NRS 440 Trends in Nursing and Healthcare Paper

Consensus Study Report
MAY 2021
The Future of Nursing 2020°30
Charting a Path to Achieve Health Equity
The decade ahead will test the nationànearly 4 million nurses in new and
complex ways. Nurses live and work at the intersection of health, education,
and communities and in a wide array of settings and practice at a range of
professional levels. They are often the most frequent line of contact with people
of all backgrounds and experiences seeking care and they represent the largest
of the health care professions.
THE ROLE OF NURSES IN ADVANCING HEALTH EQUITY
A nation cannot fully thrive until everyone¯ matter who they are, where
they live, or how much money they makeán live their healthiest possible
life, and helping people live their healthiest life is and has always been the
essential role of nurses. Nurses have a critical role to play in achieving the
goal of health equity, but they need robust education, supportive work
environments, and autonomy. Accordingly, at the request of the Robert Wood
Johnson Foundation, on behalf of the National Academy of Medicine, an ad
hoc committee under the auspices of the National Academies of Sciences,
Engineering, and Medicine conducted a study aimed at envisioning and
charting a path forward for the nursing profession to help reduce inequities
in peopleàability to achieve their full health potential. The ultimate goal
is the achievement of health equity in the United States built on
strengthened nursing capacity and expertise. (For a full list of the
committeeàrecommendations, view the Recommendations insert.)
The committee developed a framework identifying the key areas for
strengthening the nursing profession to meet the challenges of the decade
ahead. These areas include the nursing workforce, leadership, nursing
education, nurse well-being, and emergency preparedness and response,
as well as responsibilities of nursing with respect to structural and individual
determinants of health. Nurses play multiple roles in acute care, community,
and public health settings, through which they can influence the medical
and social factors that drive health outcomes, health equity, and health care
equity.
HIGHLIGHTS
ACTING NOW TO IMPROVE THE HEALTH AND WELL-BEING OF THE NATION
The demand for nurses will increase in the decade ahead due to the health needs of the aging population,
increases in behavioral and mental health conditions, increases in lack of access to primary health care, high
maternal mortality rates, worsening physician shortages, and other sociodemographic factors and health workforce
imbalances. The nursing workforce will also face challenges from within the health care system and the health care
workforce, and from health-related policies and other factors that affect the scope of practice, size, distribution,
diversity, and nursing education. In the current system, care is often disjointed. Nurses provide care coordination
that helps ensure seamless care, serve as advocates for patients and communities, and assist in increasing
individuals4rust in and engagement with the health care system.
LIFTING BARRIERS TO EXPAND THE CONTRIBUTIONS OF NURSING
The past two decades have seen progress in lifting state-level regulations restricting the scope of practice for
advanced practice registered nurses (APRNs), but 27 states still do not allow full practice authority for nurse
practitioners.1 Eliminating these restrictions so APRNs can practice to the full extent of their education and
training will increase the types and amount of high-quality health care services that can be provided to those
with complex health and social needs. Institutional barriers also need to be lifted for APRNs and other nurses,
including registered nurses (RNs) and licensed practical nurses (LPNs), to allow them to practice to the top of
their education and training.
DESIGNING BETTER PAYMENT MODELS
The current payment systems are not designed to pay for services that address social needs and social determinants
of health (SDOH) nor advance health equity.2 By supporting team-based care, improved communication, and
proven interventions and strategies that can reduce health disparities, payment systems can enable nurses to
make these essential contributions to improving care and outcomes for all patients. New payment models (e.g.,
accountable care organizations, accountable health communities, value-based payment) can give health care
organizations the flexibility to address social needs and SDOH and advance health equity.
STRENGTHENING NURSING EDUCATION
Nursing education coursework and experiential learning that prepare students to promote health equity, reduce
health inequities, and improve the health and well-being of the population will build the capacity of the nursing
workforce. Substantive education in community (e.g., schools, workplaces, home health care, public health clinics)
and telework settings allows nursing students to learn about the broad range of care environments and to work
collaboratively with other health and non-health professionals. Additionally, nursing schools should continue
expanding efforts to recruit and support diverse students and faculty that reflect the populations they serve,
through holistic efforts to support, mentor, and sponsor students and faculty from a wide range of backgrounds.
