EVERETT, HALSTEAD: Nurses need more training—quickly

September 7, 2013

everett-halstead-viewpointIndiana’s health care work force is ill-equipped to meet the daunting challenges and requirements of health care reform without strategic work force development efforts. With an estimated 30 million additional people—about 800,000 in Indiana—receiving coverage under the Patient Protection and Affordable Care Act, more primary care providers are needed to meet the demand for quality, affordable and accessible health care.

It’s projected that Indiana will need additional advanced practice registered nurses (APRNs)—such as nurse practitioners and clinical nurse specialists.

Nursing is the largest health care profession, and nurses have key leadership roles to play in health care’s evolution. However, the ongoing nursing shortage, especially among APRNs, will severely limit nurses’ ability to deliver and manage health care in the not-so-distant future. The work force shortage must be addressed, and nursing education levels must increase to best serve the needs.

In its 2010 report The Future of Nursing, the Institute of Medicine underscored the need for a highly educated nursing work force when it recommended that the number of nurses with doctoral degrees double by 2020 and that nurses be allowed to practice to the full extent of their education and training.

The reason: Health care reform and quality patient care hinge on a highly educated nursing work force. Nurses with higher levels of education, like APRNs, are best prepared to think critically, manage complex illnesses, and coordinate health care services in newly reformed environments.

They are also well-prepared to deliver primary health care.

Indiana is at a crossroads. Our largely rural population is aging. It’s rife with obesity, heart disease, cancer, diabetes and health problems leading to strokes. Unmanaged symptoms related to these chronic conditions lead to more hospitalizations, higher health costs and lower quality of life.

Simultaneously, the state suffers from an inadequate supply of primary care providers; 60 percent of Indiana’s counties have health professional shortages, and 77 percent are medically underserved areas. Advanced practice nurses can fill these gaps.

Indiana’s nursing work force can increase its educational preparation to meet the challenges of health care reform. Only 9 percent of the nursing work force in Indiana holds a master’s degree or higher. This level of educational preparation isn’t sufficient to meet Indiana’s needs.

The time to act is now. We need more nurses with advanced degrees to deliver primary care and teach in our nursing programs. Several key strategies can be implemented:

• Use work force development funds to support the academic progression of nurses with associate’s and bachelor’s degrees, enabling them to acquire advanced nursing degrees at the master’s and doctoral levels.

• Establish state-funded grant programs for nurses who pursue advanced education in exchange for service in Indiana’s primary care clinics upon graduation.

• Ensure adequate clinical training sites for APRN students by more proactively cultivating interdisciplinary health professions training models in primary care clinics.

• Engage in career development activities to prepare a pipeline of nurses who enter the profession with the intent to acquire an advanced nursing degree.

By aggressively supporting the advanced education of registered nurses, we can better position Indiana to meet the health care needs of its citizens.•


Everett is executive vice president and chief nurse executive at Indiana University Health, associate dean for clinical affairs at the IU School of Nursing, and board president of the Indiana Center for Nursing. Halstead is a nursing professor and director of online education at IU and president of the National League for Nursing. Send comments on this column to ibjedit@ibj.com.

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