMCS NCIN NCIPE NCLEX NCSBN NHIS NJAC NLN NP NPI NSSRN National Ambulatory Medical Care Survey New Careers in Nursing National Center for Interprofessional Practice and Education National Council Licensure Examination National Council of State Boards of Nursing National Health Interview Survey New Jersey Action Coalition National League for Nursing nurse practitioner National Provider Identifier National Sample Survey of Registered Nurses OHSU Oregon Health & Sciences University PA PIN physician assistant Partners Investing in Nursing’s Future RN RWJF SIP registered nurse Robert Wood Johnson Foundation State Implementation Program SOC SOP Standard Occupational Classification scope of practice UHC University HealthSystem Consortium VA VHA U.S. Department of Veterans Affairs Veterans Health Administration PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing Summary1 Nurses make up the largest segment of the health care profession; there are approximately 3 million registered nurses in the United States. Nurses work in a wide variety of settings, including hospitals, public health centers, schools, and homes, and provide a continuum of services involving direct patient care, health promotion, patient education, and coordination of care. They serve in leadership roles, are researchers, and work to improve health care policy. As the health care system undergoes transformation, in part as a result of the Patient Protection and Affordable Care Act (ACA), the nursing profession is having a wide-ranging impact by providing patient-centered, accessible, and affordable care. In 2010, the Institute of Medicine released The Future of Nursing: Leading Change, Advancing Health report, offering recommendations for nursing in the new health care landscape. The present report assesses progress made toward implementing those recommendations. This report also identifies areas that should be emphasized over the next 5 years to advance the recommendations’ implementation. The 10 recommendations offered in the present report are intended to help the Future of Nursing: Campaign for Action (the Campaign) and the nursing profession effect change in the culture in which health care is provided by addressing scope of practice, education, collaborative leadership, diversity in the nursing profession, and improving the collection of nursing workforce data. In the past decade, the changing climate of health care policy and practice has sharpened the national focus on the challenges of providing high-quality and affordable care to an aging and increasingly diverse population. The priorities of this changed climate will increasingly require the collaboration of health professionals to provide patient-centered, coordinated, and community-based primary and specialty care services. Nurses, who are the largest group of health care professionals, are positioned to lead and partner in teams that provide services across the continuum of care (hospitals, ambulatory care, public health, schools, long-term care, and home health). Nurses are also positioned to provide leadership within a variety of health care systems and policy settings. In 2008, the Robert Wood Johnson Foundation (RWJF) partnered with the Institute of Medicine (IOM) to establish an Initiative on the Future of Nursing, which convened a committee 1 This summary does not include references. Citations for the discussion presented in the summary appear in the subsequent report chapters.

PREPUBLICATION COPY: UNCORRECTED PROOFS S-1 Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing S-2 ASSESSING PROGRESS ON THE IOM REPORT THE FUTURE OF NURSING that in 2010 released the report, The Future of Nursing: Leading Change, Advancing Health (FON). This report offered a series of recommendations to advance nursing’s contributions to the new health care environment (see Box S-1). Shortly after release of the FON report, AARP and RWJF launched the Future of Nursing: Campaign for Action (the Campaign), to shepherd the FON report’s recommendations. The Campaign, coordinated through the Center to Champion Nursing in America (CCNA), works nationally and through state Action Coalitions (ACs) to advance its goals. The Campaign’s efforts target six major areas, or “pillars”: • • • • • • advancing education transformation, leveraging nursing leadership, removing barriers to practice and care, fostering interprofessional collaboration, promoting diversity, and bolstering workforce data. Reports released by many other organizations (for example, the World Health Organization, the Carnegie Foundation, and the Tri-Council for Nursing) contemporaneously with the FON report called for similar changes. The FON report lent momentum to a movement that was under way, offering tangible and specific recommendations. BOX S-1 Key Areas Addressed by Recommendations from The Future of Nursing: Leading Change, Advancing Health 1. 2. 3. 4. 5. 6. 7. 8. Remove scope-of-practice barriers. Expand opportunities for nurses to lead and diffuse collaborative improvement efforts. Implement nurse residency programs. Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020. Double the number of nurses with a doctorate by 2020. Ensure that nurses engage in lifelong learning. Prepare and enable nurses to lead change to advance health. Build an infrastructure for the collection and analysis of interprofessional health care workforce data. STUDY CHARGE AND APPROACH In 2014, RWJF asked the IOM to convene a committee to assess progress made on implementing the FON report recommendations and identify areas that should be emphasized over the next 5 years to help the Campaign fulfill its aims. The committee considered the utilization of the FON report by the Campaign and other groups, impact of the Campaign on areas peripheral to nursing, and the Campaign’s use of traditional and new media in meeting its goals. The committee report was based, in part, on three workshops organized by the committee that focused on practice, education, leadership, diversity, collaboration, and health workforce data. The committee’s task did not include reexamining the merits of the FON report recommendations. Given the short time since the release of the FON report, the committee did PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing SUMMARY S-3 not perform a comprehensive evaluation of the impact of the report’s recommendations or of the Campaign, but instead focused on progress achieved on report goals. Further, the committee did not attribute progress or the lack thereof in areas of the FON report’s recommendations directly to the report or to the Campaign, recognizing that other factors were at play in the environment. The committee examined how the current context of health care delivery, nursing education, and practice may affect implementation of the FON report’s recommendations and identified barriers to and unintended consequences of their implementation. The committee also considered how the recommendations might yet be advanced. STUDY CONTEXT The FON report was produced at a propitious moment in health care in the United States, a time of growing awareness that dramatic changes in the care delivery system were needed to accomplish the “Triple Aim” of better patient experience, better health of the public, and lower costs.

The FON anticipated that passage of the ACA would necessitate that nurses play a larger role in bridging the gap between coverage and access. New delivery models emphasize teamwork, care coordination for specialty care and chronic disease management, prevention, and greater focus on population health and community-based care. New payment models are moving away from fee-for-service and episodic payment to value-based payments. Rapid advances in information technology are changing the way health professionals and the public receive information and communicate with one another. Greater attention to preparing the health care workforce to meet growing and evolving needs has led to more emphasis on interprofessional education, teamwork training, and a better understanding of the roles of all health professionals in creating an optimal health care delivery system. While the committee that developed the FON report anticipated many of these changes, it could not have foreseen exactly how they would play out. STUDY FINDINGS AND RECOMMENDATIONS The present report recommendations are intended to help the Campaign, as well as policy makers, payers, and other health professions organizations, make further progress toward implementing the recommendations of the FON report. The committee found that the Campaign has made significant progress in many aspects of this effort. In a short period of time, it has galvanized the nursing community through its work at the national level and through the 51 state Action Coalitions it has organized. The committee found that the Campaign has met or exceeded expectations in many areas. However, given the changing health care culture and, in particular the increasing importance placed on interprofessional collaboration, the Campaign needs to engage a broader network of stakeholders. The present report also recommends addressing challenges in the areas of scope of practice, education, collaboration, leadership, diversity, and data. The committee believes these contributions can change the impact of nurses on the health care system and on patient care and outcomes. PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing S-4 ASSESSING PROGRESS ON THE IOM REPORT THE FUTURE OF NURSING In the committee’s view, the work of the Campaign and others would best be advanced if it were driven by the following three themes: • • • the need to build a broader coalition to increase awareness of nurses’ ability to play a full role in health professions practice, education, collaboration, and leadership; the need to continue to prioritize promoting diversity in the nursing workforce; and the need for better data with which to assess and drive progress. The committee hopes that, taken together, the 10 recommendations presented in this report provide a blueprint for advancing implementation of the FON report recommendations. Removing Scope-of-Practice Barriers The FON report proposes that advanced practice registered nurses (APRNs), could help build the workforce necessary to meet the country’s health care needs if permitted to practice to the full extent of their education and training. In 2010, 13 states were classified as meeting criteria for full practice authority. Since then, 8 more states (Connecticut, Maryland, Minnesota, Nebraska, Nevada, North Dakota, Rhode Island, and Vermont) have changed their laws to give nurse practitioners (NPs) full practice and prescriptive authority. As of this writing, 17 states are categorized as having reduced practice authority and 12 as having restricted practice authority. Some states—for example, Kentucky, New York, Texas, and Utah—have made incremental improvements to their laws but are still categorized as having reduced or restricted practice authority for APRNs. These broad categorizations, while useful for classification purposes, mask a number of subtle differences among state laws.

