Report Details Crucial Role Nurses Can Play in Addressing Unmet Health Needs of the 21st Century

A medical team including nurses planning

Nurses today have the potential to help transform the health care system to tackle growing health problems that are deeply rooted in social and economic conditions, issues not adequately addressed by the current highly centralized, medicalized system of providing health care. A new report commissioned by the Robert Wood Johnson Foundation describes how the nursing profession can ameliorate this public health crisis of the 21st century.

“Life expectancy in the U.S. is stagnating and other industrialized nations far outperform our country on many health indicators,” said Patricia Pittman, PhD, the author of the report and co-director of the George Washington University Health Workforce Institute. “There is growing recognition that medical care alone is insufficient to address health problems of today’s world. Nurses are uniquely positioned to coordinate partnerships and provide the kind of holistic, patient-centered care that can address modern health problems including ‘diseases of despair,’ such as substance use disorders, suicides and alcohol-related diseases.”

Pittman conducted a literature analysis and interviewed nursing leaders, policymakers and others to produce a comprehensive report, “Activating Nursing to Address Unmet Needs in the 21st Century.” The report makes the case that nursing has an historic opportunity to address our current healthcare crisis by embracing more holistic approaches that flourished in the early part of the 20th century when nurses developed strong partnerships with social workers. This approach was revived in the 1960s and’70s with alternative patient-centered care models and the movement of nursing education into the university, where the profession formalized nursing science and theories.

The report identifies health policy and health management drivers that are facilitating and can further the shift back to this kind of care for the nursing community. They include the slow decline of fee-for-service payments in health care and the expansion of alternative value-based payment arrangements. The advancement of health technologies, the changing physician workforce and new rules for oversight of tax-exempt hospitals may also play a role.

To expand nursing’s role to meet the unmet needs identified in the report, Pittman says nursing leaders must strengthen a core set of nursing functions. They will also need to embrace the idea of working at the intersection of other professions, and bolster nursing education with a stronger focus on population health, health equity and programs to ensure diversity in the nursing workforce. The report describes today’s most innovative nurse-led or nursing models and the evidence of their impact, and it concludes with an analysis of solutions to the current crisis.

Educators, employers and policymakers must also be willing to work with nursing leaders to create jobs with roles that allow them to build trust, establish partnerships and provide holistic care that can help individual patients, families and entire communities stay healthy, according to the report. It recommends that government officials and policymakers align payment and regulatory policies with the goal of transforming the health care system. Finally, Pittman, who is also a professor of health policy and management at the George Washington University Milken Institute School of Public Health, calls for a robust research agenda aimed at spurring the process of change.

The report, “Activating Nursing to Address Unmet Needs in the 21st Century," provides background for the National Academy of Medicine’s Committee on the Future of Nursing 2020-2030.