The Future of Nursing 2020–2030: Charting a path to achieve health equity

•The National Academy of Medicine report, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity calls for a series of policy reforms to unleash the potential of nurses to play greater roles in advancing health equity. •The report recommends that the systems that educate, pay and employ nurses: 1) permanently remove barriers to care; 2) value their contributions; 3) prepare nurses to tackle health equity; and 4) diversify the workforce. The need to fully support nurses is interwoven throughout the report. •All nurses should work in partnership with others to advance the nine major report recommendations. The National Academy of Medicine's long-anticipated report, The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity, offers an aspirational vision: the achievement of health equity in the United States built on strengthened nursing capacity, diversity, and expertise (Wakefield, 2021Wakefield M. Federally qualified health centers and related primary care workforce issues. Jama. 2021; 325: 1145-1146Crossref PubMed Scopus (10) Google Scholar). Released in May 2021, the report arrives at a critical moment for the profession. Many nurses are burned out, exhausted, and have experienced moral injury from caring for an unrelenting stream of patients with COVID-19. The pandemic has laid bare and further exacerbated long-existing health inequities. School closings during the pandemic similarly exacerbated educational disparities, and poor treatment of Black, Indigenous, and other people of color by police spotlighted inequities in law enforcement. Collectively, these inequities have resulted in renewed calls to dismantle structural, cultural, and interpersonal racism, including within nursing. This new report provides a roadmap for how the nursing profession can contribute its expertise to create a fairer, more just and healthier world. The report is the second collaboration between the Robert Wood Johnson Foundation (RWJF) and the National Academy of Medicine (NAM) on the future of nursing. The first report, released in 2010, re-conceptualized the role of nurses in transforming the healthcare system (Shalala et al. , 2011Shalala D. Bolton L. B. Bleich M. R. Brennan T. Campbell R. Devlin L. The future of nursing: Leading change, advancing health. 10. The National Academy Press, Washington DC2011: 12956https: //www. nap. edu/catalog/12956/the-future-of-nursing-leading-change-advancing-healthGoogle Scholar). RWJF and AARP formed The Future of Nursing: Campaign for Action, a nationwide initiative to advance the report recommendations. Over the past decade, the nursing field strengthened nursing education, advanced practice, promoted leadership, and increased workforce diversity. In doing so, the nursing field has built – and is continuing to build – its capacity to provide high-quality care to more Americans. As nursing built its capacity and as the evidence increasingly linked inequities to poorer health status, it became clear that nurses could do more to build healthier communities and advance equity. Nurses are the most trusted profession and the first point of contact for most people seeking health care. They are bridge builders and collaborators who engage and connect with people, communities, and organizations to promote health and well-being (Pittman, 2019Pittman, P. (2019,. March 12). Activating nursing to address the unmet needs of the 21st century: Background paper for the NAM Committee on Nursing 2030. Robert Wood Johnson Foundation. Available at: https: //publichealth. gwu. edu/sites/default/files/downloads/HPM/Activating%20Nursing %20To%20Address%20Unmet%20Needs%20In%20The %2021st%20Century. pdfGoogle Scholar). Their expertise could be better used to combat the many shortcomings of the U. S. health system. The United States spends 3. 5 trillion each year on health care (CMS, 2020) more than any other country in the world but ranks last compared with other high-income countries on equity, access to care, health care outcomes, and administrative efficiency (Schneider et al. , 2021Schneider, E. et al. , (2021, August) ) Mirror, Mirror 2021 — Reflecting Poorly: Health Care in the U. S. compared to other high-income countries (Commonwealth Fund). https: //doi. org/10. 