For example, Maine, a state with full practice authority, has legislative prohibitions against NP hospital privileges. At the federal level, the Centers for Medicare & Medicaid Services in 2012 issued a final rule broadening the concept of medical staff, permitting hospitals to allow other practitioners (for example, APRNs, physician assistants, and pharmacists) to perform all functions within their scope of practice. Despite this rule, medical staff membership and hospital privileges remain subject to existing state laws and business preferences. The Federal Trade Commission has engaged in competition advocacy for APRNs scope of practice in many states, providing letters, comments, and/or testimony. While there has been on-the-ground collaboration between medicine and nursing, opposition by some physicians and physician organizations has been noted as a barrier to expansion of APRNs’ scope of practice. The health care environment continues to evolve and demand greater team-based and value-based care. There is growing evidence that new models of practice in which all health professionals practice to the full extent of their education and training offer greater efficiency and quality of services. Several studies have shown, moreover, that these care models enhance satisfaction among health care providers. This is an important contextual change since the release of the FON report, one that offers potential common ground for that report’s goals regarding scope-of-practice expansion. PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing SUMMARY S-5 Recommendation 1: Build Common Ground Around Scope of Practice and Other Issues in Policy and Practice. The Future of Nursing: Campaign for Action (the Campaign) should broaden its coalition to include more diverse stakeholders. The Campaign should build on its successes and work with other health professions groups, policy makers, and the community to build common ground around removing scope-of-practice restrictions, increasing interprofessional collaboration, and addressing other issues to improve health care practice in the interest of patients. Achieving Higher Levels of Education According to the FON report, transformation in the health care system and practice environments requires a corresponding transformation in nursing education. If nurses are to be prepared to meet increasingly complex patient needs, function as leaders, and advance the science of care, they need to achieve higher levels of education, upon entering the workforce and throughout their careers. Baccalaureate Education In 2010, approximately half of the nation’s 3 million nurses held a baccalaureate or higher degree. The FON report recommends that this proportion be increased, suggesting an ambitious goal of 80 percent by 2020. Baccalaureate program enrollment has increased substantially in the 5 years: entry-level baccalaureate enrollment increased from 147,935 in 2010 to 172,794 in 2014; accelerated baccalaureate enrollment increased from 13,605 to 16,935; and baccalaureate completion enrollment (so-called registered nurse [RN] to bachelor of science in nursing [BSN]) increased from 77,259 to 130,345. The number of nursing programs grew significantly over the last decade, particularly 4year college programs. There is also an increasing preference for hiring BSNs; however, a majority of employers do not require a BSN. The increase in the quantity of baccalaureate programs is commendable; however, attention to the educational quality in these programs is essential to ensure that nurses—and patients—are reaping the assumed benefits of the additional education. The committee is concerned that the funding for nursing education has been relatively flat for the past decade creating logistical problems for students (for example, taking time away from work to pursue education), which are identified as barriers to obtaining a baccalaureate degree.

Transition-to-Practice Residency Programs The FON noted a high turnover rate among newly graduated nurses; some nurses leave their first job for a different care setting, but some leave the profession entirely. The report recommends that nurses be supported in their transition to practice through residency programs to help reduce attrition. The FON report focuses largely on residencies for postlicensure RNs, but acknowledges that residencies would be useful for nurses transitioning to new care settings or entering practice as APRNs. PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing S-6 ASSESSING PROGRESS ON THE IOM REPORT THE FUTURE OF NURSING In 2011, the National Council of State Boards of Nursing (NCSBN) began to study transition-to-practice models for new nurse graduates in hospitals as well as in long-term care, home health, and other settings. Transition-to-practice residencies appear to have some positive outcomes, including improved ability to organize, manage, and communicate, as well as higher retention. These residencies vary considerably and comprehensive data are sparse. It is difficult to gauge growth in programs overall, within particular settings, and for nurses of different educational levels. Despite their positive benefits, cost and a lack of data on the value of these programs remain barriers to broader implementation. This committee believes that residencies for both RNs and APRNs are beneficial and need to be encouraged, and that attention to residency programs for outpatient care is insufficient. Doctoral Education The small number doctorate-trained nurses, who are needed to teach, perform research, and serve as leaders in clinical practice and health policy, remains a substantial barrier. In 2010, fewer than 1 percent of nurses held a doctoral degree. The FON recommended doubling this number by 2020, but was not specific about types of doctoral programs (doctor of nursing practice [DNP], PhD in nursing, PhD in another field). Because doctoral degrees typically take years to complete, the committee was unable to assess progress on this recommendation. Since fall 2010, enrollment in DNP programs has more than doubled, from 7,034 to 18,352 students (a 161 percent increase). Meanwhile, enrollment in PhD programs has increased by 15 percent over the past 5 years, with 5,290 students now pursuing the research-focused doctorate. An assessment of the mix of doctorally prepared nurses is needed, and more emphasis on PhD program expansion, incentives for nurses to return to school, and more scholarships for baccalaureate-to-PhD programs is warranted. Many schools need more faculty to increase enrollment at all levels, especially nurses with doctorates. Barriers cited to meeting this challenge include insufficient faculty expansion and funding, faculty recruiting difficulty, and the limited number of doctorally prepared nurses. Lifelong Learning After nurses obtain their degrees, lifelong learning is necessary to provide quality care. Continuing education and competence has not kept pace with the needs of the increasingly complex, team-based health care system. Nurses and other providers will increasingly need to update skills for providing care in both hospital and community-based settings. One obstacle to progress on this recommendation of the FON report is a lack of data on continuing education for nurses as well as on whether nurse certification and credentialing lead to better patient outcomes. Greater understanding of the impact of nurse certification and credentialing has implications for advancing not only lifelong learning, but also on scope of practice and care delivery, and on collaboration and leadership to improve health care system design and delivery. Recommendation 2: Continue Pathways Toward Increasing the Percentage of Nurses with a Baccalaureate Degree. The Future of

