Appendixes

A
Methods and Information Sources

The Committee on the Robert Wood Johnson Foundation (RWJF) Initiative on the Future of Nursing, at the Institute of Medicine (IOM) was asked to produce a report providing recommendations for an action-oriented blueprint for the future of nursing. The broad scope of this 13-month study included an examination of public and private policies at the national, state, and local levels. The recommendations presented in this report identify vital roles for nurses in designing and implementing a transformed health care system that provides Americans with high-quality care that is accessible, affordable, patient centered, and evidence based. To provide a comprehensive response to its charge, the committee tapped the wide-ranging expertise of its members and reviewed data from a variety of sources, including recent literature; data and reports from the Nursing Research Network, supported by RWJF; public and stakeholder input gathered through a series of technical workshops and public forums; site visits to a variety of health care settings where nurses do their work; and commissioned papers on selected topics.

EXPERTISE

The committee was composed of 18 members with expertise and experience in diverse areas, including nursing, federal and state administration and regulations, hospital and health plan administration, business administration, health information and technology, public health, health services research, health policy, workforce research and policy, and economics. On occasion, the committee identified areas related to its charge that required specialized knowledge and expertise not available within its membership, such as specific areas of law, scope-of-prac-



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A Methods and Information Sources The Committee on the Robert Wood Johnson Foundation (RWJF) Initiative on the Future of Nursing, at the Institute of Medicine (IOM) was asked to produce a report providing recommendations for an action-oriented blueprint for the fu- ture of nursing. The broad scope of this 13-month study included an examination of public and private policies at the national, state, and local levels. The recom- mendations presented in this report identify vital roles for nurses in designing and implementing a transformed health care system that provides Americans with high-quality care that is accessible, affordable, patient centered, and evidence based. To provide a comprehensive response to its charge, the committee tapped the wide-ranging expertise of its members and reviewed data from a variety of sources, including recent literature; data and reports from the Nursing Research Network, supported by RWJF; public and stakeholder input gathered through a series of technical workshops and public forums; site visits to a variety of health care settings where nurses do their work; and commissioned papers on selected topics. EXPERTISE The committee was composed of 18 members with expertise and experience in diverse areas, including nursing, federal and state administration and regula- tions, hospital and health plan administration, business administration, health information and technology, public health, health services research, health policy, workforce research and policy, and economics. On occasion, the committee iden- tified areas related to its charge that required specialized knowledge and expertise not available within its membership, such as specific areas of law, scope-of-prac- 2

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2 THE FUTURE OF NURSING tice regulations, nursing research methods and data analysis, and health policy. In such cases, the committee called upon the foremost experts in those fields to serve as consultants and advisors during its deliberations (see the acknowledg- ments section of the report for a list of these individuals). In addition, the com- mittee benefited from resources made available through the unique partnership between the IOM and RWJF, which allowed for borrowed-staff agreements that provided the committee with additional expertise from RWJF on nursing, nursing research, and communications. This partnership also facilitated the availability of additional information resources that were provided through AARP’s Center for Championing Nursing in America and AcademyHealth. LITERATURE REVIEW Over the course of the study, the committee received and reviewed a wide range of literature from a variety of sources that was relevant to all aspects of its charge. Staff monitored key developments related to nursing, including newly published literature and legislative activity on both on the federal and state levels, with input from the Center to Champion Nursing in America, the NRN (described below), and GYMR public relations. Each committee meeting and public forum provided an opportunity for distinguished experts to submit articles and reports relevant to their presentations. Finally, committee members and the public were invited to submit articles and reports that would further support the committee’s work. In total, the committee’s database of relevant documents included almost 400 articles and reports. Nursing is a frequently studied profession. Since the 1923 release of the Goldmark Report, funded by the Rockefeller Foundation, hundreds of public and private commissions and task forces have examined many facets of the pro- fession, including its education system, diversity, scope of practice, workforce capacity, and relationship to other health professions and the public (Goldmark, 1923). The primary driver for this interest in the profession is nurses’ essential role in caring for the sick and supporting the well. A number of factors affect the implementation of recommendations contained in previous reports, such as the exclusion of nurses from their production; the failure of the profession itself, through a lack of either resources or political will, to act on the recommendations; or the failure to redirect the focus from nurses to what is necessary to improve patient care. Additional factors, such as context, time, and place, also influence the success of a study and the implementation of its recommendations. Since 1997, the IOM has produced at least 20 reports or workshop sum- maries related directly or indirectly to the nursing profession. They all share at least four common themes: nurses are a critical factor in health care because they are the closest to and spend the most time with patients; nurses need the skills and knowledge to keep patients safe and help them stay healthy or recover from illness; new models of care should be developed to better utilize nurses’ skills