26099/01dv-h208. Google Scholar). Life expectancy, infant mortality and maternal mortality are worse in the United States compared with other high-income nations. Disparities in health care access and outcomes related to race, income, geography and other social and environmental factors are also common. RWJF has long believed that nurses have enormous potential for tackling the shortcomings of health and health care in the United States and in 2019 asked the NAM to form a committee tasked with charting a path for the nursing profession to create a culture of health, reduce health disparities, and improve the health and well-being of the nation. As the committee was well into the process of reviewing evidence and preparing to write the report, the pandemic took hold across the country and shined a light on the nation's rampant health inequities. The committee delayed the report to incorporate the major lessons from the pandemic: its disproportionate and devastating toll on poor and marginalized populations that could largely be attributed to persistent health disparities; the need to fully support nurses; and better prepare the workforce for future disasters. Released in May 2021, the report called for a series of policy reforms to unleash the potential of nurses to play greater roles in advancing health equity. The report recommends that the systems that educate, pay, and employ nurses: (1) permanently remove barriers to care; (2) value their contributions; (3) prepare nurses to tackle health equity; and (4) diversify the workforce. The report underscores that prioritizing nurse well-being is paramount to advancing the recommendations. In addition, the report calls on national nursing organizations to develop a shared agenda for addressing the social determinants of health and achieving health equity. Finally, the committee prioritized research needs to build the evidence base to support nurses in advancing health equity. Each of these areas is discussed below. Far too often in the United States, people do not see a health care provider when they need one. Nearly 30 million people are uninsured in the United States, and roughly 40 million have health plans that leave them potentially underinsured (Collins et al. , August 2020Collins, Sara R. , Gunja, Munira Z. , geographic inaccessibility to services and providers, particularly in rural and underserved urban areas; lack of health literacy; and fundamental mistrust of the health care system and providers. Research demonstrates that delays in obtaining care can lead people to experience worse symptoms and disease progression (Man et al. , 2018Man R. X. G. Lack D. A. Wyatt C. E. Murray V. The effect of natural disasters on cancer care: A systematic review. The Lancet Oncology. 2018; 19: e482-e499https: //doi. org/10. 1016/S1470-2045 (18) 30412-1Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar). Nurses can help to explicitly address these gaps in access to care. For example, about 70% to 80% of advanced-practice nurses work in primary care, including in pediatrics, adult practice, gerontology, and nurse midwifery. While the primary care nurse practitioner field has grown, the number of physicians entering primary care has stagnated or declined (Barnes et al. , 2018Barnes H. Richards M. R. McHugh M. D. Martsolf G. Rural and nonrural primary care physician practices increasingly rely on nurse practitioners. Health Affairs. 2018; 37: 908-914https: //doi. org/10. 1377/hlthaff. 2017. 1158Crossref PubMed Scopus (127) Google Scholar; Barnes et al. , 2018Xue Y. Ye Y. Brewer C. Spetz J. Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review. Nursing outlook. 2016; 64: 71-85https: //doi. org/10. 1377/hlthaff. 2017. 1158Crossref PubMed Scopus (117) Google Scholar). Care provided by nurse practitioners has been found to be comparable to the care provided by physicians, according to numerous studies (Perloff et al. , 2019Perloff J. Clarke S. DesRoches C. M. O'Reilly-Jacob M. Buerhaus P. Association of state-level restrictions in nurse practitioner scope of practice with the quality of primary care provided to Medicare beneficiaries. Medical Care Research and Review. 2019; 76: 597-626Crossref PubMed Scopus (24) Google Scholar; Yang et al. , 2020Yang B. K. Johantgen M. E. Trinkoff A. M. Idzik S. R. Wince J. Tomlinson C. State Nurse Practitioner practice regulations and US health care delivery outcomes: A systematic review. Medical Care Research and Review. 2021; 78: 183-196https: //doi. org/10. 1177/1077558719901216Crossref PubMed Scopus (32) Google Scholar). They are less expensive to employ than physicians and are more likely to care for vulnerable populations, including those in rural areas (Perloff et al. , 2016Perloff J. DesRoches C. M. Buerhaus P. Comparing the cost of care provided to Medicare beneficiaries assigned to primary care nurse practitioners and physicians. Health Services Research. 2016; 51: 1407-1423Crossref PubMed Scopus (83) Google Scholar). However, the ability of nurses to expand access to care is limited by state and federal laws, institutional barriers, and restrictive health systems policies that prohibit them from working to the full extent of their education and training (Wakefield et al. , 2021Wakefield M. K. Williams D. R. Le Menestrel S. Flaubert J. L. The future of nursing 2020-2030: Charting a path to health equity. National Press, Google Scholar). The report calls for and organizations to remove these and as well as restrictive policies and In during the and provided full practice to nurse is just about the effect of the to expand scope of practice during the pandemic et al. , R. 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