VALUING COMMUNITY AND PUBLIC HEALTH NURSING
Community and public health nurses play a vital role in advancing health equity. School nurses, for example, are
front-line health care providers, serving as a bridge between the health care and education systems and other
sectors as well as links to broader community health issues through the student populations they serve. More
school nurses need the practice authority and payment structure to address complex health and social needs.
The COVID-19 pandemic has also heightened the need for team-based care, infection control and prevention,
person-centered care, and other population-based skills that reflect the strengths of community and public
health nurses.
APRNs hold at least a masteràdegree in addition to the initial nursing education and licensing required for all RNs, and may continue
in clinical practice or prepare for administrative and leadership positions.
2
The conditions of the environments in which people live, learn, work, play, worship, and age that affect a wide range of health, functioning,
and quality-of-life outcomes and risks.
1
FOSTERING NURSES OLES AS LEADERS AND ADVOCATES
A new generation of nurse leaders is now neededîe that recognizes the importance of diversity and equity and
is able to use and build on the increasing evidence base supporting the link between SDOH and health status.
This requires the contributions of nurses in all roles and settings in a collaborative system of leadership. Nurse
leaders can play an important role in acknowledging the history of racism within the profession and health care
and help mitigate the effects of discrimination and implicit bias on health.
PREPARING NURSES TO RESPOND TO DISASTERS
The COVID-19 pandemic has revealed chasms within an already fragmented U.S. health care system, resulting in
significant excess mortality and morbidity and glaring health inequities. Most affected are communities of color,
who suffer from the compound disadvantages of racism, poverty, workplace hazards, limited health care access,
and pre-existing health conditions. Articulating the roles and responsibilities of nurses in disaster response and
public health emergency management is critical to the nationàcapacity to plan for and respond to these types
of events.
SUPPORTING THE HEALTH AND WELL-BEING OF NURSES
Nurses(ealth and well-being are affected by the demands of their workplace, and in turn affect the quality of
and safety of the care they provide. Thus, it is essential to address the systems, structures, and policies that create
workplace hazards and stresses that lead to burnout, fatigue, and poor physical and mental health among the
nursing workforce. The pandemic has illuminated and exacerbated the day-to-day demands of nursing. Nurses
often cope with unrealistic workloads; insufficient resources and protective equipment; risk of infection; stigma
directed at health care workers; and the mental, emotional, and moral burdens of caring for patients with a new
and unpredictable disease and helping with contact tracing and testing. To help address the many SDOH, nurses
need to first feel healthy, well, and supported. Policy makers, nurse employers, nursing schools, nurse leaders,
and nursing associations all have a role in achieving this goal. Ultimately, the health and well-being of nurses
influence the quality, safety, and cost of the care they provide, as well as organizations and systems of care.
CONCLUDING REMARKS
Nurses are bridge builders and collaborators who engage and connect with people, communities, and organizations
to promote health and well-being. They need ongoing support from the systems that educate, train, employ,
and enable nurses to advance health equity. The COVID-19 pandemic has starkly revealed the challenges nurses
face every day, and has added significant new challenges. It has also given some nurses more autonomy, shifted
payment models, and sparked overdue conversations about dismantling racism in health care. Policy makers
and system leaders should seize this moment to support, strengthen, and transform the largest segment of the
health workforce so nurses can help chart our countryàcourse to good health and well-being for all.
Committee on the Future of Nursing 2020°30
Study Sponsor
Mary K. Wakefield (Co-Chair)
The University of Texas at Austin
Greer Glazer
University of Cincinnati
Robert Wood Johnson Foundation
David R. Williams (Co-Chair)
Harvard University
Marcus Henderson
Fairmount Behavioral Health
System
University of Pennsylvania
Maureen Bisognano
Institute for Healthcare
Improvement
Angelica Millan
County of Los Angeles
Department of Public Health
Jeffrey Brenner
JunaCare
Peter I. Buerhaus
Montana State University
William M. Sage
The University of Texas at Austin
Marshall H. Chin
University of Chicago
Regina S. Cunningham
Hospital of the University of
Pennsylvania
University of Pennsylvania
Jos
. Escarce
University of California,
Los Angeles
John W. Rowe
Columbia University
Victoria L. Tiase
NewYork-Presbyterian Hospital
Winston Wong
University of California,
Los Angeles
Study Staff
Suzanne Le Menestrel
Study Director (from June 2020)
Susan B. Hassmiller
Senior Scholar in Residence and
Advisor to the President on
Nursing, National Academy of
Medicine
Jennifer Lalitha Flaubert
Program Officer
Adrienne Formentos
Research Associate
Tochi Ogbu-Mbadiugha
Senior Program Assistant (from
October 2020)
Cary Haver
Study Director (until June 2020)
Carol Sandoval
Senior Program Assistant (until
September 2020)
Ashley Darcy-Mahoney
National Academy of Medicine
Distinguished Nurse Scholar-inResidence (August 2020 to August
2021)
Allison Squires
National Academy of Medicine
Distinguished Nurse Scholar-inResidence (March 2019 to August
2020)
Sharyl Nass
Senior Director, Board on Health
Care Services
Lori Brenig
Senior Program Assistant (until
May 2020)
To read the full report, please visit
nam.edu/publications/the-future-of-nursing-2020-2030
http://www.nationalacademies.org/future-of-nursing-2020-2030
Copyright 2021 by the National Academy of Sciences. All rights reserved.
