In 2010, the Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) released a historic report, “The future of nursing: leading change, advancing health.” These two venerable institutions joined forces in 2008 in a 2-year initiative to make recommendations that would guide the transformation of nursing to advance health and lead change in the rapidly evolving healthcare environment. When examining the multiple issues surrounding healthcare in the United States, the professionals charged with this task asked who better to discuss caring than nursing. In fact, it was felt that improving health and healthcare for Americans could not be done without the nursing profession. The focused outcome was to be an initiative regarding the Future of Nursing. The committee developed four 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 professionals, in redesigning health care in the United States.
- • Effective workforce planning and policy making require better data collection and an improved information infrastructure.
These recommendations offer nurses parity in the workforce, support the need for advanced education and training, and assure a seat at the table to help redesign the health care system. The committee focused on conceptualizing the role of nurses within the context of the entire workforce, the nursing shortage, societal issues, and current and future technology. The assumptions of the IOM report include the fact that we are working within a radically shifting health environment with the implementation of health care reform and that nurses are the largest component of the healthcare workforce. The IOM asserts that “Accessible, high-quality care cannot be achieved without exceptional nursing care and leadership.” (IOM report, Foreward, p ix) and that “…nursing can fill such new and expanded roles in a redesigned healthcare system.” (Preface, p xi)
These are exciting times for nursing—a social mandate for nurses to have a significant role in transforming the healthcare system to ensure a healthier America. In order to meet the demands of the IOM report, the following is needed: expansion of nursing faculty, increase in the capacity of nursing schools, and redesign of nursing education to assure that it can produce an adequate number of well prepared nurses able to meet current and future health care demands. We must examine and create innovative solutions related to care delivery and health professional education by focusing on nursing and the delivery of nursing services; and attract and retain well prepared nurses in multiple care settings, including acute, ambulatory, primary care, long term care, community and public health.
Key recommendations from the committee include the need to:
- • Remove scope of practice barriers.
- • Expand opportunities for nurses to lead and diffuse collaborative improvements.
- • Implement nurse residency programs.
- • Increase nurses with the BSN to 80% by 2020.
- • Double the number of nurses with doctorates by 2020.
- • Ensure that nurses engage in lifelong learning.
- • Prepare and enable nurses to lead change and advance health.
- • Collect and analyze workforce data in order to plan for the future.
How does this impact forensic nursing practice? Most importantly, forensic nurses must be prepared to practice to the full extent of their education and training. In this expanding and complex healthcare system where violence is an every day reality, attention to violence must be addressed at all levels, from entry to practice through advanced practice.
- • First, we are asking that the International Association of Forensic Nursing (IAFN) sign on along with other major nursing organizations to endorse this report.
- • We are also asking that the recommendations from the report be tied to elements of our strategic plan so that the membership has the necessary resources to initiate and sustain change.
IAFN was founded by nurses who recognized the lack of appropriate services for victims of sexual assault and wanted to develop programs that would educate nurses as to how to provide the best care possible for victims of sexual assault. However, the field has expanded to include the care of all victims of violence as well as perpetrators. This expansion of the forensic nursing role challenges us to step up to the practice requirements that include the assessment and treatment of all victims and perpetrators of violence. Advancement of the professional obliges us to ask “How exactly will we best meet these demands?”. Exceptional work by groundbreaking forensic nurse clinicians and researchers has provided evidence that our specialty is uniquely equipped to do just that. However, if we fail to explicitly demonstrate how forensic nursing will provide this care as a key element of the future of nursing, then someone else will fill the void.
In order for forensic nurses to responsibly take the lead in developing this broader role we must acknowledge the need to establish educational standards and to clearly define our standards of practice within the framework of the larger healthcare community. Nurses must achieve higher levels of education and training through improved educational infrastructures that promote seamless academic progression. Forensic nurses who have already achieved advanced practice education and are established in practice must serve as role models for new forensic nurses. They must encourage colleagues to enhance their education as BSN, Masters and doctoral prepared nurses, and support them in roles that contribute to their ability to participate in research initiatives. In order to achieve recognition as experts in this important new practice area we must be prepared at the highest levels of education possible.
It is clear that we must continue to develop credible and defensible evidence-based standards on which to base our practice. Many forensic nurses have acquired a wealth of knowledge and experience, but often other healthcare professionals overlook that expertise. For example, what do we do with the vast amounts of information and data that is collected on a daily basis in the care of patients? Advanced education can prepare nurses to collect and analyze this data, situate it in the context of existing science, and to establish evidence-based practice standards. They could then disseminate their findings to the broader forensic community and beyond. These well-trained forensic nurses will be valued as full partners, with physicians and other health professionals, in redesigning health care in the United States.
The IAFN must go on record as supporting the new IOM report. As part of our shared commitment to the patients we serve, we absolutely must take responsibility for the future of forensic nursing. Most importantly, this means we must assume leadership roles in education and in health care organizations where we can successfully turn our strategic vision into reality.