Nursing leaders can deliver a new model of care.

Millions more insured Americans. Increasing numbers of older patients. Higher rates of chronic illness. Fewer providers. How can our healthcare system not only manage these challenges but also improve performance and access to care while containing costs? The answer lies with our nurses. In some parts of the United States, nurses provide the full spectrum of primary and preventive care. They have successfully improved access and quality in rural areas. In other parts, nurses' hands are tied by antiquated laws and regulations that limit their ability to expand access to care. Our system cannot increase access when we have providers who are not allowed to perform to the top of their education, training, and capability. It is time to rethink how we deliver primary and preventive care and redefine the roles of doctors and nurses. This article examines the history of the Institute of Medicine's (IOM) Future of Nursing report (chaired by the author) and the resulting Future of Nursing Campaign for Action, which is working to institute the report's recommendations in all 50 states. The IOM report's recommendations are simple: 1. Remove outdated restrictions on nursing practice. 2. Promote nurse leadership on hospital boards and in all healthcare sectors. 3. Strengthen nurse education and training, and increase the number of nurses with advanced degrees. 4. Increase diversity in the nursing workforce to better reflect the patient population. 5. Improve data reporting and compilation to predict workforce needs. New York, Kentucky, and Minnesota are three recent states to remove barriers pre venting advanced practice registered nurses from practicing at the top of their license. Similar efforts in California, Florida, and Indiana failed initially but are expected to make progress in the near future. The article makes clear how and why the Center to Champion Nursing in America (an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation) is working to advance healthcare through nursing, and it explores the progress being made to remove unnecessary restrictions on nursing practice.

Interview with quality leaders: Dr. Donna E. Shalala and Dr. Linda Burnes Bolton on the committee on the Robert Wood Johnson Foundation initiative on The Future of Nursing at the Institute of Medicine. Interviewed by Diane Storer Brown.

The Institute of Medicine released a consensus report in October 2010, titled The Future of Nursing (FON): Leading Change, Advancing Health, which concluded significant change was needed in nurses' roles, responsibilities, and education to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system (http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx). Dr. Donna Shalala, Chair of the study, and Dr. Linda Burnes Bolton, Vice Chair of the study, spoke about the Future of Nursing (FON) at the Collaborative Alliance for Nursing Outcomes (CALNOC) conference to a predominately nursing and quality professional audience. This follow-up interview expands the discussion specifically for quality professionals, many of whom are nurses.