This second mandated report from the
National Advisory Council on Nurse Education
and Practice (NACNEP) is presented to
the Secretary of Health and Human Services
and the Congress within a climate of the
continuing shortage of registered nurses
(RNs). Hospitals and other providers of
care within the health care delivery system
point to the current lack of a sufficient
supply as an important deterrent to their
ability to give the population the full
scope of health care required. The availability
of a sufficient supply of RNs is key to
providing the population with quality
health care. RNs have a critical role
in affecting the health and safety of
the nation in the aftermath of 9/11. The
nursing shortage is of increasing concern
as plans are developed and enacted for
the safeguarding of the population in
the face of threats of terrorism.
Section 845 of Title VIII of the Public
Health Service Act as amended by The
Nurse Education and Improvement Act of
1998 (P.L. 105-392) directed NACNEP
to report its activities and the resultant
advice and recommendations annually. (See
Appendix A) Thus, while NACNEP from
time to time in the past had provided
the Secretary, and more recently the Congress
as well, with reports on its findings
and recommendations about specific issues
related to nursing, it is only in this
1998 legislation that NACNEP has been
required to do so. In the 1998 legislation
NACNEP also, for the first time, was given
the dual responsibility of advising both
the Secretary and the Congress. NACNEP's
first mandated report, covering a three-year
period as stipulated in the 1998 legislation,
was sent to the Secretary and the pertinent
Congressional Committees in December 2001.
The first report summarized NACNEP's
activities since the enactment of the
1998 legislation. The report included
a review of the projects supported through
Title VIII of the Public Health Service
Act during the period. Title VIII programming
outcomes are central to NACNEP's development
and assessment of its own policy advice
and recommendations for the Secretary
and the Congress. It summarized NACNEP's
development of a national agenda to address
issues surrounding the disparity between
the diversity of the RN workforce and
that of the nation's population as a whole.
Seeing the issue of diversity as one related
to both the distribution of RNs and improving
the health care of the country's culturally
diverse population, NACNEP continues to
identify the area as critical to achieving
its on-going goals and objectives.
This first report documented the steps
taken jointly with the Council on Graduate
Medical Education (COGME) to respond to
the need to reduce medical errors and
enhance patient safety through collaborative
education approaches. It reiterated the
major findings underlying the joint recommendations
to foster interdisciplinary education
and practice contained in the Councils'
widely disseminated report Collaborative
Education to Ensure Patient Safety.
Building on this joint work on patient
safety, the two Councils have moved into
other collaborative activities fostering
interdisciplinary objectives and approaches
as described in the review of NACNEP's
activities in Section II.
The severity of the nursing shortage
was a prime focus of NACNEP's work during
the period covered by the first report.
NACNEP presented its view of the issues
underlying the critical lack of enough
RNs to satisfy demands. The report cited
the slower growth rate in the supply of
registered nurses currently over what
existed in the past at a time when the
aging population and the significant technological
and therapeutic advances are placing increased
pressures on the health care system. It
examined the implications of the rising
age level of the RN workforce, the decrease
in the number of entrants into educational
programs preparing individuals to become
RNs, and factors contributing to the lack
of attraction of nursing in comparison
to other career choices available to both
men and women. In considering the qualitative
along with the quantitative issues facing
the availability of RN resources, NACNEP
reviewed the adequacy of the educational
background of the current RN workforce
in the light of the demands on RNs brought
about by the increased complexity of care
and the broader scope of practice required
of today's RN. Thus, the first report
presented a wide-ranging set of recommended
actions that might be taken to assist
in providing the country's residents with
better health care from an adequate and
qualified nurse workforce.
This second report provides an overview
of all the activities undertaken by NACNEP
during the year (November 2001- November
2002) following the submission of the
first report. In recognition of the overriding
concerns arising out of the continuing
nursing shortage, the status of the nurse
workforce was once again the main focus
of NACNEP's activities. As it continued
its examination of nurse workforce issues,
NACNEP recognized that approaches necessary
to alleviate the current nursing shortages
are different than those required to ensure
that the shortages of today are not also
the picture of the future. Thus, this
second report, in Section III, features
the nursing workforce shortage issues,
from two perspectives, the present and
the future. It emphasizes the impact of
nurse faculty shortages on concerns for
the future availability of the nurse supply.
Also included in this report in Appendices
A through G are papers presented to NACNEP
during the meetings held in the year.
The information and conclusions contained
in the papers helped NACNEP crystallize
its thoughts on the issues presented in
this report.
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