Susan B. Hassmiller, Ph.D., R.N., F.A.A.N., Initiative Director, Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine and Senior Adviser for Nursing at the Robert Wood Johnson Foundation. 

It would be easy to get caught up in the day-to-day news coverage of the ongoing health reform discussions taking place in Washington and begin to think that health reform is only about access to care and coverage issues. It certainly is about those concerns, but it’s also about so much more. We forget that we are at the tip of a very large iceberg. The goals of health reform are not only who pays for health care, which is the topic that currently dominates health reform discussions, but how we make quality health care affordable. This goal, and the vital role that nurses play in achieving it, are at the core of the Foundation’s Initiative on the Future of Nursing, at the Institute of Medicine.Sue Hassmiller

Nursing represents the critical components in the implementation of health reform including expertise in caring for older and chronically ill patients, care management and preventive care. But in order to fulfill the promise of nursing, we must address the challenges facing the profession including: identifying innovative solutions to solving the nursing shortage; ensuring that the nursing education system has the capacity to educate and prepare nurses for providing care in the 21st century; attracting and retaining nurses in all heath care settings; and recognizing the vast potential for improving quality of care through optimal utilization of nursing care.

The success of this initiative depends on the input from not only nurses, but from others who should care about the availability of high quality health care, including health care administrators and providers, purchasers, consumers, and even those from the business community. The health care system—both in its current and future states—affects all Americans, and we must engage fully in its delivery. The future of our health care system is a societal issue that impacts every individual the same way that matters concerning our education system start with teachers, but touch everyone’s life.

The initiative will examine solutions to these challenges through a series of public workshops and forums. The first, taking place in mid-September in Washington, D.C., will be a technical workshop consisting of three panels: one focusing on the Prime Minister’s Commission on the Future of Nursing and Midwifery, the second on the health policy aspects of health reform, and the third will deal with health care capacity issues. Following the technical workshop will be a series of three Forums on the Future of Nursing. The first, taking place in Los Angeles on October 19, will be held at Cedars-Sinai Medical Center and will focus on nursing in acute care settings. The second will address nursing issues in community and public health care settings and will take place on December 3 in Philadelphia. Finally, the third forum, being held in Houston in February 22 will examine nursing education.

Portions of each meeting will be open to the public and will include a mechanism for public comment. Detailed information on the time, location and registration for the meetings will be available online at The meetings will be webcast for those who are unable to attend in person.

As the initiative begins to address these challenges, it is always in the mindset of finding solutions to the barriers that currently stand in the way of the promise that nursing holds for the future of health care. We are on the cusp of an amazing transformation in health care, and the work that we accomplish through this initiative will play a major role in determining how we deliver quality, affordable health care to every individual in the future.


Comment submitted on December 10, 2009

Submitted on 2009/12/10 at 10:46am

Dear Dr. Shalala,

Thank you for your efforts in addressing the nursing shortage. The National Tuberculosis (TB) Nurse Coalition conducted a nationwide survey to determine the challenges facing public health nurses that provide TB care in the US. Seven hundred and thirty-seven (737) nurses completed the survey. Major challenges noted include the loss of an experienced nursing workforce, complexity of the TB cases and erosion of the public health infrastructure. Thirty-four percent (34%) of the nurses will leave TB control within 5 years and 75% within 10 years. Thirty-one percent (31%) of the nurses have already experienced a loss of TB nursing staff and the erosion of the public health infrastructure. This loss of nursing expertise is occurring at a time when TB cases are more complex and difficult to treat due to co-morbidity, drug resistance, severity of disease, missed and delayed diagnosis, and social, cultural and ethnic challenges. Furthermore, there is an increase in the need for costly inpatient TB care. TB treatment requires a minimum of 6 months and can be longer than 2 years depending on the level of drug resistance, relapse and/or co-morbidity. Close monitoring and assessment is needed to cure patients, stop community transmission, and prevent the development of additional drug resistance. Nurses are specifically asking for assistance from colleagues who are experienced in TB control to assist them in managing these complex cases, and for additional resources in public health to prevent a resurgence in TB in the US.


Kathleen Hursen, R.N., M.S.