Report urges education, broader duties for nurses

January 4, 2011
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Michigan is one of five states chosen to lead the nursing profession by implementing measures outlined in a 2010 report called “The Future of Nursing: Leading Change, Advancing Health.”

As a pilot state, Michigan is being asked to identify best practices in the topics covered in the report so that others can emulate them, said Carole Stacy, director of the Michigan Center for Nursing.

Stacy is co-chair of the 18-member Regional Action Coalition that will work toward implementing the report’s recommendations in Michigan.

“There were four major messages and then there were eight areas of recommendation, and under each recommendation are actual action plans,” added Cynthia McCurren, dean of the Kirkhof School of Nursing at Grand Valley State University and a coalition member.

“The whole document itself is over 600 pages. We see it to be a major document for nursing.”

The Future of Nursing recommendations were developed after two years of study by the Institute of Medicine and the Robert Wood Johnson Foundation Initiative on the Future of Nursing, with representatives of many facets of health care.

The report calls for improved education for nurses, better data collection for work-force planning and policy making, more leadership opportunities for nurses as health care unfolds, and a wider scope of practice for nurses with advanced degrees.

A Nov. 30-Dec. 1 summit in Washington, D.C., which was webcast to gatherings across the country, launched the implementation phase, McCurren said. GVSU hosted one of four or five meetings in the state in conjunction with the summit, drawing about 65 nurses.

McCurren said that as health care reform provisions are rolled out, increased demand for primary care services will reach advanced health professionals such as nurse practitioners and physician assistants. The report calls for a standardized and expanded scope for nurse practitioners and for separate insurance coverage of their services.

Stacy said that Michigan nurses are hopeful that the new Legislature will expand the scope of practice for nurse practitioners to include some duties now handled exclusively by doctors, including prescribing medications. Michigan is one of 16 states that limits nurse practitioner duties.

“The good news is the Legislature is brand new. The bad news is the Legislature is brand new,” Stacy said. “It’s going to take a while for them to get up to speed. Really, the Legislature goes on information they receive. What we need to do is get everybody on the same page.”

That may prove to be a challenge. The American Medical Association was sharply critical when the report was issued in October.

“Nurses are critical to the health care team, but there is no substitute for education and training,” the AMA stated. “With a shortage of both nurses and physicians, increasing the responsibility of nurses is not the answer to the physician shortage.”

Doctors have more education and training than nurse practitioners, the AMA statement said. In states where nurse practitioners practice independently, they tend to work in urban areas where doctors are already located, the organization said.

“An expansion of the scope for any practitioner ought to be tied to an expansion of education requirements, as well,” said Sheri W. Greenhoe, director of marketing communication and media for the Michigan State Medical Society.

“We need to quit fighting turf battles,” McCurren added. “Nurses don’t’ want to be physicians. That’s not the point of it.”

The Future of Nursing report calls for registered nurses with higher levels of education, she said. In Michigan, about 40 percent of RNs have at least a bachelor’s degree, but the new report sets the goal at 80 percent. “We’ve been doing what we can over the last five years to flip that,” Stacy said.

“There’s a large body of evidence that shows better outcomes with highly educated nurses,” McCurren added.

The report also calls for nurses to continue their education to the master’s and doctorate level, and asks employers to provide benefits such as help with tuition. Higher-level study not only produces college nursing instructors, but touches another Future of Nursing goal by preparing nurses to lead.

The report also suggests that the profession should institute residency programs for nurses, giving them a transition from training to practice in the same manner as doctors. Only a few nursing residency programs exist today.

“Nursing is the only health profession that does not have a residency program,” McCurren said, adding that she thinks such programs would combat early career attrition.

The report also urges nurses and nursing schools to develop leadership training and competencies to ensure that nurses are prepared for joining other health professions in setting policy during a time of change.

In addition, data is needed to develop a balance of “skills and perspectives” among the health professions and ensure an adequate nursing work force, the report states.

Stacy said that one reason Michigan was chosen as a pilot state is because of the data it has collected about the nursing work force — and other health professions, as well — in surveys it conducts with those renewing their licenses.

“I think one of the reasons Michigan was selected as one of the five pilot states is we have a very stable nursing infrastructure,” Stacy said. “We are the only state with an office of chief nurse executive. We have a very strong center for nursing and we have very good nursing work-force data. We have a lot of things going for us.”

Also selected as pilot states were California, Mississippi, New Jersey and New York.

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