RECOMMENDATIONS
MAY 2021
HE FUTURE OF NURSING 2020°30: CHARTING A PATH TO ACHIEVE
HEALTH EQUITY
Recommendation 1: In 2021, all national nursing organizations should initiate work to develop
a shared agenda for addressing social determinants of health and achieving health equity. This
agenda should include explicit priorities across nursing practice, education, leadership, and
health policy engagement. The Tri-Council for Nursing and the Council of Public Health Nursing
Organizations, with their associated member organizations, should work collaboratively and
leverage their respective expertise in leading this agenda-setting process. Relevant expertise should
be identified and shared across national nursing organizations, including the Federal Nursing Service
Council and the National Coalition of Ethnic Minority Nurse Associations. With support from the
government, payers, health and health care organizations, and foundations, the implementation
of this agenda should include associated timelines and metrics for measuring impact.
Recommendation 2: By 2023, state and federal government agencies, health care and public
health organizations, payers, and foundations should initiate substantive actions to enable the
nursing workforce to address social determinants of health and health equity more comprehensively,
regardless of practice setting.
Recommendation 3: By 2021, nursing education programs, employers, nursing leaders, licensing
boards, and nursing organizations should initiate the implementation of structures, systems, and
evidence-based interventions to promote nurses(ealth and well-being, especially as they take on
new roles to advance health equity.
Recommendation 4: All organizations, including state and federal entities and employing
organizations, should enable nurses to practice to the full extent of their education and training
by removing barriers that prevent them from more fully addressing social needs and social
determinants of health and by improving health care access, quality, and value. These barriers
include regulatory and public and private payment limitations; restrictive policies and practices;
and other legal, professional, and commercial1 impediments.
Recommendation 5: Federal, tribal, state, local, and private payers and public health agencies
should establish sustainable and flexible payment mechanisms to support nurses in both health
care and public health, including school nurses, in addressing social needs, social determinants of
health, and health equity.
Recommendation 6: All public and private health care systems should incorporate nursing
expertise in designing, generating, analyzing, and applying data to support initiatives focused on
social determinants of health and health equity using diverse digital platforms, artificial intelligence,
and other innovative technologies.
Recommendation 7: Nursing education programs, including continuing education, and
accreditors and the National Council of State Boards of Nursing should ensure that nurses are
prepared to address social determinants of health and achieve health equity.
Recommendation 8: To enable nurses to address inequities within communities, federal
agencies and other key stakeholders within and outside the nursing profession should strengthen
and protect the nursing workforce during the response to such public health emergencies as the
COVID-19 pandemic and natural disasters, including those related to climate change.
Recommendation 9: The National Institutes of Health, the Centers for Medicare & Medicaid
Services, the Centers for Disease Control and Prevention, the Health Resources and Services
Administration, the Agency for Healthcare Research and Quality, the Administration for Children
and Families, the Administration for Community Living, and private associations and foundations
The term ïmmercial2efers to contractual agreements and customary practices that make antiquated or unjustifiable
assumptions about nursing.
1
should convene representatives from nursing, public health, and health care to develop and support
a research agenda and evidence base describing the impact of nursing interventions, including
multisector collaboration, on social determinants of health, environmental health, health equity,
and nurses(ealth and well-being.
To read the full report, visit
nam.edu/publications/the-future-of-nursing-2020-2030
nationalacademies.org/our-work/the-future-of-nursing-2020-2030
NATIONAL ACADEMY OF MEDICINE
Copyright 2021 by the National Academy of Sciences. All rights reserved.

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