needs of the U.S. population in the 21st century. The chapter then delineates the roles of nurses in realizing this vision. The third section explains why a fundamental transformation of the nursing profession will be required if nurses are to assume these roles. The final section presents conclusions.

A VISION FOR HEALTH CARE

During the course of its work, the Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine developed a vision for a transformed health care system, while recognizing the demands and limitations of the current health care system outlined above. The committee envisions a future system that makes quality care accessible to the diverse populations of the United States, intentionally promotes wellness and disease prevention, reliably improves health outcomes, and provides compassionate care across the lifespan. In this envisioned future, primary care and prevention are central drivers of the health care system. Interprofessional collaboration and coordination are the norm. Payment for health care services rewards value, not volume of services, and quality care is provided at a price that is affordable for both individuals and society. The rate of growth of health care expenditures slows. In all these areas, the health care system consistently demonstrates that it is responsive to individuals’ needs and desires through the delivery of truly patient-centered care. Annex 1-1 lists the committee’s definitions for three core terms related to its vision: health, health care, and the health care system.

THE ROLE OF NURSES IN REALIZING THIS VISION

The ACA provides a call to action for nurses, and several sections of the legislation are directly relevant to their work.1 For example, sections 5501 through 5509 are aimed at substantially strengthening the provision of primary care—a need generally recognized by health professionals and policy experts; section 2717 calls for “ensuring the quality of care”; and section 2718 emphasizes “bringing down the cost of health care coverage.” Enactment of the ACA offers a myriad of opportunities for the nursing profession to facilitate improvements to the health care system and the mechanisms by which care is delivered across various settings. Systemwide changes are needed that capture the full economic value of nurses and take into account the growing body of evidence that links nursing practice to improvements in the safety and quality of care. Advanced practice registered nurses (APRNs) should be called upon to fulfill and expand their potential as primary care providers across practice settings based on their

1

For a list of nursing-related provisions included in the ACA, see http://championnursing.org/sites/default/files/nursingandhealthreformlawable.pdf.



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