10 years after the IOM’s Future of Nursing Report: How is Washington measuring up?

In 2010, the National Academies of Sciences, Engineering, and Medicine (formally known as the Institute of Medicine), put out a report calling for drastic changes to the responsibilities and education of nurses to improve health care nationally. The report, The Future of Nursing: Leading Change, Advancing Health, made specific recommendations addressing nursing education, state practice environments, interprofessional collaboration, the engagement of nurses in leadership roles, workforce data collection and diversity.

To put these recommendations into action, the Robert Wood Johnson Foundation, AARP and the AARP Foundation created the Future of Nursing: Campaign for Action, with Action Coalitions in every state and Washington, D.C., carrying out the work of the Campaign. The Washington Nursing Action Coalition (WNAC) leads the collaborative work in our state to transform health and health care through nursing, with the goal of a healthier population supported by a nursing workforce with advanced education.

The Future of Nursing report gave states a set of goals to aim for as they developed their nursing workforce. Now, almost a decade later, how is the state of Washington measuring up to the recommendations outlined in the report? Let’s take a look.

Nursing Education

The IOM recommended that by 2020, 80% of nurses be prepared with a baccalaureate degree.

Younger RNs are leading in this recommendation. Based on weighted survey responses, 81.4% in the 19-24 age group, 74.9% in the 25-29 age group and 68.7% in the 30-34 age group had a baccalaureate in nursing or higher. In contrast, each of the age groups for nurses 35 or older had approximately 60% or lower completing at least a baccalaureate degree.

According to a 2018 WA State RN workforce survey conducted by the Washington Center for Nursing (WCN) and the University of Washington’s Center for Health Workforce Studies, in Washington state, 63% of surveyed nurses have a baccalaureate or higher nursing degree.

The study also found that the associate degree was the initial degree received for 43.2% of RNs with a Washington state license. This number has seen little change since 2007, the last time this survey was conducted, when the number stood at 43.1%. The percentage of licensed Washington RNs receiving a baccalaureate degree as their initial degree stands at 42.5%, up from 39.7% in 2007.

The IOM goes on to recommend that the number of nurses pursuing doctorate degrees double by 2020. According to a report from the Washington State Department of Health, Nursing Education Programs 2016-2017 Annual School Report, this has been accomplished in the state of Washington. The report shows that there were 161 graduates with a nursing doctorate in 2016-2017, compared with only 33 in 2009-2010.

State Practice Environments

The IOM recommended that sates, federal agencies and health care organizations remove scope of practice barriers.

The report states that nurses are the primary care providers for patients, make up most of the health care workforce, and contribute valuable acumen to improving health care quality and safety. The report goes on to recommend that, “States, federal agencies, and health care organizations should remove scope of practice barriers that hinder nurses from practicing to the full extent of their education and training.” The report points out that this is particularly problematic for APRNs.

Washington state leads the nation in this recommendation and is currently one of 21 states plus the District of Columbia where APRNs have full practice authority.

Interprofessional Collaboration

The IOM recommended the expansion of opportunities for nurses to lead and disseminate collaborative improvement processes.

This can be achieved through a variety of means such as involving nurses in quality improvement initiatives and making interprofessional education more robust.

In 2015, WNAC set its focus on the IOM recommendation to prepare nurses to lead change and advance health. To do this, WNAC partnered with the Health Care Authority to appoint nurses to each of the five accelerator committees that would advise the implementation of the Healthier Washington Initiative to promote whole-person care in the state. These committees were created to inform the Health Innovation Leadership Network (HILN) in the following priority areas: collective responsibility, clinical engagement, communities and equity, integrated physical and behavioral health, and rural health innovation.

At the beginning of 2019, and with funding from a Robert Wood Johnson Foundation grant, WNAC launched a campaign to improve awareness of social determinants of health, and subsequently surveyed nearly 400 nurses around the state to see if and how they were addressing these determinants where they work.

Leadership

To accelerate nurses’ influence on community health, the IOM recommended that health care decision-makers ensure leadership positions are available to nurses.

Nurses on Boards is a national campaign aimed at increasing the number of nurses serving on boards to 10,000 by 2020. The mission of the campaign is twofold; first, to connect the unique perspective of nurses to the communities where they live and work; and second, to give nurses opportunities to develop valuable leadership skills.

To reach the goal number of nurses serving on boards across the country, each state was given a target number to support the success of the campaign. The goal for WA was 158 board seats. As we approached the end of 2019, WA was at 79% of our goal with 125 nurses serving on boards.

To get involved in Nurses on Boards and the Be Counted initiative, go to nursesonboardscoalition.org.

Workforce Data

The IOM recommended that each state build an infrastructure for the collection and analysis of interprofessional workforce data to help nurse leaders make informed hiring decisions and to address shortages in the nursing workforce.

WCN is working with the Nursing Commission to gather data on LPNs, RNs, and ARNPs based on the minimum nursing dataset. This data will enable us to have more information on the supply (or characteristics) of these nursing categories in Washington. Examples are educational attainment, ethnicity, place of residence as well as place of employment, area of practice, age and gender.

Diversity

The IOM recommended making diversity in the nursing workforce a priority.

Members of ethnic groups that are underrepresented in nursing typically face multiple obstacles to entering the profession. These can include inadequate preparation in science and math, the high cost of college, limited exposure to the health professions and lack of professional role models.

To encourage diversity and inclusion in the state’s nursing workforce the focus has been on identifying and removing barriers to nursing education in the state.

In 2013 the WCN developed a nursing mentorship program to help connect minority nursing students with a working nurse mentor to help support professional development. In both 2015 and 2017, WCN put together several implicit bias trainings to educate working nurses, nursing students, nurse educators and healthcare providers about the impacts of biases in nursing – including delivery of care.

In 2019, WCN’s Diversity Advisory Committee implemented a pilot program entitled So You Want to be a Professor. This program aims to encourage underrepresented nurses and nursing students to pursue a career in nursing education. The program was well-received, and a grant has been awarded to continue the program for two years with the potential for an additional two-year extension beyond that.

What’s next

Given the WCN and WNAC’s work to move the 2010 Future of Nursing goals forward, efforts have already been underway to shape goals for the 2030 Future of Nursing report. A likely theme is nursing’s potential to promote health equity, address health disparities, and to grow a more robust and diverse nursing workforce. This means continued data collection and analysis of the nursing workforce, improved strategies to move nursing education forward, and a focus on where diversity in nursing is most challenging.