Expand Nurses' Scope of Practice, Strengthen Nursing Education to Advance Health Equity, Report Advises

Joan Stephenson
2021 JAMA Health Forum  
A new report from the National Academy of Medicine says that strengthening the nursing profession in several areas over the next decade-including lifting scope-of-practice barriers and expanding nursing education-is needed to promote health equity, develop a skilled and diverse nursing workforce, and protect nurses' health and well-being. As a group, the nearly 4 million nurses in the United States comprise the largest component of the nation's health care workforce. Meeting the demands that
more » ... the demands that nurses will increasingly face, such as caring for an aging population, helping to shape policies aimed at breaking down structural racism and addressing social determinants of health, and responding to an increase in mental and behavioral health conditions, will require significant increases in the number, types, and distribution of nurses across not only geographic areas, but also across specialties and care settings, the report notes. "This is a transformational time for the field of nursing. While the pandemic has changed nearly every aspect of health care, the impacts on nursing may be the most profound, as demand for their skills is at an all-time high," said Mary Wakefield, PhD, RN, visiting professor at Georgetown University and at the University of Texas at Austin and co-chair of the committee that wrote the report, in a statement. During the COVID-19 pandemic, increased demands on health care systems prompted some states to waive or ease restrictions on the care nurses can deliver under their licenses. One of the report's chief recommendations is to lift scope-of-practice barriers and make these changes permanent. As of January 2021, 23 states and the District of Columbia allow full practice authority for nurse practitioners, which permits them to prescribe medication, diagnose patients, and provide treatment without a physician present. However, physician oversight is required in 16 states for prescribing medication and in 11 states for all aspects of practice. The committee that developed the report recommends that by 2022, "all changes to institutional policies and state and federal laws adopted in response to the COVID-19 pandemic that expand scope of practice, telehealth eligibility, insurance coverage, and payment parity for services provided by [advanced practice registered nurses (APRNs)] and RNs should be made permanent." The group also urges state and local governments to provide more funding for school and public health nurses, noting that although a school nurse may be the only health professional some students see regularly, about 25% of schools lack a school nurse and that school nursing is inadequately funded, especially in schools attended by children in low-income homes. National nursing organizations, led by the Tri-Council for Nursing and the Council of Public Health Nursing Organizations, should work to develop a shared agenda for addressing social determinants of health and achieving health equity by the end of 2021, the committee advises. Upon the development of such an agenda, government agencies, health care and public health organizations, payers, and foundations should take action to ensure that nurses have the resources and support "to address social determinants of health and health equity more comprehensively, regardless of practice setting." Strengthening nursing education is essential to equip future nurses to address these challenges, the report says, noting that nursing education programs have historically emphasized training for care in hospitals rather than in other settings in the community, including schools, workplaces, and
doi:10.1001/jamahealthforum.2021.1527 fatcat:kt5ld6gxojbiriwqdzuegsc2fq