Nurses are an integral part of the health care system and their role continues to evolve. The growing need for qualified nurses is a result of several factors including an aging population, the millions of newly insured under the Affordable Care Act and the shortage of nurse educators.

Consider the facts:

• Nationally, the shortage of registered nurses is 8.1 percent.
• By 2025, our nation is expecting a shortage of 260,000 registered nurses, a shortage twice as severe as any our nation has seen since the 1960s.
• In Pennsylvania, the nursing shortage is expected to reach 14 percent by 2017

With more than 3 million members, the nursing profession is the largest segment of the nation’s health care workforce. Working on the front lines of patient care, nurses can play a vital role in helping realize the objectives set forth in the 2010 Affordable Care Act, legislation that represents the broadest health care overhaul since the 1965 creation of the Medicare and Medicaid programs.

Nurses practice in many settings, including hospitals, schools, homes, retail health clinics, long-term care facilities, battlefields, and community and public health centers. They have varying levels of education and competencies—from licensed practical nurses, who greatly contribute to direct patient care in nursing homes, to nurse scientists, who research and evaluate more effective ways of caring for patients and promoting health. The committee considered nurses across roles, settings, and education levels in its effort to envision the future of the profession. Through its deliberations, the committee developed four key messages that structure the recommendations presented in this report:

• Nurses should practice to the full extent of their education and training

While some states have regulations that allow nurse practitioners to see patients and prescribe medications without a physician’s supervision, a majority of states do not. Consequently, the tasks nurse practitioners are allowed to perform are determined not by their education and training but by the unique state laws under which they work. The report offers to ensure that nurses can practice to the full extent of their education and training.

• Nurses should achieve higher levels of education and training

To ensure the delivery of safe, patient-centered care across settings, the nursing education system must be improved. Patient needs have become more complicated, and nurses need to attain requisite competencies to deliver high-quality care.

• Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States

Efforts to cultivate and promote leaders within the nursing profession—from the front lines of care to the boardroom—will prepare nurses with the skills needed to help improve health care and advance their profession. As leaders, nurses must act as full partners in redesign efforts, be accountable for their own contributions to delivering high-quality care, and work collaboratively with leaders from other health professions.

The United States has the opportunity to transform its health care system, and nurses can and should play a fundamental role in this transformation.