Nurses' roles, responsibilities and education must be expanded to meet the growing demand for care under reform and the nation's evolving care needs, according to a new report from the Institute of Medicine. The report calls for four changes to the profession:

  1. Nurses should practice to the full extent of their education and training. States, federal agencies and health care organizations should remove scope-of-practice barriers, which are particularly problematic for advanced practice registered nurses, such as nurse practitioners, nurse anesthetists, nurse midwives and clinical nurse specialists.
    Because licensing and practice rules vary across states, the tasks that APRNs are allowed to perform are determined not by their education and training but by the unique state laws under which they work. And as access to health coverage increases under reform, APRNs' skills will be needed to meet the demand for primary care.
  2. Nurses should achieve higher levels of education and training through an improved education system that includes the creation of a residency program and additional opportunities for lifelong learning. Nurses can attain undergraduate education through diploma, associate degree or bachelor's degree programs, but health care does not provide sufficient incentives for them to pursue higher degrees or additional training.
    Lack of academic progression has prevented nurses from working in faculty and advanced practice roles. Report authors recommend that the profession increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020 and double the number who pursue doctorates.
  3. Nurses should be full partners with physicians and other health care professionals in redesigning the health care system. Health care organizations, including nursing associations and schools, should provide nurses greater opportunities to gain and practice leadership skills, the report noted. In turn, nurses need to recognize their responsibility and capability to contribute on management teams, boards and other groups shaping health care.
  4. Effective workforce planning and policy require better data collection and an improved information infrastructure. Transforming the health care system and the practice environment will require comprehensive data on the numbers and types of health professionals currently available and required to meet future needs.

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