The Future of Nursing in an Evolving Healthcare System

Subject: Nursing
Pages: 5
Words: 1230
Reading time:
5 min
Study level: College


Owing to its huge workforce and adaptive capability, the nursing profession has the capability to trigger far-reaching shifts in the health care system if stakeholders focus increased attention to the realities beneath the findings of a 2010 report detailing the future place of nursing in the United States (Institute of Medicine, 2010). The present paper purposes to discuss the “Future of Nursing” report including its development, key messages and recommendations, and also to investigate the role of a Texas-based action coalition and how it goes about progressing the goals of the “Future of Nursing: Campaign for Action.”

Background Information on RWJF and IOM

It is reported in the literature that, in 2008, the “Robert Wood Johnson Foundation” (RWJF) contacted the “Institute of Medicine” (IOM) to put forward a proposal that aimed at exploring and responding to the need to transform the nursing profession, particularly in accomplishing the pledge of a transformed healthcare system as well as satisfying the nation’s health-related needs (Institute of Medicine, 2010). The vision that led the RWJF to seek the two-year partnership with IOM was embedded in the attainment of a future transformed health care system that would have the capacity to not only make valuable care easily available to multicultural populations in the United States and deliberately enhance life quality and disease prevention but also dependably improve health outcomes and avail selfless, holistic care across the lifespan. The report titled “Future of Nursing: Leading Change, Advancing Health” is the culmination of the two-year partnership funded by the RWJF and prepared by an IOM committee, nationwide celebrated professionals from health-related domains and other disciplines, as well as nursing leaders from throughout the United States (Fights, 2011; Institute of Medicine, 2010).

Significance of the IOM’s “Future of Nursing” Report

The importance of the IOM report is substantially embedded in the key messages or recommendations developed by the RWJF-IOM initiative for an action-learning proposal for the needs of nursing into the future. In brief, the key messages or recommendations of the report are as follows: (1) nursing professionals should endeavor to practice to their fullest educational potential, training discourse, and licensure requirements, hence the need to remove the scope of practice barriers that include anticompetitive conduct in the healthcare market and absence of transition-to-practice residency programs, (2) nursing personnel should aim to realize advanced education and training through a rejuvenated education arrangement that facilitates flawless scholastic progression and lifelong learning, (3) nurses should act as full allies to physicians and other experts in the system, particularly in redesigning and implementing health care services throughout the country, and (4) effective healthcare workforce scheduling and policymaking oblige superior data gathering techniques and an enhanced information infrastructure, especially as it relates to the contribution of nurses in the care environment (Fights, 2011; Institute of Medicine, 2010).

Role of “State-Based Action Coalitions”

The “state-based action coalitions” that are characteristic of the nursing profession in the United States have a multiplicity of roles intended to highlight the profession in setting the nursing agenda and influencing policies. On most occasions, these coalitions are charged with the responsibility of not only educating legislators, the public, and other relevant agencies on the value of the nursing profession, but also reinforcing the need for a policy shift to address the current challenges facing the profession, and providing nurses with an environment for optimal care delivery (Eaton, 2012). A state-based action coalition, for example, may intend to address the nursing faculty deficiency by advocating for legislative procedures aimed at enhancing faculty remuneration and promoting nursing education; however, such a coalition must develop strong justifications for their actions or requests, with the view to shifting state-wide policy-making approach and providing an effective plan for the future success of the nursing profession.

The “Future of Nursing” report calls for more nurse involvement in the reform of health care systems in the United States through advocating for initiatives and strategies that will not only enhance the delivery of quality health care and increase workplace efficiency, but also guarantee the continuous professional development of nurses through education (Eaton, 2012). Consequently, it can be argued that the major rationale of the state-based action coalitions is predicated upon the facilitation of a coordinated, proactive and elaborate response by relevant stakeholders and policymakers to the scope of practice developments at the state level. Drawing from these expositions, it is clear that the “state-based action coalitions” progress the objectives of the “Future of Nursing: Campaign for Action” by not only acting as the engine behind designated operations at the local/state levels and developing a formidable, connected state-wide network of assorted parties working to transform healthcare through nursing, but also using the various advocacy and capacity building initiatives to ensure all citizens in the United States have access to a qualified nurse professional to address their needs (Eaton, 2012; Goeschel, 2011).

Moving on, the two initiatives spearheaded by “Texas Team Advancing Health through Nursing” (Texas Team AC) include urging for the compensation of “registered nurse first assistants” (RNFAs) by Medicare and corroborating with the Texas Healthcare Trustees (THT) to enhance nurse involvement on health care and community boards of directors. In November 2012, the Texas Team AC, which is a nonpartisan action coalition designed by the RWJF and the American Association of Retired Persons (AARP) to assume a leadership position in Texas in terms of executing the recommendations of IOM’s “Future of Nursing” report, highlighted the importance of reimbursing RNFAs by Medicare not only to allow for cost savings to the reimbursement authority but also to guarantee a competent first assistant is utilized in surgical settings for optimal care delivery (Association of periOperative Registered Nurses, 2012; Texas Team, 2012). In the initiative to enhance nurse involvement in health care and community boards of directors, it was expected that the two coalitions would partner to provide nursing professionals “with governance and leadership education in order for them to be even more valuable assets to both hospital and community boards” (Texas Healthcare Trustees, 2013 para. 1).

Consequently, it can be argued that the two initiatives advance the nursing profession in Texas by providing nurses with the financial capability to continue with their education and capacity to become better leaders in healthcare systems. Some of the barriers to nursing advancement prevailing in Texas, in my view, include lack of reimbursement of nurses by Medicare, existing constraints for physician supervision in nursing practice, limitations on the prescriptive ability for nurses, challenges for nursing graduates transitioning from educational institutions to practice, high levels of turnover among nurses, as well as an aging workforce. Available literature demonstrates that such challenges may be overcome by increasing nursing education and empowerment, advocating for extra resources, and triggering a paradigm shift in the prevailing policies to allow for expanded roles in nursing practice (Summers, 2011; Tanner, 2010).


The present paper has discussed pertinent issues relating to the “Future of Nursing” report and the role of the Texas-based action coalition (Texas Team AC) in ensuring the future of the nursing profession. Overall, it can be concluded that the future of the nursing practice and profession in the contemporary American health care system is embedded in the implementation of the IOC’s key messages or recommendations as discussed in this paper, as well as in providing nurses with avenues to advocate and negotiate better terms and efficient workplaces through state-based action coalitions for optimal delivery of care.


Association of periOperative Registered Nurses. (2012). IOM update: Texas action coalition urges reimbursement of RNFAs by Medicare. Web.

Eaton, M.K. (2012). Professional advocacy: Linking Virginia’s story to public policy-making theory, learning from the past and applying it to our future. Policy, Politics & Nursing Practice, 13(2), 105-112.

Fights, S.D. (2011). Future of nursing initiative: Nurses are key. MEDSURG Nursing, 20(2), 58-59.

Goeschel, C. (2011). The future of nursing: Leading change, advancing health stories to ignite the transformation. Nursing in Critical Care, 16(5), 217-219.

Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Web.

Summers, L. (2011). APRN focus. Advocacy at the state level: Why it’s important. American Nurse, 43(5), 9-9.

Tanner, C.A. (2010). Transforming prelicensure nursing education. Nursing Education Perspectives, 31(6), 347-353.

Texas Healthcare Trustees. (2013). New partnership for nurse leadership. Web.

Texas Team Advancing Health through Nursing – an Action Coalition. (2012). Web.