of the team and of nursing in particular. For example, HIT or other technological innovations may allow health care workers with less training to move into expanded roles with efficiency gains while maintaining quality, e.g., lab techs rather than nurses recording and monitoring biological responses to treatment changes; simultaneously these innovations may lead to improved care by moving clinicians into previously unmet clinical arenas, e.g., moving RNs into providing care management. In both instances these role redefinitions—lab techs moving into clinical lab monitoring from which nurses exit as they assume new roles in care management—change the roles and skills mix of health team members in significant ways.

This recommendation provides strategies to develop and evaluate a broad range of workforce configurations and assess their implications for health care workforce planning. Moreover, by shifting the focus from personnel shortages to skill shortage we invite a wider and more diverse array of policy options to meet the care delivery needs of the public with more effective skill-mix configurations.

Recommendation 3: Nursing education must become a full partner of health care system redesign through meaningful participation in redesign initiatives, and revamping its educational enterprise to meet the needs of redesigned service delivery.

Health care services redesign and the nursing education enterprise are not well aligned, as noted in highlights from the recent Carnegie Foundation study on nursing education:

A major finding from the study is that today’s nurses are undereducated for the demands of practice. Previous researchers worried about the education-practice gap; that is, the ability of practice settings to adopt and reflect what was being taught in academic institutions. Now, according to the authors, the tables are turned: nurse administrators worry about the practice-education gap, as it becomes harder for nursing education to keep pace with the rapid changes driven by research and new technologies. (Carnegie Foundation for the Advancement of Teaching, 2009)

Delivery system redesign initiatives included in health reform depend upon a set of skills and experiences that nursing education has yet to incorporate demonstrably into its pedagogy. Primary nursing education is still largely located in the acute care domain, with students mastering the care of the acute manifestations of chronic disease rather than care management of complex chronic illness. Care coordination and management are not integral to the classroom and clinical activities of nursing students, and yet it is a role that nurses can and have ably assumed in delivery settings where such skills will be increasingly demanded. Transitional care, which the evidence to date shows is a critical feature in pre-



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