Abstract
In the autumn of 2010, The Institute of Medicine (IOM) released the landmark report, The Future of Nursing: Leading Change, Advancing Health (IOM, 2011). The work resulted from an initiative designed to transform nursing in light of the challenges presented by the Affordable Care Act of 2010, which is bringing broad change to health care in the United States. There were four key recommendations emerging from the work.
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 profession.
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 information infrastructure.
In December 2011, nursing editors were invited to participate in a telebriefing about The Future of Nursing: Campaign for Action that is funded by the Robert Wood Johnson Foundation ([RWJ] 2011). The reason for the meeting was to disseminate the Campaign for Action details to specialty partners in nursing and by tapping nursing journals, dissemination could be cast broadly. The focus of the campaign is designed to address practice, education, leadership, and workforce issues. I participated in the telebriefing and have been thinking about the message that I bring to school nurses. I am using the editorial to presents comments for each campaign focus and implications for school nursing.
Practice: The first recommendation is to remove the scope of practice barriers for nurses. The campaign issue is to allow nurses to practice to the full extent of their education. While school nurses may have limits on their scope of practice working in the nonhealth care settings, the focus primarily addresses limitations placed on nurse practitioners.
Education: The recommendations regarding education are very specific. Among them is the recommendation to institute nurse residency programs to facilitate transition to practice settings for nurses coming into practice from pre-licensure programs, advanced practice degrees, or going into a new clinical settings. There are some states that require school nurse certification programs including school nursing internships; however, many states do not require certification. With the fiscal fragility of education systems, what can school nursing do to advance the IOM challenge for residencies of nurses coming into the specialty?
The challenge from the Campaign for Action includes a goal of having 80% of nurses prepared with a bachelor of science in nursing (BSN) by 2020. Nursing leaders are charged with developing partnerships with accrediting bodies, funders, and employers to monitor progress so that the nursing workforce can meet the needs of the population. While the National Association of School Nurses (NASN) recognizes the BSN as the entry to practice degree, employers of school nurses remain constrained by misunderstanding the qualifications of fully credentialed nurses. A recent survey of NASN members showed an educated workforce with 83% of school nurses holding a bachelor’s degree or higher. The survey results also show that 46% held a BSN; and among those with a master’s degree, only 15% have the degree in nursing (Bergren & Monsalve, 2012). Another educational challenge emanating from the campaign is to double the number of nurses prepared at the doctoral level by 2020, to ensure an adequate pool of nursing faculty and researchers. The proposed partnerships among sectors, including the nursing professorate, NASN, and federal funding agencies, can help foster a focus on school health that will provide evidence for school nursing practice as the pool of nursing researchers expands. The campaign challenges nursing leaders to ensure that nurses engage in “lifelong learning.” While licensing requirements for registered nurses address continuing education to a point, the implication related to the IOM position is that the competent nurse must be continually engaged in learning environments to meet the changing needs of their client populations.
Leadership: The Campaign for Action promotes creation, identification, and expansion of opportunities for nurses to be prepared as leaders and to, in fact, fill leadership positions. The challenge to develop leadership in nursing is delivered to funders, health care organizations, nursing education programs, and nursing associations. Concurrently, nursing education programs and nursing associations are challenged to advance nurses as leaders by means of sound preparation at all levels as decision makers ensure availability of positions for nurses. Leadership in school nursing is important and on a national level is found in NASN and the National Association of State School Nurse Consultants (NASSNC). Locally, however, leadership may be tenuous. The doctorate of nursing practice (DNP) may well be the credential that could place school nurses on the same educational level as other leaders in the education community and content-wise prepare school nurses for leadership.
Workforce: The campaign reiterates the challenge that nurses engage in lifelong learning that is built into agency accreditation requirements, into schools of nursing, and through health care organizations. What about requirements in school districts that employ school nurses? Since 92% (67,801) of school nurses are employed by school districts (Health Resources and Services Administration [HRSA], 2010), how will nursing leaders collaborate with these non–health care employers to ensure the school nursing workforce is engaged in continuing education to use up-to-date evidence for practice? Finally, the IOM campaign recommends the establishment of an infrastructure that will collect and analyze workforce data. Explicit in the challenge is the inter-professional collaboration to have data across health care professions. Imagine the benefit of a network that is integrated with student health information across sectors: schools, primary care and specialty providers, and emergency departments?
What Does All This Mean for School Nursing?
My take away from the telebriefing and a read of the IOM Campaign for Action is that school nursing and other nursing specialties in the community may be at a disadvantage for accepting the challenge to advance their practice and meet the needs of the diverse American population. A disadvantage lies in the availability of financial support for education, be it degree advancement or continuing education. Across the country, many school nurses are deemed ineligible for nursing loan repayment and scholarships. The HRSA offers education loan repayment but has set priorities and eligibility requirements that exclude school nursing. Many states have identified an eligibility requirement of direct patient care for loan repayment related to baccalaureate education, thus excluding any nurse providing population-focused care. Master’s level education is not even considered for loan repayment, unless it is as a nurse practitioner program.
All is not lost, however. The Campaign for Action calls for nursing organizations to collaborate with funders, health care organizations, colleges of nursing, and decision makers to assure a nursing workforce that can respond to diverse health care needs. The NASN President, Linda Davis-Aldritt, has charged school nurses to use the IOM report and the Scope and Standards of Practice: School Nursing (2011) as “tools” for supporting their professional growth (Davis-Alldritt, 2012). I turn to NASN and the NASSNC to activate the connections to education systems, organizations of nursing specialties, funders of nursing research and education as well as colleges of nursing to advance school nursing and consequently the health of school children nationwide. With school nurses at the grassroots level and organizations representing school nurses joining forces, the message of the IOM/RWJ Campaign for Action can be carried forward.
References
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