Rural Nurse Organization Resolves
The Rural Nurse Organization supports the Institute of Medicine’s (IOM) report, The Future of Nursing: Leading Change, Advancing Health, sponsored by the Robert Wood Johnson Foundation. The Rural Nurse Organization is committed to using the report as a blueprint for future action.
The report’s eight recommendations revolve around four key themes:
• Nurses should practice to the full extent of their education and training.
• Nurses should achieve higher levels of knowledge and practice through an improved education system and professional development that promotes seamless progression with periodic competence measurement.
• Nurses should be full partners with other health care professionals in redesigning health care in the United States.
• Effective workforce planning and policy-making requires an improved information infrastructure to increase data collection and advanced data analysis for decision making.
New professional opportunities will grow out of the recommendations. Health information analysis, geriatric care, genetics, team administration and leadership, case management, chronic disease management, and quality improvement research are expected to expand. Nursing pioneers will create opportunities not yet envisioned as health reform unfolds.
The Institute’s recommendations impact many aspects of rural nursing. Nurses in rural settings will work with public, private, regional, state, and national organizations to:
Recommendation 1. Remove scope-of-practice barriers.
Rural nurses should influence policy decisions in order practice to the limits of their abilities. For instance, policy change requires active involvement of rural nurses with other health care professionals and consumers in order to ensure nurse practitioners practice independently in all states. Since community centers and rural clinics depend on nurse practitioners, laws, and organizational policies need to permit nurses to practice to the extent of their education.
Recommendation 2. Expand opportunities for nurses to lead and diffuse collaborative improvement efforts.
There are many opportunities for rural nurses to provide leadership in collaborative partnerships and innovations. Rural nurse expertise can even inform urban care. Now is the time to demonstrate the expertise developed by years of providing care in frontier and rural settings. The AARP and the Center to Champion Nursing in America encourage working with businesses, other professions, health provider organizations, governments, and consumers to reform health care.
Nurses need to lead out in new collaborative endeavors in order to improve health care. About 32 million new patients will require new strategies for increasing quality in health and self-care. Rural nurses are experienced in leading patient/family and provider health care teams. Respecting culture and patient preferences, leveraging existing resources with inter professional collaboration, and empowering self-care are competences future nurses need to develop.
Researchers need to study advanced inter professional team competencies for patient care. Educators need to teach the competencies needed to provide quality care and nurses use these competencies to assure their
capabilities. Providing care in teams also requires the support of new administrative strategies and educational preparation. Educators should also provide students with practice opportunities in rural communities.
Recommendation 3. Implement nurse residency programs.
Rural nurses require advanced education in crisis assessment and management in order to provide competent care. Transition-to-practice programs are vital for all beginning and transferring nurses. Academics and providers should create collaborative transition-to-practice programs to increase safe quality patient care and nurse retention.
Strategies to increase nursing education for all nurses are needed.
Recommendation 4.Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020.
Evidence indicates rural providers employ more associate degree nurses than other levels of education. Other workforce evidence suggests that employing higher percentages of baccalaureate nurses reduces mortality rates and increases the quality of facility and community leadership. In 2008 the American Nurses Association adopted a resolution to require registered nurses (RNs) to obtain a baccalaureate degree in nursing within 10 years of initial licensure. The development of state policies and creative academic programs are needed in order to increase rural nursing education. The Rural Nurse Organization supports the development of seamless academic education programs.
Recommendation 5. Double the number of nurses with a doctorate by 2020.
Doctorates of nursing practice and philosophy are needed to advance nurse clinical thinking and organizational leadership. One of the profession’s greatest needs is the development of more faculty to produce more nurses. The Rural Nurse Organization supports the development of new doctorates that support the research and delivery of patient care in rural settings.
Recommendation 6. Ensure that nurses engage in lifelong learning.
Professional organizations, governments, and health care providers should collaborate to develop new career competence measurement strategies and continuing education requirements. The Institute of Medicine issued another report in 2010 called Redesigning Continuing Education in the Health Professions suggesting an integrated and inter-professional education system. Other recommendations include delivery changes and increased competence measurement.
Recommendation 7. Prepare and enable nurses to lead change to advance health.
Advanced leadership skills are required from the first day of rural practice. Many nurses begin practice in a middle management position, as well as lead their communities in a variety of roles. The IOM suggests organizations should provide nurses with opportunities to lead decision making teams and health care teams. The Rural Nurse Organization will continue to provide opportunities for nurses to lead advances in health care. There is always a need for committee members, leaders and officers to advocate for improvements in rural nursing and health care.
Recommendation 8. Build an infrastructure for the collection and analysis of inter professional health care workforce data.
Infrastructure includes equipment and minimal data sets; as well as standards for measurement. Development of useful rural information requires understanding of rural practice. Differences between data from large urban and small rural facilities should be addressed during standards development. Data collected in facilities should reflect contextual and cultural concerns.
The Rural Nurse Organization seeks to raise awareness, develop standards, and support health care reform in rural settings.