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The Future of Nursing

  1. Read the synopsis of the IOM Report, “The Future of Nursing” at

    What does this report do for the image of nursing?
  2. Access the following websites to examine the image of nursing as it is being
    portrayed by pro-fessional organizations in the media
    How is nursing viewed? Do you think that the strategy behind these websites
    promotes a positive image for nursing?
  3. Go to the website of the American Assembly of Men in Nursing .
    How does this website portray nursing? Compare and Contrast with the ANA or
    Sigma Website
  4. How does the above websites compare to the media’s portrayal of nursing in
    shows such as Scrubs, ER, Nurse Jackie, Grey’s Anatomy, Chicago MD, Code Black or
    � Are Nurses as Characters on television and or in movies portrayed to have
    professional competence? (cite examples)
    � Identify what television show and Nurse you are examining?
    � If other health care providers are included in the program what differences are
    seen in their personality traits as compared with the nurse character? See page 43 (Black,
  5. What can you do as a nursing student to promote a positive image for nursing?
    (refer to the literature)


The image of the nursing profession is viewed in different ways by different people,
groups or organizations. The image of nursing changes and evolves with time. The IOM report
gives a crucial analysis about the nursing profession. The report helps create the image of

nursing as an autonomous, evolving and intellectual profession that requires focus and high level
of commitment. Through the report, they enhance the perception that nursing is a top profession
and important in nature thus they help promote it. Through the IOM challenges faced by the
nurses are identified where recommendations are made to rebrand and shape the image of
nursing and their future for the better (Vallina, 2012). The report also helps identify and promote
nursing as the diversified profession by emphasizing on the need of recruiting men into the
workforce. In accordance to ANA, Nursing is viewed as a dynamic profession with standards of
practice and a well-established code of ethics. Nurses are recognized for expertise in various
areas of clinical specialty. ANA views the images of nurses as caring and competent people with
quality academic credentials.
The patient promise website views nurses as vital role models who shape the perspectives
of others, especially in a work environment. The nurses are thus required to ensure they fulfill
their promise of leadership to others. The Sigma website view nursing as a promising profession
thus encourages people to join the profession since the career offers many opportunities. These
sites have effectively helped in the promotion of a positive nursing image. These websites and
broadcast media are used by organizations to explain the many good opportunities found in the
nursing career. The websites have also branded nursing as a diversified profession and
effectively raised the visibility of nurses of different roles, gender or ethnic background (Vallina,
2012). The promotional materials for the public as advocated by the websites have efficiently
created a positive image for nursing.
The American Assembly for Men in Nursing views the nursing profession as a female
dominated field where the men are faced with barriers hindering them from pursuing the career.
The male nurse is faced by the misperception that identifies nursing as not appropriate for them.

The nursing field is portrayed as consisting of under presentations and lack of diversity. The
AAMN compares with the ANA website since both advocate for the diversity of the nursing
field and eliminating the perception that one gender should dominate it (Vallina, 2012). Both
sites are working towards shaping the image of nursing positively. AMMN has concentrated on
the recruitment of men and diversifies nursing regarding gender thus contrasting with ANA and
Sigma which considers all factors affecting diversity such as age, race, and gender.
There is a huge difference between the way the nursing profession is portrayed in the
shows and the media. The television shows have overshadowed the nursing profession creating a
negative perception to the viewers. While the websites have promoted a positive perception, the
shows have undermined the profession and misrepresented it. The websites portray nurses as
vital to the success of health organizations while the shows brand them as invisible to the extent
that physicians are performing their roles. One of the characters known as Nurse Olivia in Grey’s
Anatomy TV show does not professional competencies of nurses. The character concentrates on
STDs and lover affairs which creates a negative perception that nursing is based on sex scandals.
The weakened authority of nurses is created and the importance of the profession undercut. The
inclusion of another health care providers would lead to an improvement in the performance of
tasks and creation of a better perception. Another healthcare provider to fit in the place of the
character would ensure the ethical standards and regulations are adhered to thus not portraying
the profession as full of unethical people not concentrating on the improvement of patient’s
health (Vallina, 2012). The healthcare provider would also ensure better presentation of the
profession rather than represent nurses as people concentrating on the unnecessary thing while at

There are various ways that I can use to help in the promotion of nursing image as a
nursing student. Involvement in the forums that allow for personal interactions with the public
would help in advocacy of nursing as a profession thus creating a positive image. Such initiatives
would help educate people about the profession eliminating misconceptions. Effective
communication and positive appearance while participating in public community activities
creates a professional image of nursing. Exhibiting good practices and been a good example
creates a positive image. Ina nutshell, all nurses should ensure they adhere to recommended
practices to promote the positive image of the nursing profession.