Nursing: Campaign for Action, the nursing education community, and state systems of higher education should continue efforts aimed at strengthening academic pathways PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing SUMMARY S-7 for nurses toward the baccalaureate degree—both entry-level baccalaureate and baccalaureate completion programs. • Efforts to expand and encourage partnerships between community colleges and 4-year universities, as well as other models for establishing these pathways, should continue to be promulgated. Employers play a critical role in promoting educational progression and should be encouraged to provide financial and logistical support for employees pursuing a baccalaureate degree. • In addition, the quality of new programs should be monitored to ensure consistency in effective educational practices and to ensure the ability of nursing graduates to qualify to attend other accredited schools as they pursue advanced studies. This monitoring could be conducted through a national accrediting body such as the Commission on Collegiate Nursing Education or the American Commission for Education in Nursing. Recommendation 3: Create and Fund Transition-to-Practice Residency Programs. The Future of Nursing: Campaign for Action, in coordination with health care providers, health care delivery organizations, and payers, should lead efforts to explore ways of creating and funding transition-topractice residency programs at both the registered nurse and advanced practice registered nurse levels. Such programs are needed in all practice settings, including community-based practices and long-term care. These efforts should include determining the most appropriate program models; setting standards for programs; exploring funding and business case models; and creating an overarching structure from which to track and evaluate the quality, effectiveness, and impact of transition-to-practice programs. With respect to funding models, • government agencies, philanthropic organizations, and foundations should support these programs on a temporary basis to help better understand how the programs should be designed; and • health care organizations should support these programs on a permanent basis as they can be beneficial in the evolving value-based payment system. Recommendation 4. Promote Nurses’ Pursuit of Doctoral Degrees. The Future of Nursing: Campaign for Action should make efforts, through incentives and expansion of programs, to promote nurses’ pursuit of both the doctor of nursing practice (DNP) and PhD degree so as to have an adequate supply of nurses for clinical care, research, faculty, and leadership positions. More emphasis should be placed on increasing the number of PhD nurses in particular. To maximize the potential value of their additional education, nurses should be encouraged to pursue these degrees early in their careers. PhD and DNP programs should offer coursework that prepares students to serve as faculty, including preparing them to teach in an evolving health care system that is less focused on acute care than has previously been the case. PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing S-8 ASSESSING PROGRESS ON THE IOM REPORT THE FUTURE OF NURSING Recommendation 5: Promote Nurses’ Interprofessional and Lifelong Learning. The Future of Nursing: Campaign for Action (the Campaign) should encourage nursing organizations, education programs, and professional societies, as well as individual nurses, to make lifelong learning a priority so that nurses are prepared to work in evolving health care environments. Lifelong learning should include continuing education that will enable nurses to gain, preserve, and measure the skills needed in the variety

of environments and settings in which health care will be provided going forward, particularly community-based, outpatient, long-term care, primary care, and ambulatory settings. Nurses should work with other health care professionals to create opportunities for interprofessional collaboration and education. The Campaign could serve as a convener to bring together stakeholders from multiple areas of health care to discuss opportunities and strategies for interdisciplinary collaboration in this area. Need for Diversity in the Nursing Workforce African Americans make up 13.6 percent of the general population aged 20 to 40, but 10.7 percent of the RN workforce, 10.3 percent of associate’s degree graduates, and 9.3 percent of baccalaureate graduates. The disparity is even greater for Hispanics/Latinos, who make up 20.3 percent of the general population aged 20 to 40, but only 5.6 percent of the RN workforce, 8.8 percent of associate’s degree graduates, and 7.0 percent of baccalaureate graduates. Men make up just 9.2 percent of the RN workforce, 11.7 percent of baccalaureate nursing students, and 11.6 percent of graduates. While the FON report does not offer a specific recommendation on this topic, it identifies lack of diversity as a challenge for the nursing profession, and indicates that a more diverse workforce will better meet current and future health care needs and provide more culturally relevant care. Associate’s degree nursing programs and community colleges appear to provide entry into the nursing profession for underrepresented populations. Initiatives to retain diverse and underrepresented students in nursing education programs include financial support, mentorship, social and academic support, and professional counseling. Only 5 years after the release of the FON report, it is too soon to see significant changes in the diversity of the national nursing workforce that may be attributable to the report’s recommendations or the activities of the Campaign and others. Changing the diversity of the overall nurse workforce is a slow process because only a small percentage of the workforce leaves and enters each year. To be successful, any effort to improve the diversity of the nursing workforce must focus on each step along the professional pathway from recruitment to educational programs, retention and success within those programs, graduation and placement in a job, and retention and advancement within a nursing career. Recommendation 6: Make Diversity in the Nursing Workforce a Priority. The Future of Nursing: Campaign for Action (the Campaign) should continue to emphasize recruitment and retention of a diverse nursing workforce as a major priority for both the national Campaign and the state Action Coalitions. In broadening its coalition to include more diverse stakeholders PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing SUMMARY S-9 (see Recommendation 1), the Campaign should work with others to assess progress and exchange information about strategies that are effective in increasing the diversity of the health workforce. To that end, the Campaign should take the following actions: • Develop a comprehensive, specific diversity plan with actionable steps that can be taken by state Action Coalitions and by nursing and other health professions stakeholders, including trade organizations and educational institutions. • To assist planning and policy making at the state level, use the Campaign’s dashboard infrastructure to develop and publish annual data reports on the diversity of nursing and other health professions graduates and enrollees by state, and compare the representation of minorities in each state with their representation in the state’s general population. • Convene an advisory group to identify best practices from both within and outside of the Campaign that are improving the diversity

of the nursing and other health professions workforce to reflect that of the general population. Areas for research and assessment might include barriers that prevent individuals from diverse backgrounds from entering the nursing profession and from achieving higher levels of education, modes of academic progression to promote diversity in nursing programs at all levels, and the use of holistic admissions policies and need-based aid to support students from underrepresented and economically challenged backgrounds in obtaining nursing degrees. Results of these studies could be disseminated to key relevant stakeholders, including schools of nursing and employers. • Assist state Action Coalitions in obtaining funds available for the development of new, innovative, targeted programs and strategies for increasing the diversity of nursing students and the nursing workforce and/or for the identification and tailoring of those programs that have been shown to be effective. • Collect data to ensure that the call for higher educational attainment among nurses has positive implications for diversity (including economic, racial/ethnic, geographic, and gender diversity). The Campaign should research the opportunities for and barriers to utilization of baccalaureate completion programs by underrepresented minorities and economically and educationally disadvantaged individuals so that the Campaign and other stakeholders can more effectively implement programs to advance the educational attainment of African Americans, Hispanics/Latinos, and other underrepresented groups in nursing. • Encourage state Action Coalitions to work with their state nursing workforce centers and state boards of nursing to collect and make available data on variables that can be used to assess progress toward PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing S-10 ASSESSING PROGRESS ON THE IOM REPORT THE FUTURE OF NURSING increasing the diversity of the nurse workforce, the nursing student population, and nursing faculty. Collaboration, Leadership, and Communication The FON report includes recommendations for nurses to lead and disseminate collaborative improvement efforts and to lead change to advance health. Nurses are needed to lead and participate in the ongoing reforms to the system, to direct research on evidence-based improvements to care, to translate research findings to the practice environment, to be full partners on the health care team, and to advocate for policy change. Collaboration Expansion in the area of collaboration has been supported by the Campaign and state Action Coalitions, and by organizations such as the Josiah Macy Jr. Foundation and the Interprofessional Education Collaborative (IPEC). Going forward, the scope of the FON report’s recommendation to expand opportunities for nurses to lead and diffuse collaborative improvement efforts will need to be broadened to acknowledge that no profession can lead and expand interprofessional collaboration alone. Collaboration requires all members of a team working to their full potential on behalf of the patient and with respect for the contributions of other professions to the work. The Campaign acknowledged that this shift was needed in 2013 when it asked its state Action Coalitions to look beyond nursing as they worked to improve health and health care for individuals and families. Leadership According to the FON report, nurses are needed in leadership positions to contribute their unique perspective and expertise on such issues as health care delivery, quality, and safety. A 2011 survey of 1,000 hospitals found that nurses account for only 6 percent of board membership, compared with 20 percent for physicians; in 2014, the percentage of physician board members remained the same while the percentage of board members that are nurses decreased to 5 percent. Opportunities in

