Step by Step, Nurses Gaining Sway Over Patient Care
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Nurses are signing up in droves for higher degrees and gaining more independence in treating patients — but blacks and Latinos are still left out of the nursing workforce, according to a new report.
The report, released Friday by the Institute of Medicine, analyzes how far the nation’s 3 million nurses have come since 2010, when the institute issued a Future of Nursing report with recommendations for advancing the field.
Here’s a look at some of the findings.
Nurse practitioners gaining power
One of the goals laid out in 2010 was to eliminate barriers keeping nurses from performing to the full scope of their training.
Since 2010, eight more states have passed laws granting nurse practitioners — nurses with advanced clinical training and master’s degrees — the right to prescribe medicine and treat patients without a physician’s supervision. That brings the total to 21 states, according to the report. Those changes have been spurred in part by a shortage in primary care providers.
Other states, such as Massachusetts, have chosen not to expand nurse practitioners’ authority, amid amid concerns that they don’t have enough training to do so. Some physicians’ groups have argued that giving nurses too much responsibility could endanger patients.
Higher degrees
Another goal laid out in 2010 was to boost nurses’ level of education.
Nurses are getting on board: Enrollment in nursing baccalaureate programs increased substantially in the past five years. So did the number of registered nurses enrolling in Bachelor of Science nursing programs, which shot up nearly 70 percent between 2010 and 2014. In the same period, enrollment in Doctorate of Nursing Practice programs shot up by 161 percent. And enrollment in nursing PhD programs grew by 15 percent, to 5,290 students.
The surge in interest in higher education is encouraging, said Patricia Reid Ponte, president-elect of the American Nurses Credentialing Center. She was not involved in the report.
“Our biggest problem right now is people can’t get into schools of nursing,” said Reid Ponte, who also teaches doctorate-level nursing classes at two Boston colleges. “There’s not space for them.”
While patients may benefit from better-trained nurses, the report also issued a warning: Hospitals now favor nurses with more education, which may lead to “unintended consequences” for “the employment, earning power, skills, and roles and responsibilities” of nurses with less education.
National Nurses United, a union representing 185,000 registered nurses, raised precisely that concern. About half of registered nurses have baccalaureate degrees or higher; the Institute of Medicine aims to boost that to 80 percent by 2020.
“We see this as eliminating opportunities for employment for communities of color,” in which nurses often have only associate’s degrees from publicly funded community colleges, said Bonnie Castillo, the union’s nursing practice director. Already, some hospitals are turning those applicants away, she said.
Still too white
Black and Latino representation in the nursing workforce has grown since 2001, but it remains low, the report found. African-Americans make up nearly 14 percent of people ages 20 to 40, but less than 11 percent of registered nurses. For Latinos, the gap is wider: Their share of that population segment is 20 percent, but they’re less than 6 percent of registered nurses.
“Much more needs to be done,” said Stuart Altman, an economist at Brandeis University who chaired the committee that conducted the recent analysis. Altman said there was a particular need to recruit more Spanish-speaking nurses to communicate with patients.
Nurse leaders
To give nurses more voice in shaping policy, the 2010 report recommended giving them seats on hospital boards.
That didn’t happen: The proportion of nurses on hospital boards actually fell from 6 percent to 5 percent from 2011 to 2014. Physician seats on boards held steady at 20 percent, according to a survey of 1,000 hospitals cited in the recent analysis.
Altman and his co-authors said more research is needed on the number of nurses in c-suite jobs or in charge of government programs.
Inspired to change
Reid Ponte said when the 2010 report came out, it became “a standard-bearing thing,” and it was “almost irresponsible not to pay attention to the recommendations.” It prompted the Dana-Farber Cancer Institute, where she serves as chief nursing officer, to examine its practices, including the makeup of its board.
“You would think we would have had a nurse on the board here,” said Reid Ponte. “But we didn’t.”
Dana-Farber hunted for a nurse leader and put one on its board.
The report also inspired Dana-Farber to look hard at its workforce, where 94 percent of staff nurses are white, according to Reid Ponte. The hospital reinstated a nurse residency program, which hires newly licensed nurses and gives them 10 months of extra training and supervision. The program is small — just one nurse per year, growing to two next year — but Reid Ponte said it has begun to increase racial diversity.
The analysis released Friday was funded by the Robert Wood Johnson Foundation, which also funded a campaign to implement the 2010 recommendations. Altman and his co-authors found there were too many changes in the health-care landscape, including the Affordable Care Act, to let them measure the impact of the foundation’s campaign.
