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Dr. Ann Cary's Testimony to NAM Future of Nursing Committee

Published March 20, 2019

National Academy of Medicine Future of Nursing 2020-2030 Committee - Public Session March 20, 2019

Testimony presented by Ann Cary, PhD, MPH, RN, FNAP, FAAN, Chair of the AACN Board of Directors

Good afternoon, I am Ann Cary, and I am grateful for the opportunity to address the Committee as Chair of the Board of Directors of the American Association of Colleges of Nursing.  AACN is the national voice for baccalaureate and higher degree nursing programs in the United States. The 825 schools affiliated with AACN are responsible for educating the nation’s baccalaureate-prepared nursing workforce as well as all of our advanced practice nurses, nurse scientists, and nurse faculty. AACN represents all members of the academic nursing unit, including more than 45,000 faculty members and 540,000 nursing students.

Since the first Future of Nursing report was released in 2010, we have seen great progress in achieving the report’s recommendations related to creating a more highly educated and diverse nursing workforce. According to data published by the Center to Champion Nursing’s Campaign for Action, the percentage of nurses in the workforce with a baccalaureate degree or higher is at an all-time high of 56%. AACN’s own data shows growing diversity in our student population where more than one-third of all students currently enrolled in baccalaureate, master’s and doctoral programs come from groups under-represented in nursing.

Much of this progress can be attributed to our nation’s nursing schools and their work to expand capacity in their programs in keeping with the Future of Nursing report’s recommendations. We applaud the Robert Wood Johnson Foundation for being the catalyst behind this forward momentum and for helping all stakeholders understand the value of nursing education and its impact on patient outcomes.

As we consider the charge of the new Committee and work ahead to achieve the vision driving this agenda, it is clear that academic nursing has a large role to play. Moving toward a culture of health, reducing health disparities, and improving health care will take a coordinated response from academia, practice, and all stakeholders who wish to impact health on a national scale. Such a paradigm shift will assuredly require a change in how we prepare nurses to provide care across the continuum in communities and settings beyond acute care, including remotely through systems that provide Connected Care. More education will be needed to prepare the next generation of nurses to use the latest technology – including artificial intelligence and virtual reality – to assess patient needs and facilitate clinical decision-making.

Fortunately, AACN already is engaged in work that will reshape the future of nursing education as we revise what we call the Essentials series. The AACN Essentials outline the necessary curriculum content and expected competencies of graduates from baccalaureate, master’s, and Doctor of Nursing Practice programs, as well as the clinical support needed to ensure quality nursing education. The new Essentials will be used to accelerate nursing’s move in the direction of competency-based education, which will shape the development of hundreds of programs accredited by the Commission on Collegiate Nursing Education and other entities. As part of this work, AACN is reviewing the UN’s Sustainable Development Goals, publications by the National Academies, recommendations in AACN’s new white paper on the Vision for Academic Nursing, and other evidence with the goal of achieving consensus on how best to prepare the future nursing workforce. The updated Essentials are targeted for release in March 2020.

In addition, AACN recognizes the need to foster inclusive learning environments that prepare nurses to provide high quality, culturally appropriate, and congruent health care. Evidence indicates that a more diverse workforce is associated with improved access to care for racial and ethnic minority patients, greater patient choice and satisfaction, and better educational experiences for students. AACN is committed to preparing a community of scholars, clinicians, educators, and leaders who fully value the importance of diversity, inclusion, and equity to promoting the health of the nation. We are well positioned to help identify system barriers and facilitators to developing a nursing workforce that more closely mirrors the patient population.

Over the next 10 years, AACN recommends collaborative action and engagement in these priority areas in order to meet the Committee’s charge:

  • To prepare nurses to be leaders in advancing a culture of health, an intentional shift is needed to refocus nursing curricula beyond its current emphasis on the biomedical aspects of care. The Committee should consider convening curriculum specialists from across the health professions to develop competencies and a common curriculum, which address the social determinants of health. AACN can facilitate this work given our leadership with the Interprofessional Education Collaborative and our affiliation with the Federation of Associations of Schools of the Health Professions. 

  • To improve healthcare outcomes and the public’s health, nursing faculty in sufficient numbers will be needed to prepare future nurses with the requisite knowledge and skills to practice across settings, provide care to diverse populations, and minimize health disparities. Maintaining a robust faculty population is vital to this work, and a real challenge given the ongoing faculty shortage that is driven by an aging professoriate, increasing competition with clinical positions, and non-competitive salaries. According to a recent article published in Nursing Outlook by Dr. Di Fang, one third of the current nursing faculty workforce in baccalaureate and graduate programs are expected to retire by 2025. AACN recommends initiatives to address the faculty shortage, as well as support for a national faculty development initiative to enhance the preparation of nurses and other healthcare providers related to teaching the social determinants of health.

  • Despite the increasing number of baccalaureate and doctoral program graduates, more must be done to ensure that the nurses entering the profession are representative of our nation’s diverse population. The Committee should consider mechanisms for identifying and promoting best practices related to the recruitment and retention of individuals from under-represented backgrounds into nursing, including holistic admission processes and successful recruitment strategies used by other health professions. 

  • Though enrollment in DNP programs is growing, the number of students entering PhD programs has declined in recent years, which is a cause for alarm given the need for more faculty, researchers, and leaders. AACN data show that since 2014, enrollment in PhD programs has declined by 11%, even with a slight increase in PhD students last year. The Committee should work with AACN and others to develop strategies for overcoming barriers to building capacity in PhD programs, including the lack of qualified faculty mentors, the cost of doctoral level education, ensuring quality education, and expanding interprofessional engagement. The Committee should recommend post-baccalaureate PhD programs for nurses seeking academic roles and provide incentives to prospective students who commit to focusing their research on identifying gaps and effective approaches to eliminating healthcare disparities.

  • For nurses to serve as change agents and effective advocates for a culture of health, they need to be inspiring and agile leaders. The Committee should advocate for leadership development that builds both skills and resilience for those looking to have greater impact. To enhance leadership in academic nursing, we launched the AACN LEADS program last year to provide meaningful professional development opportunities to all individuals within the academic nursing enterprise. This approach was developed to tailor learning experiences to fit individual needs. This model could be adapted to address the leadership development needs of nurses in practice and other arenas.

In closing, I want the Committee to know that AACN remains committed to working with all stakeholders to better prepare nurses to lead and transform care across roles and practice settings. We strongly believe in the power of collaboration and the need for all nurses to advance their education to better serve patients and communities. AACN is here as a resource for you, and we are willing to leverage our data resources, our interprofessional network, and our industry knowledge to help advance the Committee’s work. Thank you.

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