leadership have been established and expanded by nursing education programs, nursing associations, and private organizations. While some progress has been observed in nurses appointed to health-related boards, there is a lack of data on nurses serving as leaders in other areas, and the data that are available are fragmented and incomplete. There is no single source of information about nurse training in leadership entrepreneurship or innovation. Campaign Communication Effective communication with groups within and outside of the nursing profession is critical to collaboration and leadership efforts. The Campaign has engaged targeted audiences through strategic communication initiatives that have leveraged both traditional media and new media platforms. The Speakers Bureau has sent Campaign representatives and leaders to various conferences across the country to raise awareness of and inform key audiences about the recommendations of the FON report, and gather relevant data and information to advance Campaign goals. Online communication tools provide Campaign volunteers with comprehensive materials with which to engage media, policy makers, and interested stakeholders. PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing SUMMARY S-11 The Campaign acknowledges that the capacity and ability of state Action Coalitions to communicate about their efforts vary greatly. Further, while the goal is to engage a wide range of stakeholders, the Campaign acknowledges that its efforts have been focused largely on engaging nurses. Strong relationships are needed with health policy and business reporters; editors and columnists at national, state, and local news outlets; and bloggers who cover related issues. Recommendation 7. Expand Efforts and Opportunities for Interprofessional Collaboration and Leadership Development for Nurses. As the Future of Nursing: Campaign for Action (the Campaign) broadens its coalition (see Recommendation 1), it should expand its focus on supporting and promoting (1) interprofessional collaboration and opportunities for nurses to design, implement, and diffuse collaborative programs in care and delivery; and (2) interdisciplinary development programs that focus on leadership. Health care professionals from all disciplines should work together in the planning and implementation of strategies for improving health care, particularly in an interprofessional and collaborative environment. Interdisciplinary development programs and activities should: • Feature content in leadership, management, entrepreneurship, innovation, and other skills that will enable nurses to help ensure that the public receives accessible and quality health care. Courses could be offered through or in partnership with other professional schools. The Campaign should monitor nursing programs that offer these types of courses and programs and track nurses’ participation, if possible, in order to assess progress. • Include interprofessional and collaborative development or continuing competence in leadership skills—for example, through the participation of nurses in spokesperson and communication programs designed to teach persuasive communication skills that will facilitate their leading and managing collaborative efforts. Recommendation 8. Promote the Involvement of Nurses in the Redesign of Care Delivery and Payment Systems. The Future of Nursing: Campaign for Action (the Campaign) should work with payers, health care organizations, providers, employers, and regulators to involve nurses in the redesign of care delivery and payment systems. To this end, the Campaign should encourage nurses to serve in executive and leadership positions in government, forprofit and nonprofit organizations, and health care delivery systems (e.g., as hospital chief executive officers or chief operations officers), and advisory committees. The Campaign should expand its metrics to measure the progress of nurses in these areas.

Types of organizations targeted by this recommendation could include • health care systems; • insurance companies and for-profit health care delivery systems (e.g., Minute Clinic); • not-for-profit organizations that work to improve healthcare (e.g., National Quality Forum); PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing S-12 ASSESSING PROGRESS ON THE IOM REPORT THE FUTURE OF NURSING • • the National Academy of Medicine and other professional membership groups; and Federal, state, and local governmental bodies related to health (e.g., Veterans Health Administration, Department of Defense, Centers for Medicare & Medicaid Services). Recommendation 9. Communicate with a Wider and More Diverse Audience to Gain Broad Support for Campaign Objectives. The Future of Nursing: Campaign for Action (the Campaign) should expand the scope of its communication strategies to connect with a broader, more diverse, consumer-oriented audience and galvanize support at the grassroots level. The Campaign, including its state Action Coalitions, should bolster communication efforts geared toward the general public and consumers using messages that go beyond nursing and focus on improving health and health care for consumers and their families. The Campaign should recruit more allies in the health care community (such as physicians, pharmacists, and other professionals, as well as those outside of health care such as business leaders, employers, and policy makers) as health care stakeholders to further demonstrate a collaborative approach in advancing the recommendations of The Future of Nursing report. Need for Better Data for Assessing and Driving Progress Major gaps exist in understanding the numbers and types of health professionals, where they are employed, and what roles they fill. This knowledge is critical to support new models of health care delivery. The FON report recommends that an infrastructure be built and led by the National Health Care Workforce Commission to improve the collection and analysis of data on the health care workforce. Because the National Health Care Workforce Commission has not been funded by Congress, this recommendation cannot be implemented as it was written. Nonetheless, progress has been made over the past 5 years in the collection and analysis of workforce data, for both the nursing workforce and other health professions. Barriers to the collection of data on the nursing workforce include the lack of national indicators providing consistent information from states, lag time in the collection and reporting of data, the lack of standardized databases with which to track ideal indicators of progress, and the need to use proxy measures to assess progress toward the FON report’s recommendation (given the short timeframe for seeing progress in the outcomes of the FON recommendations). Little progress has been made on building a national infrastructure that could integrate the diverse sources of the necessary data, identify gaps, and improve and expand usable data not just on the nursing workforce, but on the entire health care workforce. Recommendation 10. Improve Workforce Data Collection. The Future of Nursing: Campaign for Action (the Campaign) should promote collaboration among organizations that collect workforce-related data. Given the absence of the National Health Care Workforce Commission, the Campaign can use its strong brand and partnerships to help improve the collection of data on the nursing workforce. PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing SUMMARY • • • S-13 The Campaign should play a role in convening, supporting, and promoting collaboration among organizations and associations to consider how they might create more robust datasets and

