policy, and financial changes that uphold patient-centered care as the organizing principle for a reformed health care system. The education and training of nurses support their ability to offer a wider range of services safely and effectively—as documented by numerous studies. And nurses must respond to the challenge, reinventing themselves as needed in a rapidly evolving health care system. Nursing is, of course, not the only profession to confront the need to transform itself in response to new realities; similarly disruptive challenges have been faced in other fields, such as medicine, health care, publishing, education, business, manufacturing, and the military. In the field of health care, expansion of scopes of practice to reflect the full extent of one’s education and training should occur for all health professionals to maximize the contributions of each to patient care. For example, one impact of enhancing nurses’ scopes of practice may be to allow the currently inadequate numbers of physicians to better use their time and skills on the most complex and challenging cases and tasks, as well as broaden the array of services they can offer as part of a collaborative team of providers (e.g., within new models of care—ACOs, medical homes, transitional care—that are part of the ACA, as well as in groups of specialty providers). To facilitate the most effective transition to team practice, as well as practice that encompasses the full extent of their scope, all providers will require continual teaching and learning to facilitate the highest level of team functioning (see Chapter 4).

Key factors that will contribute to the success of managing such a transition include technological literacy, good communication skills, adaptability to organizational changes, and a willingness to evaluate and reinvent how work is organized and accomplished (Kimball and O’Neil, 2002). Going forward under the ACA and whatever reforms may follow, the health care system is likely to change so rapidly that building the adaptive capacity of the nursing workforce to work across settings and in different types of roles in new models of care will require intentional development, expanded resources, and policy and regulatory changes.

Finally, the committee believes that if practice is to be transformed, nurses graduating with a bachelor’s degree must be better prepared to enter the practice environment and confront the challenges they will encounter. Therefore, the committee concludes that nurse residency programs should be instituted to provide nurses with an appropriate transition to practice and develop a more competent nursing workforce.


AACN (American Association of Colleges of Nursing). 2007. White paper on the education and role of the clinical nurse leader. http://www.aacn.nche.edu/Publications/WhitePapers/ClinicalNurseLeader07.pdf (accessed March 26, 2010).

AACN. 2008. The essentials of baccalaureate education for professional nursing practice. Washington, DC: AACN. http://www.aacn.nche.edu/education/pdf/BaccEssentials08.pdf.

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