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2 APPENDIX A and knowledge while improving patient care and decreasing costs; and patients receive better care when nurses and other health professionals work together ef- fectively. The last broad-based study of the nursing profession published by the IOM was Nursing and Nursing Education: Public Policies and Private Actions (IOM, 1983). More recently, the IOM published Keeping Patients Safe: Trans- forming the Work Environment of Nurses (IOM, 2004). This report describes strategies for improving nurses’ work environments and responding to the over- whelming demands they often face, with the ultimate goal of improving the safety and quality of care. As the committee was conducting this study, a number of additional re- ports about nursing and nursing education, in particular, were released. Four months prior to the launch of the study, Prime Minister Gordon Brown charged a commission in England to examine the future of nursing and midwifery. The commission’s report, Front Line Care: The Future of Nursing and Midwifery in England (Prime Minister’s Commission on the Future of Nursing and Mid- wifery in England, 2010) states that nurses and midwives have great potential to influence health and must renew their pledge to society to deliver high-quality, compassionate care, and that they must be well supported to do so. A report re- leased by the Josiah Macy, Jr. Foundation, Who Will Provide Primary Care and How Will They Be Trained? (Cronenwett and Dzau, 2010), likewise suggests that nurses are well positioned to improve health and recommends that any barriers preventing nurse practitioners from serving as primary care providers or leading models of primary care delivery be removed. Several reports emphasize that continuing education is crucial if nurses, and other health professionals, are to deliver high-quality and safe care throughout their careers. They include Continuing Education in the Health Professions: Improving Healthcare Through Lifelong Learning (Hager et al., 2008), another report from the Macy Foundation; the IOM’s Redesigning Continuing Education in the Health Professions (IOM, 2009); and Lifelong Learning in Medicine and Nursing (AACN and AAMC, 2010), which was cosponsored by the American Association of Colleges of Nursing and the Association of American Medical Colleges. A report specifically addressing the initial education of nurses, pub- lished by Dr. Patricia Benner and her team at the Carnegie Foundation, Educating Nurses: A Call for Radical Transformation (Benner et al., 2009), calls for a more highly educated nursing workforce, recommending that all entry-level registered nurses (RNs) be prepared at the baccalaureate level and that all RNs earn at least a master’s degree within 10 years of initial licensure. RWJF NURSING RESEARCH NETWORK To increase the amount, relevance, and accessibility of research available to the committee, RWJF launched a parallel project called the Nursing Research Network (NRN) that generated, synthesized, and disseminated a broad range of

