The Future of Nursing:
IOM’s Call to Action
Catherine Dower
San Diego, CA January 12, 2011
$ 11+
2
30+
½
4th-8th
17%
million
trillion
100,000/25,000/10,000
2700
million
#1
37/190
19/19
Explore with me
how APRN
Consensus
Model may fit in
context of . . .
IOM Report
PPACA
Inbox
IOM Report
Key Messages
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 care professionals, in redesigning health
care in the United States.
4. Effective workforce planning and policy making
require better data collection and an improved
information infrastructure.
Key Message #1.
Nurses should practice to the full
extent of their education and training.
–The variability of scope-of-practice regulations across
states may hinder advanced practice nurses from giving
care they were trained to provide and contributing to
innovative health care delivery solutions.
–Although some states have regulations that allow nurse
practitioners to see patients and prescribe medications
without a physician’s supervision, a majority of states do
not.
–The federal government is well suited to promote reform
of states’ scope-of-practice laws by sharing and providing
incentives for the adoption of best practices.
Scope of
practice laws
are statebased and
politically
driven…

… resulting in
state
variability
and
unnecessary
limitations on
practice.
Best example of poor match in US is NPs
No MD Involvement
11
No MD Involvement
except for Rx
20
MD Supervision &
collaboration
10
3
7
MD Supervision
MD Collaboration
Requirements for physiciannurse collaboration, 2010
NOTE: Collaboration refers to a mutually agreed upon relationship between nurse and physician.
SOURCE: AARP, 2010b. Courtesy of AARP. All rights reserved.
Exclusive scopes
of practice
exacerbate
interprofessional
tensions.
Several
states have
new ways to
help decide
scope issues.
California uses a waiver process to
test new scopes of practice
Source: Center for the Health Professions, UCSF 2010
Evidence pyramid gives guidance.
Metaanalyses
Controlled
trials
Demonstrations
Research studies
Government data, OIG reports
State laws & regulations
Educational curricula, accreditation standards
Survey articles, state studies
Expert opinion, opinion pieces, anecdotes
© 2008 UCSF Center for the Health Professions
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 actions for
the following entities:
 State Legislatures
 Congress
 Centers for Medicare and Medicaid Services
 Office of Personnel Management
 Federal Trade Commission and Antitrust Division of
the Department of Justice
Citizen Advocacy Center
2nd Quarter 2010
www.cacenter.org
Patient
Protection and
Affordable Care
Act
Coverage
Five ACA
categories
relate to our
work
Workforce
Financing
Pay for
quality
Innovations in
Care Delivery
Expand
Coverage
Workforce
Supply and
Demand
Financing:
Provider
payment
policies
A September 2010
Google search for
“Accountable Care
Organizations”
brings up 346,000
results
Tying
payment
to quality
Practitioner
Credentialing
• Patient-Centered
Medical/Health Homes
Innovative
Practice
Models
• Community Clinics
• Nurse-Managed
Health Clinics
• School-based clinics
• Sites using telehealth
New
models will
push
providers
and
consumers
to rethink
how and
where care
is delivered.
New
models will
encourage
shift from
acute and
specialty
care to…
•Management of
chronic conditions
•Primary care and
care coordination
•Prevention and
wellness
•Prevention of
adverse events
New models will push for
expanded scopes of practice
Inbox
2008 Percent GDP to Health Care
20%
16.2%
11.0%
10%
Costs
0%
US
EU Avg
US % Bankruptcies due to Medical Bills
70
60
50
40
30
20
10
0
2001
2007
Demographic
shifts
Technology
Consumers
400
360
300
200
Market
100
0
MD/100K
400
300
178
200
100
0
MD/100K
Baicker & Chandra, Health Affairs 2004
Three TakeAway Themes
INTEGRATION
ACCOUNTABILITY
CREATIVITY
Understanding
how the APRN
Consensus
Model fits into
current health
care context
provides
tremendous
opportunity.

 PPACA
 Inbox
IOM Report
Catherine Dower
UCSF Center for the Health
Professions
http://futurehealth.ucsf.edu
(415) 476-1894
cdower@thecenter.ucsf.edu