Vallina, J. (2012). Teaching IOM’s new edition released with companion student volume.
American Nurse, 44(4), 14.

The Future of Nursing
Leading Change, Advancing Health

Advising the nation/Improving health
For more information visit
Report Recommendations

Report Recommendations 1
Key Messages
• Nurses should practice to the full extent of their education and training.
• Nurses should achieve higher levels of education and training through an
improved education system that promotes seamless academic progression.
• Nurses should be full partners, with physicians and other health care professionals,
in redesigning health care in the United States.
• Effective workforce planning and policy making require better data collection
and an improved information infrastructure.


Recommendation 1: Remove scope-of-practice barriers. Advanced practice registered
nurses should be able to practice to the full extent of their education and training. To achieve this goal,
the committee recommends the following actions.
For the Congress:
• Expand the Medicare program to include coverage of advanced practice registered nurse
services that are within the scope of practice under applicable state law, just as physician
services are now covered.
• Amend the Medicare program to authorize advanced practice registered nurses to perform
admission assessments, as well as certification of patients for home health care services and
for admission to hospice and skilled nursing facilities.
• Extend the increase in Medicaid reimbursement rates for primary care physicians included
in the ACA to advanced practice registered nurses providing similar primary care services.
• Limit federal funding for nursing education programs to only those programs in states that
have adopted the National Council of State Boards of Nursing Model Nursing Practice Act
and Model Nursing Administrative Rules (Article XVIII, Chapter 18).
For state legislatures:
• Reform scope-of-practice regulations to conform to the National Council of State Boards
of Nursing Model Nursing Practice Act and Model Nursing Administrative Rules (Article
XVIII, Chapter 18).

• Require third-party payers that participate in fee-for-service payment arrangements to pro-
vide direct reimbursement to advanced practice registered nurses who are practicing within

their scope of practice under state law.

2 The Future of Nursing
For the Centers for Medicare and Medicaid Services:
• Amend or clarify the requirements for hospital participation in the Medicare program to
ensure that advanced practice registered nurses are eligible for clinical privileges, admitting
privileges, and membership on medical staff.
For the Office of Personnel Management:
• Require insurers participating in the Federal Employees Health Benefits Program to include
coverage of those services of advanced practice registered nurses that are within their scope
of practice under applicable state law.
For the Federal Trade Commission and the Antitrust Division of the Department of Justice:
• Review existing and proposed state regulations concerning advanced practice registered
nurses to identify those that have anticompetitive effects without contributing to the health
and safety of the public. States with unduly restrictive regulations should be urged to amend

them to allow advanced practice registered nurses to provide care to patients in all circum-
stances in which they are qualified to do so.

Recommendation 2: Expand opportunities for nurses to lead and diffuse collabora-
tive improvement efforts. Private and public funders, health care organizations, nursing educa-
tion programs, and nursing associations should expand opportunities for nurses to lead and manage

collaborative efforts with physicians and other members of the health care team to conduct research
and to redesign and improve practice environments and health systems. These entities should also
provide opportunities for nurses to diffuse successful practices.
To this end:
• The Center for Medicare and Medicaid Innovation should support the development and

evaluation of models of payment and care delivery that use nurses in an expanded and lead-
ership capacity to improve health outcomes and reduce costs. Performance measures should

be developed and implemented expeditiously where best practices are evident to reflect the
contributions of nurses and ensure better-quality care.
• Private and public funders should collaborate, and when possible pool funds, to advance
research on models of care and innovative solutions, including technology, that will enable
nurses to contribute to improved health and health care.
• Health care organizations should support and help nurses in taking the lead in developing
and adopting innovative, patient-centered care models.
• Health care organizations should engage nurses and other front-line staff to work with
developers and manufacturers in the design, development, purchase, implementation, and
evaluation of medical and health devices and health information technology products.

Report Recommendations 3

• Nursing education programs and nursing associations should provide entrepreneurial pro-
fessional development that will enable nurses to initiate programs and businesses that will

contribute to improved health and health care.

Recommendation 3: Implement nurse residency programs. State boards of nursing,

accrediting bodies, the federal government, and health care organizations should take actions to sup-
port nurses’ completion of a transition-to-practice program (nurse residency) after they have com-
pleted a prelicensure or advanced practice degree program or when they are transitioning into new

clinical practice areas.
The following actions should be taken to implement and support nurse residency programs:

• State boards of nursing, in collaboration with accrediting bodies such as the Joint Commis-
sion and the Community Health Accreditation Program, should support nurses’ completion

of a residency program after they have completed a prelicensure or advanced practice degree
program or when they are transitioning into new clinical practice areas.
• The Secretary of Health and Human Services should redirect all graduate medical education
funding from diploma nursing programs to support the implementation of nurse residency
programs in rural and critical access areas.
• Health care organizations, the Health Resources and Services Administration and Centers

for Medicare and Medicaid Services, and philanthropic organizations should fund the devel-
opment and implementation of nurse residency programs across all practice settings.