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2 THE FUTURE OF NURSING research findings. These products both anticipated the committee’s information needs and were responsive to requests made by committee members throughout the study process. Many of these products informed the committee’s discussions of the present and future of nursing. Lori Melichar served as research director for the NRN initiative. She super- vised the NRN and led efforts to prioritize a research agenda that would meet the committee’s information needs. The majority of the NRN’s research activities were led and conducted by four research managers from across the country who served as consultants to the committee: Linda Aiken, University of Pennsylvania; Peter Buerhaus, Vanderbilt University; Christine Kovner, New York University; and Joanne Spetz, University of California, San Francisco. Additional researchers and experts were engaged to fill gaps as needed. The production and delivery of NRN products, including reports, research briefs, charts, tables, and commentar- ies, were coordinated by Patricia (Polly) Pittman, of AcademyHealth and subse- quently The George Washington University, and her staff. The NRN began by providing the committee with a foundational set of 20 articles in the following areas of nursing policy: chronic and long-term care, education policy, expansion of access to primary care, foreign-educated nurses, human resource management (including nurse turnover rates), improvement of quality and safety (including workforce environment and staffing issues), preven- tion and wellness, promotion of health information technology, cost containment, and workforce estimations. To date, the NRN has produced 6 reports, 48 charts and tables, and 13 research briefs. A broad range of topics has been covered, including estimates of supply and demand, scope of practice, faculty shortages, career ladders, payment systems, health information technology, and physician and patient perceptions of nursing care. All of these products will be available to the public through either RWJF’s website or peer-reviewed publications. COMMITTEE MEETINGS The committee convened for five meetings and participated in several con- ference calls throughout the study to deliberate on the content of this report and its recommendations. To obtain additional information on specific aspects of the study charge, the committee included in three of its meetings technical workshops that were open to the public and held three public forums on the future of nurs- ing and the role of nurses across various settings. Subject matter experts were invited to these public sessions to present information and recommendations for the committee’s consideration, answer the committee’s questions, and participate in subsequent discussions. The three technical workshops were held in conjunction with the committee’s July, September, and November 2009 meetings. The purpose of these workshops was to gather information on specified topics. The committee determined the topics and speakers based on its information needs. The first meeting included

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2 APPENDIX A a review and discussion of the committee’s charge with the study’s sponsor, RWJF; an overview and description of the current nursing workforce and future workforce needs; and an introduction to the NRN and the resources that would be made available to the committee through the network. The second workshop was intended to provide an overview of the Prime Minister’s Commission on the Future of Nursing and Midwifery and the efforts in England to transform the nursing profession; a discussion of possible ways for the nursing profession to fulfill its promise; and a review of ongoing health care reform efforts in the United States. The third workshop looked at nurses’ role in addressing disparities; ways to ensure quality, access, and value in health care; and reimbursement and financing of care delivered by nurses. The agendas for these three workshops are provided in Boxes A-1 through A-3 at the end of this appendix. The three public forums were held in locations across the United States to engage a broader range of stakeholders and the public. The first, held in October 2009 at Cedars-Sinai Medical Center in Los Angeles, focused on quality and safety, technology, and interdisciplinary collaboration in acute care settings. The second, held in December 2009 at the Community College of Philadelphia, fea- tured presentations and discussion of achievements and challenges in care in the community and focused on community health, public health, primary care, and long-term care. The final forum, held in February 2010 at the University of Texas M. D. Anderson Cancer Center, featured discussion of three topics in nursing education: what to teach, how to teach, and where to teach. Summaries of each of these forums were published separately and are available on the CD-ROM in the back of this report. The agendas for these forums are provided in Boxes A-4 through A-6 at the end of this appendix, and highlights from the forums appear in Appendix C. In preparation for each of the forums and to augment the information gath- ered from presenters and discussants, the committee solicited written testimony through an online questionnaire (see Boxes A-7 through A-9 at the end of this appendix for the specific questions that were asked). The public and key stake- holders were invited to provide information on innovations, models, barriers, and opportunities for each of the topics covered at the forums, as well as their vision for the future of nursing overall. The committee received more than 200 submis- sions of testimony during the course of the study; many of the individuals who submitted this testimony also presented it at the forums. Each forum also included an open microphone session for ad hoc testimony and input from participants on a variety of topics relevant to the forum discussions. SITE VISITS In conjunction with each forum, small groups of committee members partici- pated in a series of site visits. These visits highlighted a wide range of settings in which nurses work, as well as their various roles. The sites visited included acute

