Typical nursing tasks – medication administration, direct care of patients, and patient education – are often subsidiary to physician work. Advanced practice nursing, however, operates as a physician substitute.
The Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) developed a diverse committee comprised of nursing leaders across the country to study the future needs of the nursing profession. The Committee on the RWJF Initiative on the Future of Nursing produced a report after a two year study period that evaluated barriers that prevent nurses from being able to respond effectively to a rapidly changing health care system.
The final report was recently released and focuses on several key themes: nurses should practice to the full extent of their education and training, they should achieve higher levels of education and training, they should become full partners with physicians, and they should become leaders in redesigning health care in the United States.
The consensus report contained eight recommendations supporting its key themes and provided “an action-oriented blueprint for the future of nursing.” The recommendations are as follows:
Recommendation 1: Remove scope practice barriers. Extend Medicaid, Medicare and third-party reimbursement rates for primary care physicians’ services to include Advanced Practice Nurses (APN) services. Allow APNs hospital admitting privileges.
Recommendation 2: Create new opportunities in various health care arenas for nurses to lead and manage collaborative efforts with physicians and other members of the health care team in research and policy.
Recommendation 3: Implement nurse residency programs. Support nurses’ completion of a transition-to-practice programs (nurse residency) after they have completed a pre-licensure or advanced practice degree program or prior to new clinical responsibilities.
Recommendation 4: Increase the proportion of nurses with baccalaureate degrees to 80 percent by 2020.
Recommendation 5: Double the number of nurses with a doctorate by 2020.
Recommendation 6: Ensure that nurses engage in lifelong learning.
Recommendation 7: Prepare and enable nurses to lead change. Nurses, nursing education programs, and nursing associations should prepare the nursing workforce to assume leadership positions across all levels of health care.
Recommendation 8: Build an infrastructure for the collection and analysis of inter-professional health care workforce data.
The RWJF IOM’s recommendations have not gained full support throughout the health care community. Leaders from various medical associations including the American Medical Association and American Osteopathic Association met with several RWJF IOM committee members to discuss the pros and cons of their recommendations last month. While the further advancement, education, and training of nurses has been applauded, the expansion of services provided by APNs has been met with criticism by medical associations.
The intensity and length of physician education and training is typically greater than APN education and training. Therefore, extending the scope of practice and compensation of APNs may not be warranted.
Patient safety has been an argument used by medical associations when previous attempts were made to extend APN’s scope of practice. In the recent years, however, there have been eye-opening studies that show similar medical error outcomes and similar quality of care whether the health care provider was a physician or an APN.
Proponents of expanding the role of APNs argue that the RWJF IOM committee’s recommendations to the double the number of APNs with doctorate degrees and require a “residency” program will bring APNs’ medical knowledge and experience similar to their physician counterparts. However, as APN training becomes more similar to the training of a physician, will there still be much practical difference between the two professions?
Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health Consensus Report: Report Recommendations. October 5, 2010, Washington, DC.
Tyree Winters, DO