how various data sets can be organized and made available to researchers, policy makers, and planners. Specifically, the Campaign should encourage − organizations and agencies to build national databases that could be shared and accessed by the Health Resources and Services Administration (HRSA) and researchers; − states to implement the Minimum Data Set (MDS) and to share their data with the National Council of State Boards of Nursing (NCSBN) so they can build the national dataset on practicing nurses; and − nursing organizations (such as American Association of Colleges of Nursing, the National League for Nursing, NCSBN, the American Association of Nurse Practitioners) that currently engage in independent data collection efforts to collaborate and share their data to build more comprehensive datasets. Other organizations representing providers that employ nurses and other health professionals, such as the American Heart Association, should be invited to participate in this collaboration. The federal government and states should expand existing data collection activities to better measure and monitor the roles of registered nurses and advanced practice registered nurses. This expansion should include the collection of data on current and former licensees in the American Community Survey and a sampling of services provided by nurse practitioners and physician assistants for their own patient panels and outside of physician offices in the National Ambulatory Medical Care Survey. HRSA should undertake a combined National Sample Survey of Registered Nurses and National Sample Survey of Nurse Practitioners survey that can be administered more frequently than once every 4 years. This effort should include the involvement of national and state nursing organizations. HRSA should continue to promote the use of the MDS and assist in and support its implementation. CONCLUSION The FON report includes a number of recommendations aimed at ensuring that nurses, who represent the largest segment of the health care profession, are prepared to help fill the need for quality health care in a delivery system that is shifting rapidly and fundamentally. The release of the report in 2010 and the launch of the Campaign were timely, coinciding with the ACA’s creation of new models of care to accommodate the large numbers of people previously without access to health insurance. These models focus on teamwork, care coordination, and prevention—models in which nurses can contribute a great deal of knowledge and skill. PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing S-14 ASSESSING PROGRESS ON THE IOM REPORT THE FUTURE OF NURSING The committee found that continued progress will require greater focus and effort in certain specific areas. Continued work is needed to remove scope-of-practice barriers; pathways to higher education need to be strengthened, with specific emphasis on increasing diversity; avenues for continuing competence need to be strengthened; and data on a wide range of outcomes are needed—from the education and makeup of the workforce to the services nurses provide and ways in which they lead. A major and overarching need is for the nursing community, including the Campaign, to build and strengthen coalitions with stakeholders outside of nursing. Nurses need to practice collaboratively; continue to develop skills and competencies in leadership and innovation; and work with other professionals, as no one profession alone can meet the complex needs of the future of health care. The committee hopes that its recommendations will be helpful to the Campaign and other organizations as they work to improve access to quality health care for all. PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing

1 Introduction In the past decade, the changing climate of health care policy and practice has sharpened national focus on the challenges of providing high-quality and affordable care to an aging and increasingly diverse population. In this era, population health needs assessment and management require the collaboration of health professionals to provide patient-centered, coordinated, and community-based primary and specialty care services. Nurses, who make up the largest segment of the health care professional workforce, are in a position to lead and partner in teams that provide services across the continuum and settings of care (hospitals, ambulatory care, public health, schools, long-term care, home care, and community health). In 2010, the Institute of Medicine (IOM) released The Future of Nursing: Leading Change, Advancing Health, which offered a series of recommendations pertaining to roles for nurses in the new health care landscape (IOM, 2011). Shortly after the report’s prepublication release in 2010, AARP and the Robert Wood Johnson Foundation (RWJF) launched the Future of Nursing: Campaign for Action (the Campaign) to help implement the report’s recommendations. The present report provides an assessment of progress made by the Campaign and other initiatives and identifies areas that need to be emphasized as work continues to pursue recommendations from The Future of Nursing report. CONTEXT The Future of Nursing report was produced at a propitious moment in health care in the United States, a time of growing awareness that dramatic changes in the care delivery system were needed to accomplish the “Triple Aim” of better patient experience, better health of the public, and lower costs. The increasing burden of chronic disease, changing demographics, and demands for greater access to care lent added urgency to the calls for change. The Future of Nursing report in many ways anticipated these trends in its recommendations. Now, 5 years later, one can appreciate how prescient and appropriately timed these recommendations were. But many changes have occurred since that report was released, and these changes have created both new opportunities and new challenges in achieving the goals laid out in the report. As described in The Future of Nursing report, it was anticipated that with the passage of the Patient Protection and Affordable Care Act (ACA), nurses would play a larger role in delivering health care, facilitating efforts that would increasingly emphasize health promotion and disease prevention, and helping to bridge the gap between coverage and access (IOM, 2011). As the report notes, “by virtue of their regular, close proximity to patients, and their scientific understanding of care processes across the continuum of care, nurses have a considerable PREPUBLICATION COPY: UNCORRECTED PROOFS 1-1 Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing 1-2 ASSESSING PROGRESS ON THE IOM REPORT THE FUTURE OF NURSING opportunity to act as full partners with other health professionals and to lead in the improvement and redesign of the health care system and its practice environment” (IOM, 2011, p. 23). It is precisely because nurses practice in various health care settings and across the continuum of care, and enter the profession through different pathways and achieve varying levels of education that they are poised to affect health and health care delivery at every level. As a result of the ACA, more than 16 million previously uninsured people have gained health insurance coverage (HHS, 2015). To fulfill the promise of access to care for these newly insured, people as well as more affordable, better-coordinated care for all, incentives have been created for new delivery and payment models. The new delivery models emphasize teamwork, care coordination for specialty care and chronic disease management, prevention, and a greater focus on population health and community-based care.

The new payment models are moving from fee-for-service and episodic payment to more comprehensive payments based on value. At the same time, there has been growing awareness of the need for more attention to a health professions workforce that must be appropriately prepared to work in this changing health care system. This awareness has led to greater emphasis on interprofessional education, teamwork training, and a better understanding of the roles of all health professionals in creating an optimal health care delivery system. Rapid advances in information technology, including mobile and digital health tools, also are changing the way health professionals and the public receive information and communicate with one another. Properly harnessed, these advances can enable greater engagement of patients in their own care, as well as support better teamwork and care coordination. Thus, the context of health care in the United States in 2015 is dramatically different from what it was when The Future of Nursing report was released in 2010. While the report anticipated many of these changes, it could not have foreseen exactly how they would play out. The terms of the ACA dictated many of these changes, but also set a tone and direction for the health care system regarding how care should be delivered. All of these changes are consistent with the key messages in The Future of Nursing report, which call for enhanced education and greater roles for nurses in the health care system (IOM, 2011). While The Future of Nursing report focuses on advanced practice registered nurses (APRNs) and registered nurses (RNs) with higher educational attainment, implications for nurses’ roles are significant. The shift from individual providers to interprofessional teams, for example, has implications for the role of nurses in teams and the education and competencies needed to provide care and function within those teams. Similarly, the shift to delivering care in the community, including retail clinics and patient homes, has important implications for how and where nurses receive clinical training. The changing landscape may enable additional strategies for achieving these goals that include value-based care, interprofessional collaboration and education, patient engagement, and new technologies. Not only did The Future of Nursing coincide with dramatic changes in the health care landscape, but many other organizations released reports shortly before or after that report calling for similar changes in nursing and health care. Examples include • • the World Health Organization’s (2009) Global Standards for the Initial Education of Professional Nurses and Midwives, developed from 2005 to 2007 and published in 2009, which calls for raising the initial education requirements for professional nurses; the Carnegie Foundation report Educating Nurses: A Call for Radical Transformation, published in December 2009 (Benner et al., 2009); PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing INTRODUCTION • • • 1-3 the consensus statement of the Tri-Council for Nursing (comprising the American Association of Colleges of Nursing [AACN], American Nurses Association [ANA], American Organization of Nurse Executives, and National League for Nursing) titled Educational Advancement of Registered Nurses, published in May 2010, which calls for all RNs to pursue further education in order to improve the quality and safety of care across all settings (AACN, 2010); Josiah Macy Jr. Foundation efforts around care delivery and interprofessional education (AACN and AAMC, 2010; Josiah Macy Jr. Foundation, 2010, 2012, 2013); and various position statements and issue briefs from professional and trade organizations related to advancing the educational preparation of nurses, interprofessional education, interprofessional collaboration and team-based care, and health workforce diversity (AACN, 2015; AONE, 2015b; NLN, 2015).