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20 THE FUTURE OF NURSING care units in Cedars-Sinai Medical Center—ranging from critical care units to the emergency department and surgical units to child and maternal health and ob- stetrics units; community health settings in Philadelphia—ranging from a school- based health center to public health clinics and nurse-managed health centers; and education settings in Houston, where committee members saw demonstrations of high-fidelity simulation laboratories and participated in discussions of interpro- fessional education and educating for quality control. Committee members also talked with nurses, other care providers, and administrators about the challenges nurses encounter daily in their work in these varied settings. Observations made during these site visits informed some of the questions committee members asked speakers at the forums and provided real-world perspectives of seasoned professionals. COMMISSIONED PAPERS The committee commissioned a series of papers from experts in subject areas relevant to its statement of task. These papers, included as Appendixes E−I on the CD-ROM in the back of this report, were intended to provide in-depth informa- tion on five selected topics: • A paper written by Barbara L. Nichols, Catherine R. Davis, and Donna R. Richardson from CGFNS International reviews the ways in which other countries educate, regulate, and utilize nurses. This paper also addresses the migration and globalization of the nursing workforce and implications for education, service delivery, and health policy in the United States. • A paper by Barbara J. Safriet describes federal options for maximizing the value of advanced practice registered nurses (APRNs) in providing quality and cost-effective health care. It includes a review of current mechanisms of payment and financing of services and impediments in the regulatory environment for APRNs, and offers an assessment of policy initiatives that could improve the value of APRNs. • A paper written by Julie Sochalski of the University of Pennsylvania and Jonathan Weiner of The Johns Hopkins University examines the nursing workforce and possible shortages in the context of a reformed health care system. It examines trends and projections for the workforce, drawbacks of current approaches to assessing the workforce, opportuni- ties and challenges of new workforce approaches, and implications for policy. • One paper was presented as a series of briefs that provides examples of transformative models of nursing across a variety of settings and locales. This paper was compiled and edited by Linda Norlander of the University of California, San Francisco, and features collaborative

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21 APPENDIX A briefs written by 27 fellows of the RWJF Executive Nurse Leadership Program. The briefs cover topics in education, acute care, chronic dis- ease management, palliative and end-of-life care, community health, school-based health, and public−private partnerships. • A collection of seven papers was written by Linda Aiken of the Uni- versity of Pennsylvania; Donald Berwick of the Institute for Healthcare Improvement; Linda Cronenwett of the University of North Carolina at Chapel Hill; Kathleen Dracup of the University of California, San Francisco; Catherine Gilliss of Duke University; Chris Tanner of Oregon Health and Science University; and Virginia Tilden of the University of Nebraska. This series of papers describes the most important initiatives required to ensure that future nursing education efforts contribute to improving the health of the population, enhancing the patient’s experi- ence of care (including quality, access, and reliability), and reducing or controlling the per capita cost of care. REFERENCES AACN and AAMC (American Association of Colleges of Nursing and Association of American Medical Colleges). 2010. Lifelong Learning in Medicine and Nursing: Final Conference Report. Washington, DC: AACN and AAMC. Benner, P., M. Sutphen, V. Leonard, and L. Day. 2009. Educating Nurses: A Call for Radical Trans- formation. San Francisco, CA: Jossey-Bass. Cronenwett, L., and V. Dzau. 2010. Who Will Provide Primary Care and How Will They Be Trained? Proceedings of a Conference Sponsored by the Josiah Macy, Jr. Foundation. Edited by B. Cul- liton and S. Russell. Durham, NC: Josiah Macy, Jr. Foundation. Goldmark, J. 1923. Nursing and nursing education in the United States: Report of the committee for the study of nursing education. New York: Macmillan Company. Hager, M., S. Russell, and S. Fletcher, eds. 2008. Continuing Education in the Health Professions: Improving Healthcare through Lifelong Learning. Proceedings of a Conference Sponsored by the Josiah Macy, Jr. Foundation. New York: Josiah Macy, Jr. Foundation. IOM (Institute of Medicine). 1983. Nursing and Nursing Education: Public Policies and Private Actions. Washington, DC: National Academy Press. IOM. 2004. Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington, DC: The National Academies Press. IOM. 2009. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. Prime Minister’s Commission on the Future of Nursing and Midwifery in England. 2010. Front Line Care: The Future of Nursing and Midwifery in England. London: Crown.

