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The National Advisory Council on Nurse
Education and Practice (NACNEP) submits
this report to the Secretary of Health
and Human Services and the Congress in
the continuing climate of a critical shortage
of registered nurses (RNs) necessary to
the provision of quality health care to
the Nation's population. The report, the
third of the series responding to the
requirement in Section 845 of Title VIII
of the Public Health Service Act (amended
by P.L.105-392) for annual reports of
its activities and recommendations, highlights
activities related to NACNEP's work during
the November 2002-April 2003 meetings.
(See Appendix A.)
During the period covered by NACNEP's
three reports, the country has been faced
with major crises affecting the health
and safety of the population. The horrendous
act of terrorism of September 11, 2001
(9/11) motivated the need for intensive
plans and actions to ensure the safeguarding
of the population in the face of possible
future acts of terrorism. During this
time as well, major studies of the country's
health care system showed the need to
enhance patient safety through the reduction
of medical errors and better collaborative
activities on the part of the health disciplines.
And, throughout the time period, the country
faced a lack of a sufficient number of
RNs to ensure the appropriate nursing
care needed by the current population
with predictions of even greater dire
straits for the future. These events provided
the framework for NACNEP's work.
In its first report, NACNEP analyzed
the role of RNs in the public's health
care and set forth its perspectives on
the issues surrounding the nursing shortage
with its view on the steps to be taken
to increase the RN supply and alleviate
the shortfall. This report also highlighted
the work undertaken under Title VIII to
enhance the effectiveness of nursing in
the health care system and discussed the
joint activities with the Council on Graduate
Medical Education (COGME) initiated during
the period to further patient safety.
The second report summarized the continuing
interdisciplinary activities and discussed
projects supported by the nursing and
medicine divisions of the Health Resources
and Services Administration (HRSA) that
arose out of NACNEP's and COGME's earlier
joint activities. The report also concentrated
on a major issue affecting the ability
to significantly increase the RN supply,
that of the nurse faculty shortage.
In this third report, NACNEP demonstrates
its continuing concerns with the state
of nursing in the country and looks toward
changes that would enhance nursing's contribution
to improvements in the health care of
the Nation's population. In August 2002,
as NACNEP was completing its review of
its activities for the second report,
Congress enacted the Nurse Reinvestment
Act (NRA) (P. L. 107-205). That Act amended
Title VIII of the Public Health Service
Act by initiating a number of major new
authorities designed to help with efforts
to recruit new nurses and to make nursing
a more attractive and rewarding career.
(See Appendix B.) The steps Congress took
in enacting the NRA responded to a number
of the actions NACNEP suggested in its
first and second reports. Therefore, NACNEP
looked forward to the implementation of
the NRA and was pleased to be called upon
to provide advice during the decision-making
process at its November, 2002 meeting.
A fuller discussion of the initiation
of the NRA appears in Chapter II of this
report.
The November 2002 meeting also focused
on the subject of responding to potential
threats of bioterrorism. Through a panel
of presenters consisting of representatives
from the Department of Health and Human
Services (DHHS) and the nursing community,
NACNEP examined response steps undertaken
within the Department and within nursing
following the events of 9/11. As key health
professional workers, nurses are first
line responders to any such threats. For
example, it was pointed out that, should
there be a need for mass prophylaxis and
vaccination, nurses would be carrying
out these activities. In the event of
a biological attack, nurses in the emergency
rooms and in physician's offices will
probably be the first ones to be involved
with the patient.
The discussions of the speakers from
the Department on its bioterrorism activities
centered on the structure of its surveillance
and response teams and the programs established
to provide education and training to health
care providers. In addition, Dr. Linda
Norman, a member of the Council, made
a presentation on the steps taken by a
number of nursing organizations and the
nursing education community, working jointly
with agencies in the Federal government,
to ensure that nurses were organized and
prepared to assist in responding to threats.
The International Nursing Coalition for
Mass Casualty Education (INCMCE) was set
up with membership from nursing educational
programs, the American Association of
Colleges of Nursing (AACN), National League
for Nursing (NLN), the National Council
of State Boards of Nursing (NCSBN), and
a number of Federal agencies. The Coalition's
purpose is to provide concerted leadership
for development of policies on nursing
practice, education, regulation and research
for mass casualty incidents. As NACNEP
considered the presentations, the discussion
centered on the need for careful planning
and coordination to ensure that both local
community and broader national considerations
are taken into account. Educational opportunities
that prepare nurses to respond to possible
bioterrorism attacks could be encompassed
within the various public health components
of the NRA.
As part of its continuing interest in
promoting interdisciplinary activities
to ensure quality health care in this
country NACNEP at the April 2003 meeting
reviewed the report from the Institute
of Medicine (IOM) entitled Health Professions
Education: A Bridge to Quality. The report
was prepared by the interdisciplinary
committee convening and guiding the June
2002 multidisciplinary invitational summit
in which NACNEP had participated as described
in its Second Report to the Secretary
of Health and Human Services and the Congress.
Representatives from NACNEP and COGME
were among the members of the committee.
The ideas proposed by the summit participants
were taken into account in the deliberations
of the committee as it developed the discussion
and conclusions of the report. (See Appendix
C.)
In the April 2003 meeting, NACNEP also
continued its exploration of approaches
to dealing with the nursing shortage.
Following its earlier work, which was
focused on nursing as a profession and
ensuring an increase of individuals into
the profession, NACNEP at this time turned
to the working environment with its possible
effect on patient safety and the retention
of nurses in this nursing shortage climate.
Studies have shown the relationship between
nurse staffing and the quality of patient
care. Numerous articles have been written
about nurses experiencing "burn out"
because of increased workloads with concerns
for the ability to provide "safe"
care to patients. Major research efforts
within nursing have looked at the effects
of the organizational and clinical role
of nursing within the workplace on the
recruitment and retention of nurses. The
grant program initiated in the NRA entitled
"Enhancing Patient Care Delivery
Systems" specifically relates to
this subject.
As part of its review of the nursing
working environment and steps to alleviate
the nursing shortage, NACNEP explored
approaches to widening the diversity of
nursing within practice and educational
settings. NACNEP's continuing goal has
been to broaden nursing's base as a means
of both providing more effective care
to an increasingly diverse patient population
and increasing nursing resources. Chapter
III expands on NACNEP's examination of
the issues affecting the workplace environment
from the perspectives of nursing practice
and education.
The subject matter covered by the November
2002 and April 2003 meetings brought out
suggestions for steps that could be taken
to further the recruitment of nurses,
provide a more positive environment to
attract and retain the critical nursing
personnel needed and enhance the delivery
of safe and effective health care to the
population. These recommendations along
with NACNEP's considerations for future
activities are summarized in the conclusions
of this report appearing in Chapter IV.
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