Building on the changing health care landscape and the release of The Future of Nursing report and these other reports, many organizations have been working diligently to make changes in nursing and health care. Nursing organizations have long been active in addressing the issues identified by the report, which lent momentum to a movement that was already under way and gave stakeholders tangible and specific recommendations toward which to work. After the report was released, these organizations continued or advanced their efforts to implement the recommended changes. Their efforts ranged from simple statements of support for the IOM report’s recommendations to the establishment of new and far-reaching initiatives, such as the Campaign. For example, the ANA released a statement citing areas in which that organization and its members were actively pursuing change, such as the efforts of state nursing associations to make state-level changes to scope-of-practice laws (ANA, 2011). The AACN held a strategic planning session to identify areas in which its activities could align with the IOM report’s recommendations and developed a new tactical plan for moving forward (AACN, n.d.). The National Council of State Boards of Nursing (NCSBN) undertook several new efforts, including the Campaign for Consensus, designed to assist states in adopting the Consensus Model regulations regarding scope of practice for APRNs, and a pilot study on lifelong learning and continued competency (Alexander, 2011). And the Jonas Center for Nursing and Veterans Healthcare, which had been supporting doctoral education for nurses through its Jonas Scholars program since 2008, began requiring students to complete a leadership project that incorporates the IOM report’s recommendations (Curley, 2015; see also Jonas Center for Nursing and Veterans Healthcare, 2015). In addition to such individual efforts, many organizations signed on to the Campaign’s Champion Nursing Council, which gives the Campaign strategic guidance on fulfilling its goal of implementing the IOM report’s recommendations to improve health care and to prepare nurses to be essential partners in addressing the nation’s health care system challenges (CCNA, n.d.-c). The Future of Nursing and the Campaign helped accelerate these and other efforts to ensure that nurses are able to provide and lead efforts in health care delivery and system redesign. STUDY SCOPE In 2014, RWJF asked the IOM to convene a committee to assess progress made toward implementing the recommendations of The Future of Nursing report, assess the progress of the PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing 1-4 ASSESSING PROGRESS ON THE IOM REPORT THE FUTURE OF NURSING Campaign toward meeting its goals, and issue a brief report including recommendations for the Campaign (see Box 1-1 for the committee’s statement of task). To conduct this study the IOM assembled a committee of 12 experts from the fields of nursing, communications, public health, research and evaluation, and medicine. The committee held four meetings over the course of 5 months that included three public workshops, during which stakeholders provided testimony on the nursing field’s progress in the areas of practice, education, leadership, diversity, interprofessional collaboration, and data needs. The committee also considered data collected and provided by RWJF, as well as from other sources (see Appendix A for further information about the study methods). BOX 1-1 Statement of Task An ad hoc committee under the auspices of the Institute of Medicine (IOM) will assess the changes in the field of nursing and peripheral areas over the last 5 years as a result of the IOM report on The Future of Nursing: Leading Change, Advancing Health. The role of the AARP and Robert Wood Johnson Foundation’s (RWJF’s) Future of Nursing: Campaign for Action (the Campaign) will be taken into consideration in assessing these field changes.

The report will assess the Campaign’s progress in meeting its stated goals, and identify the areas that should be emphasized over the next 5 years that will help the Campaign fulfill the recommendations of the IOM report. This report will be based, in part, on a series of three workshops. Each workshop, organized by the committee and held in conjunction with each of three committee meetings, will invite speakers to help assess the field’s progress of the adoption of The Future of Nursing report, in addition to the work of the Campaign. Specifically, the workshops will invite stakeholders representing nursing, medicine, health systems, consumer groups, business, and policy makers at the state and national levels to provide testimony to the committee on the following broad topics: practice, education, and leadership; with diversity, interprofessional collaboration, and needed data as cross-cutting issues. In addition to the three workshops the committee will, during its closed meetings, consider data collected and provided by RWJF and other inputs and literature gathered by the committee. In its review of data and input from workshops, the committee will consider the following: • • • • • Utilization and impact of IOM’s 2011 The Future of Nursing: Leading Change, Advancing Health report. The Campaign’s areas of focus (education, leadership, scope of practice, interprofessional collaboration, diversity, and workforce data). Impact that the Campaign has had on areas peripheral to nursing (such as activities undertaken by individuals and organizations to adopt the recommendations outside the sphere of Campaign activities and that impact). The role of traditional and new media in the impact of the Campaign. Future near-term (5 years) goals for the Campaign. The committee will author a brief report that will include conclusions and recommendations on what actions need to take place to ensure sustainable impact of the Campaign in its work to implement the recommendations of the IOM The Future of Nursing report and other activities, with an emphasis on future steps and areas of focus. PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing INTRODUCTION 1-5 The committee’s task was not to reexamine the merits of or amend the recommendations of The Future of Nursing report. The committee did not perform a comprehensive or formal evaluation of the impact of the report’s recommendations or of the Campaign’s impact on health outcomes or access to care—two of the broader goals of the 2010 IOM report’s recommendations—as 5 years is an insufficient amount of time over which to evaluate these outcomes. In addition, the committee did not perform a comprehensive assessment of the state of the nursing profession. Instead, the committee focused on how the field of nursing has been impacted by the Campaign and other such efforts. The committee reviewed how the current context of health care delivery and nursing education and practice may affect how the 2010 IOM report’s recommendations are being implemented, and identified barriers to and unintended consequences of their implementation. In the present report, the committee notes when it conducted original analyses. When data were provided by the Campaign, the committee attempted to cross-reference those data with outside sources. Further, while the committee did assess progress in implementing the recommendations of The Future of Nursing report, it was not able to attribute progress or the lack thereof directly to the report or the Campaign, given efforts by other organizations and trends in the field. Progress in the areas of education, practice, collaboration, leadership, diversity, and workforce data may be attributable to those other efforts (described below) and contemporary factors. Regardless, the committee considered how The Future of Nursing report’s recommendations have been advanced and how they might continue to be advanced.