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22 THE FUTURE OF NURSING BOX A-1 Technical Workshop #1 July 14, 2009 National Academy of Sciences Lecture Room 2100 C Street, NW, Washington, DC 20037 Public Agenda Delivery of Charge to the Committee 11:00 AM John Lumpkin, Robert Wood Johnson Foundation Lunch Available 12:00 PM 12:30−1:00 PM Outlook for the Nursing Workforce in the United States: Can Nursing Win the Game? Peter Buerhaus, Vanderbilt University Robert Wood Johnson Foundation Nursing Research 1:00−2:30 PM Network • Introduction to the Research Network - Susan Hassmiller, Robert Wood Johnson Foundation - Lori Melichar, Robert Wood Johnson Foundation • anel discussion with members of the Nursing Research P Network - Peter Buerhaus, Vanderbilt University - Christine Kovner, New York University - Arnold Milstein, Mercer Consulting - Mark Pauly, University of Pennsylvania Open Session Adjourns 2:30 PM

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23 APPENDIX A BOX A-2 Technical Workshop #2 September 14, 2009 Kaiser Family Foundation Barbara Jordan Conference Center 1330 G Street, NW, Washington, DC Public Agenda Overview of the Prime Minister’s Commission on the 9:00–10:00 AM Future of Nursing and Midwifery Ann Keen, Chair, and Parliamentary Under Secretary for Health Services Anne Marie Rafferty, Commissioner (via videoconference) Jane Salvage, Joint Lead, Support Office Fulfilling the Potential of the Nursing Workforce 10:00–11:30 AM Ann Hendrich, Ascension Health Mary Naylor, University of Pennsylvania Ed O’Neil, University of California, San Francisco (via videoconference) Break 11:30–11:45 AM Overview of the Status of Health Care Reform 11:45 AM–1:00 PM Chris Jennings, Jennings Policy Strategies, Inc. Dean Rosen, Mehlman Vogel Castagnetti, Inc. Peter Reinecke, Reinecke Strategic Solutions, Inc.

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24 THE FUTURE OF NURSING BOX A-3 Technical Workshop #3 November 2, 2009 National Academy of Sciences Lecture Room 2100 C Street, NW, Washington, DC Public Agenda The Role of Nurses in Addressing Health Disparities 8:00–9:00 AM Linda Burnes Bolton, Facilitator David R. Williams, Harvard University Nilda Peragallo, University of Miami School of Nursing Antonia M. Villarruel, University of Michigan School of Nursing Alicia Georges, Lehman College Department of Nursing 9:00–10:30 AM Reimbursement and Financing for Nursing Care David Goodman and Jennie Chin Hansen, Facilitators Mark McClellan, Brookings Institute Gail Wilensky, Project HOPE Ellen Kurtzman, The George Washington University Meredith Rosenthal, Harvard University 10:30–10:45 AM Break 10:45–11:45 AM Quality, Access, and Value: Nursing Roles for the 21st Century Donna Shalala, Facilitator • Prevention/Wellness Susan Cooper, Tennessee Department of Health • Chronic Disease Management Mary Mundinger, Dean and Professor in Health Policy, Columbia University School of Nursing • End-of-Life Care Judy Lentz, CEO, Hospice and Palliative Nurses Association Adjourn 11:45 AM

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2 APPENDIX A BOX A-4 Forum on the Future of Nursing: Acute Care October 19, 2009 Harvey Morse Auditorium Cedars-Sinai Medical Center 8700 Beverly Boulevard, Los Angeles, CA 90048 Public Agenda Welcome and Introductions 12:30 PM Linda Burnes Bolton, Cedars-Sinai Medical Center Tom Priselac, Cedars-Sinai Medical Center Acute Care: Current and Future State 1:00 PM Marilyn Chow, Kaiser Permanente Panel on Quality and Safety 1:30 PM Maureen Bisognano, Institute for Healthcare Improvement Tami Minnier, University of Pittsburgh Medical Center Reactor Panel Bernice Coleman, Cedars-Sinai Medical Center Nancy Chiang, California Student Nurses Association Kurt Swartout, Kaiser Permanente Joseph Guglielmo, University of California, San Francisco Julia Hallisy, The Empowered Patient Coalition Committee Q&A and Discussion Break 2:15 PM Panel on Technology 2:30 PM Steve DeMello, Public Health Institute Pam Cipriano, University of Virginia Health System Reactor Panel Committee Q&A and Discussion Panel on Interdisciplinary Collaboration 3:15 PM Alan Rosenstein, VHA West Coast Pamela Mitchell, University of Washington Reactor Panel Committee Q&A and Discussion Presentation of Testimony 4:00 PM [A limited number of preselected individuals will be given the opportunity to present testimony.] Closing Remarks 5:25 PM Josef Reum, The George Washington University Adjourn 5:30 PM