• Health care organizations that offer nurse residency programs and foundations should evalu-
ate the effectiveness of the residency programs in improving the retention of nurses, expand-
ing competencies, and improving patient outcomes.

Recommendation 4: Increase the proportion of nurses with a baccalaureate degree
to 80 percent by 2020. Academic nurse leaders across all schools of nursing should work together
to increase the proportion of nurses with a baccalaureate degree from 50 to 80 percent by 2020. These
leaders should partner with education accrediting bodies, private and public funders, and employers to
ensure funding, monitor progress, and increase the diversity of students to create a workforce prepared
to meet the demands of diverse populations across the lifespan.
• The Commission on Collegiate Nursing Education, working in collaboration with the
National League for Nursing Accrediting Commission, should require all nursing schools to
offer defined academic pathways, beyond articulation agreements, that promote seamless
access for nurses to higher levels of education.
• Health care organizations should encourage nurses with associate’s and diploma degrees to

enter baccalaureate nursing programs within 5 years of graduation by offering tuition reim-
bursement, creating a culture that fosters continuing education, and providing a salary dif-
ferential and promotion.

4 The Future of Nursing

• Private and public funders should collaborate, and when possible pool funds, to expand bac-
calaureate programs to enroll more students by offering scholarships and loan forgiveness,

hiring more faculty, expanding clinical instruction through new clinical partnerships, and

using technology to augment instruction. These efforts should take into consideration strate-
gies to increase the diversity of the nursing workforce in terms of race/ethnicity, gender, and

geographic distribution.
• The U.S. Secretary of Education, other federal agencies including the Health Resources and
Services Administration, and state and private funders should expand loans and grants for
second-degree nursing students.
• Schools of nursing, in collaboration with other health professional schools, should design

and implement early and continuous interprofessional collaboration through joint class-
room and clinical training opportunities.

• Academic nurse leaders should partner with health care organizations, leaders from primary
and secondary school systems, and other community organizations to recruit and advance
diverse nursing students.

Recommendation 5: Double the number of nurses with a doctorate by 2020. Schools
of nursing, with support from private and public funders, academic administrators and university
trustees, and accrediting bodies, should double the number of nurses with a doctorate by 2020 to add
to the cadre of nurse faculty and researchers, with attention to increasing diversity.
• The Commission on Collegiate Nursing Education and the National League for Nursing
Accrediting Commission should monitor the progress of each accredited nursing school to
ensure that at least 10 percent of all baccalaureate graduates matriculate into a master’s or
doctoral program within 5 years of graduation.
• Private and public funders, including the Health Resources and Services Administration and
the Department of Labor, should expand funding for programs offering accelerated graduate
degrees for nurses to increase the production of master’s and doctoral nurse graduates and
to increase the diversity of nurse faculty and researchers.
• Academic administrators and university trustees should create salary and benefit packages
that are market competitive to recruit and retain highly qualified academic and clinical nurse

Report Recommendations 5

Recommendation 6: Ensure that nurses engage in lifelong learning. Accrediting bod-
ies, schools of nursing, health care organizations, and continuing competency educators from multiple

health professions should collaborate to ensure that nurses and nursing students and faculty continue
their education and engage in lifelong learning to gain the competencies needed to provide care for
diverse populations across the lifespan.

• Faculty should partner with health care organizations to develop and prioritize competen-
cies so curricula can be updated regularly to ensure that graduates at all levels are prepared

to meet the current and future health needs of the population.
• The Commission on Collegiate Nursing Education and the National League for Nursing

Accrediting Commission should require that all nursing students demonstrate a compre-
hensive set of clinical performance competencies that encompass the knowledge and skills

needed to provide care across settings and the lifespan.

• Academic administrators should require all faculty to participate in continuing profes-
sional development and to perform with cutting-edge competence in practice, teaching, and


• All health care organizations and schools of nursing should foster a culture of lifelong learn-
ing and provide resources for interprofessional continuing competency programs.

• Health care organizations and other organizations that offer continuing competency pro-
grams should regularly evaluate their programs for adaptability, flexibility, accessibility, and

impact on clinical outcomes and update the programs accordingly.

