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Interim Dean Pam Mitchell on the Future of Nursing

June 26, 2013

In the last of my messages as Dean, I want to reflect on our activity regarding the “Future of Nursing” report and will welcome your comments about it.

Pam Mitchell OfficePam Mitchell OfficeIn October 2010, the Institute of Medicine put forth the report The Future of Nursing: Leading Change, Advancing Health (http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx). Subsequently there was much activity nationwide -- symposia and talks and a number of initiatives both large and small to implement many of the recommendations.  Here at the UWSON we spotlighted the report and its Director Sue Hassmiller in January 2011 at a panel, webinar and faculty discussions.  These were co-hosted by major nursing organizations in our State: Council on Nursing Education in Washington State (CNEWS), Northwest Organization of Nurse Executives (NWONE), Nursing Care Quality Assurance Commission (NCQAC) , Washington Center for Nursing (WCN).   

Much activity has occurred since then both locally and in the state.  This message is an opportunity to reflect on how UWSON faculty, students and alumni have been participating in the four areas of recommendation:

1) Nurses should practice to the full extent of their education and training;

 2)Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression;

3) Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States;

 4) Effective workforce planning and policy making require better data collection and information infrastructure.

We are fortunate that Washington is one of the 13 states where both basic and advanced practice nurses are able to practice to the full extent of their education and training.  Thanks to farsighted and politically astute nurse practitioner pioneers we achieved independent practice for advanced practice nurses through amendments to our nurse practice act in the early 1990’s.  I remember the regular treks to Olympia to testify on behalf of a full scope of practice for nurse practitioners and other advanced practice nurses.

Those efforts put us in a position where nursing in general and the UWSON in particular can contribute a great deal to the workforce needed to implement the Affordable Care Act and the expansion of Medicaid in the State of Washington. We are indeed working with our physician and other health professions colleagues to achieve a more functional health care system in Washington State. 

In anticipation of the 2014 full implementation of the Affordable Care Act, there has been much concern nationwide about the availability of primary care health care personnel, particularly physicians.  The American Association of Medical Colleges has estimated a shortage of 150,000 doctors in the next 15 years, as widely quoted in the Wall Street Journal (April 12, 2010), Seattle Times (July 28, 2012) and New York Times (July 29, 2012) have had full length articles about the gap between numbers needed and available of primary care MDs in 2015 and beyond. Most recently, the President of the Washington State Medical Association (WSMA) worried that we do not have enough physicians to care for the expansion of Medicaid in our state (Seattle Times, February 18, 2013).  Indeed there is an existing and growing shortage of physicians practicing primary care.  But we also know that there is a workforce beyond MDs who are capable of and licensed to provide primary care – that workforce consists of nurse practitioners.  Nurse practitioners in retail clinics, private practice and in group practices are already providing additional access to care for the insured and uninsured alike. 

The Washington Center for Nursing’s report on registered nurse supply and demand projections 2011-2031 (http://www.wacenterfornursing.org/uploads/file/data-reports/2011-Dec-WA-...) estimates that in the short-term (up to 2016) the demand and supply for registered nurses is in equilibrium, with the demand exceeding the supply thereafter due to retirements and constrained capacity of nursing education programs.  Roughly 4000 of the current nurses licensed in Washington State are advanced registered nurse practitioners (ARNP), who are prepared to help fill the gap in primary care. Nationwide, nurse practitioners and physician assistants are more likely to be practicing in rural or remote areas than are other types of primary care physicians. Further, nurse practitioner students who plan to enter primary care are graduating a much higher rate than are medical students with a primary care focus, according to the Robert Wood Johnson Foundation (Charting Nursing’s Future, July 2012) 

At UWSON we have ramped up our programs for advanced practice nurses, graduating over 600 with MN and Doctor of Nursing Practice (DNP) degrees over the past five years.  Our recent revision of the DNP curriculum promises to increase efficiency and create a more seamless progression of education for post-baccalaureate entry to advanced practice.  Further, we are collaborating with the other Health Science schools to provide interprofessional education and training for teamwork and team-based care.  The provisions of the Accountable Care Act allow experimentation with team-based care, bundled payments and the like that provide an opportunity in Washington State to work together across the health professions to solve the problems of access, cost and quality as we expand services to many formerly uninsured people. Nurse practitioners, physician assistants and physicians will probably not be able independently to fill the gap between supply and demand for primary care providers if we continue to operate independently and in a fee for service environment.  Our work together as health science practitioners and investigators holds much promise for the future of health care in Washington State, and as a model for the nation.