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2 THE FUTURE OF NURSING BOX A-5 Forum on the Future of Nursing: Care in the Community December 3, 2009 Community College of Philadelphia Great Hall (S2.19), Winnet Student Life Building 1700 Spring Garden, Philadelphia, PA 19130 Public Agenda Welcome and Introductions 12:30 PM Donna E. Shalala, University of Miami Josef Reum, The George Washington University Notes on Prescription for Pennsylvania 12:45 PM Governor Ed Rendell Committee Q&A and Discussion 1:15 PM Keynote Presentation 1:30 PM Mary Selecky, Washington State Department of Health Panel on Community and Public Health 2:00 PM Carol Raphael, Visiting Nurse Service of New York Eileen Sullivan-Marx, University of Pennsylvania School of Nursing Committee Q&A and Discussion Preselected Testimony

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2 APPENDIX A Break 3:00 PM Panel on Primary Care 3:15 PM Tine Hansen-Turton, National Nursing Centers Consortium Sandra Haldane, Indian Health Service Committee Q&A and Discussion Preselected Testimony Panel on Chronic and Long-Term Services and Supports 4:15 PM Claudia Beverly, University of Arkansas for Medical Sciences School of Nursing Lynda Hedstrom, Ovations-Evercare by UnitedHealthcare® Medicare Solutions Committee Q&A and Discussion Preselected Testimony Open Microphone Listening Session: Visions for the 5:10 PM Future of Nursing Closing Remarks 5:30 PM Josef Reum, The George Washington University Adjourn 5:35 PM

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2 THE FUTURE OF NURSING BOX A-6 Forum on the Future of Nursing: Education February 22, 2010 University of Texas, MD Anderson Cancer Center Cancer Prevention Building (CPB), 8th floor 1155 Pressler Street, Houston, TX 77030 Public Agenda Welcomes and Introductions 8:00 AM Donna E. Shalala, University of Miami John Lumpkin, The Robert Wood Johnson Foundation John Mendelsohn, University of Texas, MD Anderson Cancer Center What We Should Teach: Arm Chair Discussion #1 8:15 AM Michael Bleich, Oregon Health and Science University, Moderator Linda Cronenwett, University of North Carolina at Chapel Hill, School of Nursing M. Elaine Tagliareni, National League for Nursing, formerly Community College of Philadelphia Terry Fulmer, College of Nursing, New York University Marla Salmon, University of Washington School of Nursing Preselected Testimony 9:15 AM Donna E. Shalala, Facilitator How We Should Teach: Arm Chair Discussion #2 9:30 AM Linda Burnes Bolton, Cedars-Sinai Medical Center, Moderator Pamela Jeffries, The Johns Hopkins University Divina Grossman, Florida International University John Rock, Florida International University Bob Mendenhall, Western Governors University Cathleen Krsek, University HealthSystem Consortium, UHC/ AACN Nurse Residency Program™

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2 APPENDIX A Preselected Testimony 10:30 AM Donna E. Shalala, Facilitator Break 10:45 AM Where We Should Teach: Arm Chair Discussion #3 11:00 AM Jennie Chin Hansen, AARP, Moderator Rose Yuhos, AHEC of Southern Nevada Cathy Rick, Department of Veterans Affairs Nursing Academy Christine Tanner, Oregon Health and Science University Willis N. Holcombe, The Florida College System Preselected Testimony 12:00 PM Donna E. Shalala, Facilitator Open Microphone Listening Session: Visions for the 12:15 PM Future of Nursing Donna E. Shalala, Facilitator Closing Remarks 12:35 PM Donna E. Shalala Adjourn 12:40 PM