Recommendation 7: Prepare and enable nurses to lead change to advance health.
Nurses, nursing education programs, and nursing associations should prepare the nursing workforce
to assume leadership positions across all levels, while public, private, and governmental health care
decision makers should ensure that leadership positions are available to and filled by nurses.
• Nurses should take responsibility for their personal and professional growth by continuing
their education and seeking opportunities to develop and exercise their leadership skills.
• Nursing associations should provide leadership development, mentoring programs, and
opportunities to lead for all their members.
• Nursing education programs should integrate leadership theory and business practices
across the curriculum, including clinical practice.
• Public, private, and governmental health care decision makers at every level should include
representation from nursing on boards, on executive management teams, and in other key
leadership positions.

6 The Future of Nursing

Recommendation 8: Build an infrastructure for the collection and analysis of inter-
professional health care workforce data. The National Health Care Workforce Commission,

with oversight from the Government Accountability Office and the Health Resources and Services
Administration, should lead a collaborative effort to improve research and the collection and analysis
of data on health care workforce requirements. The Workforce Commission and the Health Resources
and Services Administration should collaborate with state licensing boards, state nursing workforce
centers, and the Department of Labor in this effort to ensure that the data are timely and publicly
• The Workforce Commission and the Health Resources and Services Administration should
coordinate with state licensing boards, including those for nursing, medicine, dentistry, and
pharmacy, to develop and promulgate a standardized minimum data set across states and

professions that can be used to assess health care workforce needs by demographics, num-
bers, skill mix, and geographic distribution.

• The Workforce Commission and the Health Resources and Services Administration should
set standards for the collection of the minimum data set by state licensing boards; oversee,
coordinate, and house the data; and make the data publicly accessible.
• The Workforce Commission and the Health Resources and Services Administration should
retain, but bolster, the Health Resources and Services Administration’s registered nurse
sample survey by increasing the sample size, fielding the survey every other year, expanding
the data collected on advanced practice registered nurses, and releasing survey results more
• The Workforce Commission and the Health Resources and Services Administration should
establish a monitoring system that uses the most current analytic approaches and data from

the minimum data set to systematically measure and project nursing workforce require-
ments by role, skill mix, region, and demographics.

• The Workforce Commission and the Health Resources and Services Administration should

coordinate workforce research efforts with the Department of Labor, state and regional edu-
cators, employers, and state nursing workforce centers to identify regional health care work-
force needs, and establish regional targets and plans for appropriately increasing the supply

of health professionals.

• The Government Accountability Office should ensure that the Workforce Commission mem-
bership includes adequate nursing expertise.

Committee list 7
Committee on the Robert Wood Johnson Foundation Initiative on
the Future of Nursing, at the Institute of Medicine

Donna E. Shalala (Chair)
President, University of Miami, Coral Gables, FL
Linda Burnes Bolton (Vice Chair)
Vice President and Chief Nursing Officer, Cedars-Sinai Health System and Research Institute, Los
Angeles, CA
Michael R. Bleich

Dean and Dr. Carol A. Lindeman Distinguished Professor, Vice Provost for Inter-professional Edu-
cation and Development, Oregon Health & Science University School of Nursing, Portland

Troyen A. Brennan
Executive Vice President, Chief Medical Officer, CVS Caremark, Woonsocket, RI
Robert E. Campbell
Vice Chairman (retired), Johnson & Johnson, New Brunswick, NJ
Leah Devlin
Professor of the Practice, University of North Carolina at Chapel Hill School of Public Health,
Catherine Dower
Associate Director of Research, Center for the Health Professions, University of California, San
Rosa Gonzalez-Guarda
Assistant Professor, School of Nursing and Health Studies, University of Miami, Coral Gables, FL
David C. Goodman
Professor of Pediatrics and of Health Policy, and Director, Center for Health Policy Research, The
Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
Jennie Chin Hansen
Chief Executive Officer, American Geriatrics Society, New York
C. Martin Harris
Chief Information Officer, Cleveland Clinic, OH

8 The Future of Nursing
Anjli Aurora Hinman
Certified Nurse-Midwife, Intown Midwifery, Atlanta, GA
William D. Novelli
Distinguished Professor, McDonough School of Business, Georgetown University, Washington,
Liana Orsolini-Hain
Nursing Instructor, City College of San Francisco, CA
Yolanda Partida
Director, National Center, Hablamos Juntos, and Assistant Adjunct Professor, Center for Medical
Education and Research, University of California, San Francisco, Fresno
Robert D. Reischauer
President, The Urban Institute, Washington, DC
John W. Rowe
Professor, Mailman School of Public Health, Department of Health Policy and Management,
Columbia University, New York
Bruce C. Vladeck
Senior Advisor, Nexera Consulting, New York

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