The next section of this chapter provides an overview of The Future of Nursing report and its findings and recommendations. This is followed by a description of the Campaign’s efforts to implement the recommendations over the past 5 years, as well as salient RWJF activities outside of the Campaign. Finally, this chapter lays out the content of remaining chapters of the report. OVERVIEW OF THE FUTURE OF NURSING: LEADING CHANGE, ADVANCING HEALTH The Future of Nursing report1 was the product of a 2-year Initiative on the Future of Nursing, established by RWJF and the IOM (IOM, 2011). The 18-person committee convened by the Initiative was led by Donna Shalala, former U.S. Secretary of Health and Human Services, and included experts in such arenas as nursing, business, education, research, and public health. The committee was asked to “examine the capacity of the nursing workforce to meet the demands of a reformed health care and public health system” and to develop a set of recommendations for changes at the national, state, and local levels (IOM, 2011, p. xiii). Specifically, the committee was asked to identify vital roles for nurses in the design and implementation of a more effective and efficient health care system and to make recommendations on how to • • reconceptualize the role of nurses within the context of the entire health care system; expand the capacity of nursing education to produce an adequate number of wellprepared nurses to meet current and future demand; 1 The full report is available at http://www.nap.edu/catalog/12956/the-future-of-nursing-leading-change-advancinghealth. PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing 1-6 ASSESSING PROGRESS ON THE IOM REPORT THE FUTURE OF NURSING • • develop innovative solutions related to professional education and health care delivery by focusing on the delivery of nursing services; and attract and retain well-prepared nurses in multiple care settings. The Future of Nursing report identifies a variety of barriers that have limited the nursing profession’s ability to contribute fully to the health care system. These barriers include an aging workforce, regulatory restrictions on nursing practice, fragmentation of health care, limited capacity of the nursing education system, and a lack of workforce data. The report is centered on four key messages. Key Message #1: Nurses should practice to the full extent of their education and training. The study committee found that historical, regulatory, and policy barriers have prevented nurses from being able to perform the full range of activities for which their education and training have prepared them. For example, regulations on nurse practitioners (NPs) vary by state, and many states limit or deny an NP’s ability to prescribe medications, assess patient conditions, order and evaluate tests, or admit a patient to the hospital. The committee formulated recommendations for Congress, state legislatures, and various federal agencies on actions that could help remove these scope-of-practice barriers. In addition, the committee found that newly graduated nurses could benefit from additional assistance in the transition to practice, and recommended the development of residency programs to help nursing graduates further hone their skills. Key Message #2: Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. The committee observed that major changes in the health care system will require equally major changes in the education of nurses to prepare them to work with sophisticated technology, analyze and synthesize complex information to make critical decisions, and collaborate with a variety of other health professionals. To meet these advanced needs, the committee recommended that more nurses obtain higher degrees so that by

2020, 80 percent of nurses would have a baccalaureate degree, and the number of nurses with a doctorate would double. The committee also recommended that nurses engage in lifelong learning throughout their careers, and that efforts be made to increase the diversity of the nursing workforce. Key Message #3: Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States. The committee found that for nurses to participate fully in the transformation of the health care system, they need to act in positions of leadership and work collaboratively with leaders from other health professions. The committee noted that these nurse leaders need to be full partners at all levels of the system—from bedside to boardroom—and to contribute actively to policy making by serving on committees, commissions, and boards. To develop this leadership capacity, the committee recommended that health care organizations, funders, and education programs provide, expand, and fund opportunities for nurses to develop leadership skills and assume leadership positions, and that health care decision makers ensure that nurses are represented in key leadership positions on boards and management teams. Key Message #4: Effective workforce planning and policy making require better data collection and an improved information infrastructure. The committee determined that to plan and prepare for fundamental changes in the health care system, it is necessary to have reliable and granular data on the health care workforce. The needed data include the numbers and types of health professionals working in the field, where and in what roles they work, and what types of activities they perform. These data are necessary to plan for workforce needs and to establish a PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing INTRODUCTION 1-7 baseline upon which to improve. The committee recommended that the National Health Care Workforce Commission (mandated by the ACA) should work with the Health Resources and Services Administration to improve research and the collection and analysis of data in this area. From the foundation of these key messages, the committee developed eight recommendations for addressing the barriers that have prevented the nursing profession from realizing its full potential in leading the transformation of the health care system (see Box 1-2). The Future of Nursing report acknowledges the growing diversity of the U.S. population and the concomitant need for an increasingly diverse nursing workforce, incorporating this critical and crosscutting issue into its recommendations relating to nurses’ educational attainment (recommendations 4, 5, and 6). The study committee directed its recommendations not only at the nursing profession, but also at other entities that play a role in improving the system, including government, businesses, health care organizations, professional associations, and the insurance industry. THE FUTURE OF NURSING: CAMPAIGN FOR ACTION Goals The Campaign launched in 2010, shortly after the release of The Future of Nursing (CCNA, n.d.-a). The Campaign is coordinated through the Center to Champion Nursing in America (CCNA), an initiative of AARP, the AARP Foundation, and RWJF. Its stated purpose is to implement the recommendations of the IOM report through actions at the national and state levels. Based on the report’s recommendations, the Campaign focuses on six major areas, or “pillars” (CCNA, n.d.-b): • • • • • • advancing education transformation, leveraging nursing leadership, removing barriers to practice and care, fostering interprofessional collaboration, promoting diversity, and bolstering workforce data. The Campaign aims to achieve its goals through a wide variety of activities, working with stakeholders including consumers, nurses, insurers, educators, and policy makers.

To support these efforts, 51 state Action Coalitions (one in each state and the District of Columbia) build grassroots networks of local stakeholders to effect change at the state and local levels (CCNA, n.d.-f). In its first 2 years, the Campaign focused its efforts on building an infrastructure (the state Action Coalitions) to convene and mobilize constituents and stakeholders around the messages and recommendations of the IOM report. In its third year, the Campaign “shifted to strategic activation and partnership development,” asking the Action Coalitions to work on five “campaign imperatives” (TCC Group, 2014, p. 1): • • move beyond nursing and focus on improving health and health care for consumers and their families; deliver short-term results while continuing to develop long-term plans; PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing 1-8 ASSESSING PROGRESS ON THE IOM REPORT THE FUTURE OF NURSING BOX 1-2 Recommendations from The Future of Nursing: Leading Change, Advancing Health* Recommendation 1: Remove scope-of-practice barriers. Advanced practice registered nurses should be able to practice to the full extent of their education and training. Recommendation 2: Expand opportunities for nurses to lead and diffuse collaborative improvement efforts. Private and public funders, health care organizations, nursing education programs, and nursing associations should expand opportunities for nurses to lead and manage collaborative efforts with physicians and other members of the health care team to conduct research and to redesign and improve practice environments and health systems. These entities should also provide opportunities for nurses to diffuse successful practices. Recommendation 3: Implement nurse residency programs. State boards of nursing, accrediting bodies, the federal government, and health care organizations should take actions to support nurses’ completion of a transition-to-practice program (nurse residency) after they have completed a prelicensure or advanced practice degree program or when they are transitioning into new clinical practice areas. Recommendation 4: Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020. Academic nurse leaders across all schools of nursing should work together to increase the proportion of nurses with a baccalaureate degree from 50 to 80 percent by 2020. These leaders should partner with education accrediting bodies, private and public funders, and employers to ensure funding, monitor progress, and increase the diversity of students to create a workforce prepared to meeting the demands of diverse populations across the lifespan. Recommendation 5: Double the number of nurses with a doctorate by 2020. Schools of nursing, with support from private and public funders, academic administrators and university trustees, and accrediting bodies, should double the number of nurses with a doctorate by 2020 to add to the cadre of nurse faculty and researchers, with attention to increasing diversity. Recommendation 6: Ensure that nurses engage in lifelong learning. Accrediting bodies, schools of nursing, health care organizations, and continuing competency educators from multiple health professions should collaborate to ensure that nurses and nursing students and faculty continue their education and engage in lifelong learning to gain the competencies needed to provide care for diverse populations across the lifespan. Recommendation 7: Prepare and enable nurses to lead change to advance health. Nurses, nursing education programs, and nursing associations should prepare the nursing workforce to assume leadership positions across all levels, while public, private, and governmental health care decision makers should ensure that leadership position are available to and filled by nurses. Recommendation 8: Build an infrastructure for the collection and analysis of interprofessional health care workforce data.