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300 THE FUTURE OF NURSING BOX A-7 Testimony Questions for the Forum on the Future of Nursing: Acute Care Question 1: Quality and Safety Please describe any or all of the following: • nnovative models in which nurses have been used to improve quality i and/or safety in acute care settings • arriers that acute care nurses face in maximizing quality and safety b • ow nurses could be further engaged or effectively used to improve acute h care quality and safety Question 2: Technology Please describe any or all of the following: • ow innovative technologies have been used in acute care settings to h improve nurse-led patient care (include information on the measurement of the improvements) • arriers to the adoption and use of innovative technology in acute care b settings • pportunities in acute care settings for further improvements in the deliv- o ery of care through the use of technology

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301 APPENDIX A Question 3: Interdisciplinary Collaboration Please describe any or all of the following: • nnovations in acute care settings that have successfully advanced inter- i disciplinary collaboration or have been used to resolve limitations related to scope of practice • imitations to interdisciplinary collaboration in acute care settings l • ow interdisciplinary collaboration could be advanced to improve delivery h of acute care and what the role of nurses should be in advancing this collaboration Question 4: Additional Comments If you have additional thoughts about nursing in acute care settings or if you would like to share information on innovations or models of care that does not fit within the categories listed above, please use the space provided below. Question 5: Presentation of Testimony If you are interested in presenting your testimony in person at the forum on Oc- tober 19th in Los Angeles, please check the box below. (Please note that there are only a limited number of 2-minute slots available, and there is no funding available to cover travel expenses to the forum.)

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302 THE FUTURE OF NURSING BOX A-8 Testimony Questions for the Forum on the Future of Nursing: Care in the Community Question 1a: Community Health Please describe any or all of the following: • nnovative models or initiatives in community health settings in which nurses i have played a major role in the design, implementation, or evaluation (include information on improvement measures and outcomes) • arriers in community health settings that nurses face in providing services or b improving community health • uggestions for how nurses could be further engaged or effectively used to s improve care provided at the community level Question 1b: Presentation of Testimony on Community Health If you are interested in presenting your testimony on community health in person at the forum on December 3 in Philadelphia, please check the box below. (Please note that there are only a limited number of 2-minute slots available, and there is no funding available to cover travel expenses to the forum.) Question 2a: Public Health Please describe any or all of the following: • nnovative models or initiatives in public health in which nurses have played a i major role in the design, implementation, or evaluation (include information on improvement measures and outcomes) • arriers in public health that nurses face in providing services or improving the b health of the public • uggestions for how nurses could be further engaged or effectively used to s improve public health Question 2b: Presentation of Testimony on Public Health If you are interested in presenting your testimony on public health in person at the forum on December 3 in Philadelphia, please check the box below. (Please note that there are only a limited number of 2-minute slots available, and there is no funding available to cover travel expenses to the forum.) Question 3a: Primary Care Please describe any or all of the following: • nnovative models or initiatives in primary care settings in which nurses have i

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303 APPENDIX A played a major role in the design, implementation, or evaluation (include infor- mation on improvement measures and outcomes) • arriers in primary care settings that nurses face in providing services or improv- b ing health outcomes • uggestions for how nurses could be further engaged or effectively used to s improve primary care Question 3b: Presentation of Testimony on Primary Care If you are interested in presenting your testimony on primary care in person at the forum on December 3 in Philadelphia, please check the box below. (Please note that there are only a limited number of 2-minute slots available, and there is no funding available to cover travel expenses to the forum.) Question 4a: Long-Term Care Please describe any or all of the following: • nnovative models or initiatives in long term care settings in which nurses have i played a major role in the design, implementation, or evaluation (include infor- mation on improvement measures and outcomes) • arriers in long-term care settings that nurses face in providing services or b improving health outcomes • uggestions for how nurses could be further engaged or effectively used to s improve long-term care Question 4b: Presentation of Testimony on Long-Term Care If you are interested in presenting your testimony on long-term care in person at the forum on December 3 in Philadelphia, please check the box below. (Please note that there are only a limited number of 2-minute slots available, and there is no funding available to cover travel expenses to the forum.) Question 5a: Your Vision of the Future of Nursing Please describe your vision of the future of nursing across care settings. Your vision could include thoughts on the type of care nurses will provide, the types of settings they will be working in, how nurses will be educated and trained, how they will be paid and reimbursed, and some of the challenges nurses will be faced with. Question 5b: Additional Comments If you have additional thoughts about nursing in community health, public health, primary care, or long-term care settings or if you would like to share information on in- novations or models of care that does not fit within the categories listed above, please use the space provided below. You may also e-mail documents or articles to support your testimony to nursing@nas.edu.

