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Introduction

On February 22, 2010, the Robert Wood Johnson Foundation (RWJF) Initiative on the Future of Nursing, at the Institute of Medicine (IOM), held a forum on the future of nursing at the University of Texas MD Anderson Cancer Center in Houston. This forum was designed to examine challenges and opportunities associated with nursing education overall. The forum was the last of three that were convened to gather information and discuss ideas related to the future of nursing. The first forum, held on October 19, 2009, at Cedars-Sinai Medical Center in Los Angeles, focused on the future of nursing in acute care. The second forum, on December 3, 2009, at the Community College of Philadelphia, examined the future of nursing care in the community, with emphases on community health, public health, primary care, and long-term care.

The forums have been part of an intensive information-gathering effort by an IOM committee that is the cornerstone of the Initiative on the Future of Nursing. The committee will use the information collected at these forums, at its two technical workshops, from data provided by the RWJF Nursing Research Network, and from a number of commissioned papers to inform the development of its findings, conclusions, and recommendations. The committee’s final recommendations will be presented in a report in fall 2010 on the capacity of the nursing workforce to meet the demands of the changing health care system.

Each of the three forums was planned with the guidance of a small group of committee members; the planning group for this forum was led by Dr. Michael Bleich. The half-day forums were not meant to be an exhaustive examination of all settings where nurses practice nor an exhaustive examination of the complexity of the nursing profession as a whole. Given the limited amount of time for each forum, a comprehensive re-



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1 Introduction On February 22, 2010, the Robert Wood Johnson Foundation (RWJF) Initiative on the Future of Nursing, at the Institute of Medicine (IOM), held a forum on the future of nursing at the University of Texas MD Anderson Cancer Center in Houston. This forum was designed to examine challenges and opportunities associated with nursing education overall. The forum was the last of three that were convened to gather information and discuss ideas related to the future of nursing. The first forum, held on October 19, 2009, at Cedars-Sinai Medical Center in Los Angeles, focused on the future of nursing in acute care. The second fo- rum, on December 3, 2009, at the Community College of Philadelphia, examined the future of nursing care in the community, with emphases on community health, public health, primary care, and long-term care. The forums have been part of an intensive information-gathering effort by an IOM committee that is the cornerstone of the Initiative on the Future of Nursing. The committee will use the information collected at these forums, at its two technical workshops, from data provided by the RWJF Nursing Research Network, and from a number of commis- sioned papers to inform the development of its findings, conclusions, and recommendations. The committee’s final recommendations will be pre- sented in a report in fall 2010 on the capacity of the nursing workforce to meet the demands of the changing health care system. Each of the three forums was planned with the guidance of a small group of committee members; the planning group for this forum was led by Dr. Michael Bleich. The half-day forums were not meant to be an ex- haustive examination of all settings where nurses practice nor an exhaus- tive examination of the complexity of the nursing profession as a whole. Given the limited amount of time for each forum, a comprehensive re- 1

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2 FORUM ON THE FUTURE OF NURSING: EDUCATION view of all facets and all players of each of the main forum themes was not possible. Rather, the forums were meant to inform the committee on important topics within the nursing profession and highlight some of the key challenges, barriers, opportunities, and innovations that nurses face while working in an evolving health care system. Many of the critical challenges, barriers, opportunities, and innovations discussed at the fo- rums overlap across settings and throughout the nursing profession and also apply to other providers and individuals who work with nurses. Unlike the two previous forums, which featured a series of presenta- tions, the Houston forum was organized into three armchair discussions that were moderated by members of the IOM committee. The first discussion, moderated by Dr. Michael Bleich, examined the broad topic of what to teach and the ideal future state of nursing curriculums (Chapter 2). The second, “How to Teach” (Chapter 3), focused on methodologies and strategies, as well as partnerships and collabora- tives, that could be used for educating nurses and was moderated by Dr. Linda Burnes Bolton. The third, “Where to Teach” (Chapter 4), was moderated by Jennie Chin Hansen and dealt with various venues and lo- cations where nurses could be educated. This summary of the forum describes the main points made during the discussions. It also summa- rizes the oral testimony presented by 12 forum attendees, along with remarks made during an open-microphone session at the end of the forum (Chapter 5). A complete agenda of the forum can be found in Appendix B, and biosketches of the discussants and moderators can be found in Appendix C. The remaining sections of this chapter describe two activities that occurred in conjunction with the forum and present the welcoming remarks of Dr. John R. Lumpkin of RWJF and Dr. John R. Mendelsohn of the University of Texas MD Anderson Cancer Center. Comments made at the forum should not be interpreted as positions of the IOM committee, RWJF, the IOM, or the University of Texas MD Anderson Cancer Center. Committee members’ questions and comments do not necessarily reflect their personal views or the conclusions that will be in the committee’s report. However, the questions and comments were designed to elicit information and perspectives to help guide the commit- tee’s deliberations.