The National Health Care Workforce Commission, with oversight from the Government Accountability Office and the Health Resources and Services Administration, should lead a collaborative effort to improve research and the collection and analysis of data on health care workforce requirements. The Workforce Commission and the Health Resources and Services Administration should collaborate with state licensing boards, state nursing workforce centers, and the Department of Labor in this effort to ensure that the data are timely and publicly accessible. _______________________ *Recommendations listed in this box are abbreviated. See Appendix B for the full version of each recommendation. SOURCE: IOM, 2011. PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing INTRODUCTION • • • 1-9 have the courage to place the right leaders at the helm or remove weak, ineffective leaders; have funding to sustain the [Action Coalition’s] work; and not ignore the diverse stakeholders critical to the [Action Coalition’s] success. Activities The Campaign operates at both the national and state levels. The national Campaign convenes leadership and advisory groups—including a Strategic Advisory Committee, Diversity Steering Committee, Champion Nursing Coalition, and Champion Nursing Council—to advance the goals of the IOM report and the Campaign (CCNA, n.d.-e). In addition, the Campaign convenes meetings around the major topics of the IOM report (including leadership, education, and scope of practice), and provides technical assistance to the state Action Coalitions, which as noted, work to advance The Future of Nursing report’s recommendations at the state and local levels (CCNA, 2015c). The state Action Coalitions are considered “the driving force of the Campaign” because they are able to work as a network to effect change at the local level (CCNA, n.d.-f). The first state Action Coalitions—in California, Michigan, Mississippi, New Jersey, and New York—were formed in November 2010; within 1 year after the launch of the Campaign, 36 Action Coalitions were operating around the country; and by January 2013, all 51 Action Coalitions were active (CCNA, n.d.-g). The Campaign provides funding to some state Action Coalitions, mainly through the State Implementation Program (SIP), but also encourages (and in the case of SIP grantees, requires) that the Action Coalitions find external funding (CCNA, 2011, 2012, 2014, 2015a). As of January 2015, only 9 Action Coalitions had not received external funding. The remainder were receiving various amounts of funding (from a few thousand dollars to more than $1 million) from various sources, including foundations, government, colleges and universities, health and hospital systems, nursing organizations, and businesses (CCNA, 2015a). Figure 1-1 shows the allocation of total state Action Coalition funds to efforts relating to The Future of Nursing report’s recommendations, the Campaign pillars, and Campaign imperatives. Thirty-one state Action Coalitions currently receive funding from Campaign SIP grants (CCNA, 2015c). These Action Coalitions receive up to $150,000 from RWJF, but are also required to secure $75,000 in matching funds from other sources (CCNA, 2011, 2012, 2014). All state Action Coalitions work to advance the recommendations of the IOM report, but SIP grantees are required to identify one or two recommendations from the report that they will work toward implementing at the state level using this funding. A 2013 survey of all state Action Coalitions by the Campaign’s external evaluator, TCC Group (see below), asked respondents to indicate whether specific topics relating to the IOM report’s recommendations were (1) a main focus for their efforts, (2) not a main focus but an issue on which they were working, or (3) not an issue on which they were working (TCC Group, 2013a). Figure 1-2 shows the attention paid to these priority areas of the IOM report and the Campaign.

Figure 1-3 shows the top priority area for each state, based on aggregated scores for respondents from each state. PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing 1-10 ASSESSING PROGRESS ON THE IOM REPORT THE FUTURE OF NURSING Unspecified 19% Education 45% Capacity Building 17% Data 2% Diversity 3% Interprofessional Collaboration 2% Residency 4% Leadership 5% Practice & Care 3% FIGURE 1-1 State Action Coalition funds by the Campaign pillar and/or imperative. SOURCE: CCNA, 2015c. PREPUBLICATION COPY: UNCORRECTED PROOFS Copyright © National Academy of Sciences. All rights reserved. Assessing Progress on the Institute of Medicine Report The Future of Nursing INTRODUCTION 1-11 Education: 80% of registered nurses will have a bachelor of science in nursing (BSN) by 2020 70% Education: Double the number of nurses with doctorates by 2020 25% Education: Residencies Education: Increasing numbers of minority bachelor of science in nursing (BSN) students Education: Increasing numbers of minority faculty 26% 53% 31% 22% 43% 23% 26% 46% 9% 4% 31% 47% 45% Removing barriers to APRN care: Legislation 51% 34% 16% Removing barriers to APRN care: Regulation 49% 36% 15% Interprofessional collaboration 29% 51% Leadership: Appointments to hospital boards 22% 43% Leadership: Appointments to statewide decisionmaking bodies 21% 43% Leadership: Appointments of minority nurses to hospital boards 9% Leadership: Appointments of minority nurses to 10% statewide decision-making bodies Data Diversity: Racial/ethnic diversity in nursing 18% 36% 35% 32% 59% 34% 56% 46% Diversity: Men in nursing 10% 20% 44% 42% 10% 48% 49% 34%  Main focus of our Action Coalition  Some work done on this but not the main focus  We are not working on this issue FIGURE 1-2 State Action Coalition members’ focus on priority areas of The Future of Nursing and the Campaign. NOTES: Data are based on responses of 1,100 survey respondents from 49 state Action Coalitions, including that of the District of Columbia. Scores were calculated for each state by aggregating and averaging all responses from that state. APRN = advanced practice registered nurse; BSN = bachelor of science in nursing. SOURCE: Personal communication, Kate Locke, TCC Group, Se… CLICK HERE TO GET A PROFESSIONAL WRITER TO WORK ON THIS PAPER AND OTHER SIMILAR PAPERS CLICK THE BUTTON TO MAKE YOUR ORDER Related posts: Waldorf University Health and Fitness Video Discussion Taif University Disaster Mental Health Discussion Response (Mt) – University of Arizona Stakeholder Management Discussion Questions (Mt) – University of Colorado Denver Consulting Jargon Discussion Questions

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