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304 THE FUTURE OF NURSING BOX A-9 Testimony Questions for the Forum on the Future of Nursing: Education Question 1a: What We Should Teach What we should teach encompasses issues and recommendations related to the ideal future state of nursing curricula. Please describe any or all of the following: • nnovative models or initiatives within nursing curricula that are being employed i to better prepare and educate nurses for future challenges in a variety of care settings • nnovative funding strategies and financial incentives for both students and i institutions that could be used to advance what we should teach • arriers to implementing expanded or new curricula b • uggestions for how the nursing curricula should change to better meet the s future health needs of the population Question 1b: Presentation of Testimony on What We Should Teach If you are interested in presenting your testimony on what we should teach in person at the forum on February 22 in Houston, please check the box below. (Please note that there are only a limited number of 2-minute slots available, and there is no funding available to cover travel expenses to the forum.) Question 2a: How We Should Teach How we should teach encompasses issues and recommendations related to method- ologies and strategies, as well as partnerships or collaboratives, that should be used for educating and training nurses in an ideal future. Please describe any or all of the following: • nnovative models or initiatives in nursing education that are being employed to i advance the way in which nurses are educated and prepared • nnovative funding strategies and financial incentives for both students and i institutions that could be used to advance how we should teach • arriers to the implementation of innovative methodologies of education and b training for nurses. • uggestions for how current education methodologies can be advanced to better s meet the future health needs of the population

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30 APPENDIX A Question 2b: Presentation of Testimony on How We Should Teach If you are interested in presenting your testimony on how we should teach in person at the forum on February 22 in Houston, please check the box below. (Please note that there are only a limited number of 2-minute slots available, and there is no funding available to cover travel expenses to the forum.) Question 3a: Where We Should Teach Where we should teach encompasses issues and recommendations related to various venues and locations where nurses should be educated and trained, as well as partner- ships and collaboratives that could be used in nursing education in an ideal future. Please describe any or all of the following: • nnovative models or initiatives in nursing education that take advantage of a i variety of venues and locations for nursing education and training/continued education • nnovative funding strategies and financial incentives for both students and i institutions that could be used to advance where we should teach • arriers to expanding nursing education beyond traditional classroom settings b • uggestions for how current education can be expanded beyond traditional s classroom settings to better meet the future health needs of the population Question 3b: Presentation of Testimony on Where We Should Teach If you are interested in presenting your testimony on where we should teach in person at the forum on February 22 in Houston, please check the box below. (Please note that there are only a limited number of 2-minute slots available, and there is no funding available to cover travel expenses to the forum.) Question 4a: Your Vision of the Future of Nursing Please describe your vision of the future of nursing across care settings. Your vision could include thoughts on the type of care nurses will provide, the types of settings they will be working in, how nurses will be educated and trained, how they will be paid and reimbursed, and some of the challenges nurses will be faced with. Question 4b: Additional Comments If you have additional thoughts about the future of nursing education, or if you would like to share information on innovations or models of care that does not fit within the categories listed above, please use the space provided below. You may also e-mail documents or articles to support your testimony to nursing@nas.edu. However, please note that only the first 250 words submitted in each section of this online form will be considered for presentation of oral testimony at the Houston forum.

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