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3 INTRODUCTION SITE VISITS Following the forum, committee members participated in visits to one of three sites in Houston: the University of Texas Health (UTH) Sci- ence Center at Houston School of Nursing, Texas Woman’s University (TWU), or the National Aeronautics and Space Administration (NASA). Detailed observations made during these site visits are not part of this summary, but the site visits have informed the committee’s deliberations on nursing education. During the site visits, committee members had the opportunity to talk with nursing students, educators, administrators, and experts in training for quality, safety, and collaboration about some of the innovations being used. The site visit at UTH included demonstrations in a physical as- sessment lab using retired physicians as educators, a high-fidelity simula- tion lab, and a nurse-managed clinic. This visit also included discussion of educational models such as distance learning and accelerated doctoral programs. Those who visited TWU saw a demonstration in a high- fidelity simulation lab and heard discussion of technology use in educa- tional settings and interdisciplinary education programs. The site visit to NASA focused on training for quality and safety, collaboration in a team environment, and continuing education. Participants at this site visit heard discussions about resource management and strategies for error reduction through collaboration. ROBERT WOOD JOHNSON FOUNDATION SOLUTIONS SESSION Following the site visits, a select group of RWJF scholars and fel- lows 1 hosted by RWJF met to discuss what they heard at the forum and observed on the site visits in the context of their own expertise, knowl- edge, and judgment. This session was independent of the IOM committee and the forum on the future of nursing. The goal of this session was to 1 RWJF works to build human capital by supporting individuals who seek to advance health and health care in America. RWJF invited alumni of 17 of its scholar, fellow, and leader programs to participate in the Forum on the Future of Nursing. The alumni came from a variety of backgrounds and disciplines, including academia, service delivery, re- search, policy, and health plan administration. Many participants were alumni of the RWJF Executive Nurse Fellows Program and the RWJF Nurse Faculty Scholars Pro- gram. Non-nurse participants included alumni of the Investigator Award Program, the RWJF Health Policy Fellows Program, and the RWJF Clinical Scholar Program.

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4 FORUM ON THE FUTURE OF NURSING: EDUCATION provide an opportunity for the fellows and scholars to consider solutions and the most promising directions for nursing education. The solutions offered by the fellows and scholars are not described in this summary of the forum. But summaries of their solutions were pro- vided to the committee for its review and consideration. WELCOMING REMARKS Dr. John R. Lumpkin, senior vice president and director of the Health Care Group at RWJF, noted that the mission of RWJF is to improve the health and health care of all Americans. The Foundation’s mission has placed it at the center of a critically important period in U.S. history, he said. At the time of the forum, shortly before the passage of health care reform, 46 million Americans were uninsured (DeNavas-Walt et al., 2009). The cost of health care was continuing to rise, and many health care providers were increasingly dissatisfied with their work environment—so much so that many were thinking about leaving the field, he said. “Regardless of what happens in Washington this year, the status quo in health and health care is unsustainable,” he said. “Change is in the wind.” Nurses are the largest component of the health care system. Not only do nurses need to be involved in changing the system in which they work, Lumpkin said, but “nurses have to help lead the change.” The IOM committee’s task is to examine how that change will happen and the role that nurses will play in the process. The Initiative hosted these three fo- rums to give nurses and other health care providers a voice in the com- mittee’s deliberations. At the same time, the Foundation is committed to the work that will need to be done after the committee has released its report: the committee’s recommendations will need to be implemented “so that nursing and nurses can play their rightful role in effecting the change that is going to be so important for the future of this country,” said Lumpkin. Dr. John Mendelsohn, president of the University of Texas MD Anderson Cancer Center, also welcomed the committee, the more than 300 people who attended the forum, and the additional 330 who regis- tered for the forum’s live webcast. The Cancer Center has 3,900 regis- tered nurses and 50 licensed vocational nurses, Mendelsohn said. Of the registered nurses, 600 have master’s degrees, and more than 20 have doctoral degrees. In 2010, the center will see more than 100,000 cancer

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5 INTRODUCTION patients, with 33,000 new registrants, and will place 11,000 patients in therapeutic clinical trials, he said. Education is “one of the four pillars of our mission. The others are patient care, research, and prevention,” Mendelsohn explained. The Can- cer Center has an academic department of nursing that is devoted to nurs- ing research and teaching. It also offers every nurse, at every level, an opportunity to advance their practices, careers, and goals. “We are grate- ful to have the resources to make nursing education and advancement a priority. We know that this makes a difference in every facet of our pa- tient care, research, and institutional culture,” he said. The work of the IOM committee will be an important response to the challenge of im- proving the quality and efficiency of U.S. health care, Mendelsohn said.

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