Who will lead the future of health care in Nevada?

A glass of red wine, 3 ounces of dark chocolate and 30 minutes of exercise daily: a recipe for health or a disaster in the making? Each and every day newspaper headlines and TV commentators announce a new study to improve our health, as individuals, a state and a nation.

Frequently confusing, with one study contradicting another, often misleading and sometimes laughable, we as Nevadans and Americans continue to wade through advice provided to us by the media, our culture, health care providers and our mothers. How do we improve the health of our state and the nation?

One answer may lie in a study completed and released by the Institute of Medicine in 2010.

The Institute of Medicine, established in 1970, is an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public, frequently serving as an adviser to improve the nation's health. As the current debate surrounding the Affordable Care Act continues, one specific concern is how the American health care system will treat an additional 32 million Americans.

To achieve the goal of making quality care accessible to the diverse populations of the United States, the Institute of Medicine realized that many aspects of the health care system needed to be changed.

The Institute of Medicine envisioned a future in which "primary care and prevention are the central drivers of the health care delivery system, interprofessional collaboration and coordination are the norm, and payment for health care services reward value, not volume of services, and quality care is provided at a price that is affordable for both individuals and society."

Recognizing that nurses comprise the largest (3 million) segment and most trusted group of the nation's health care workforce, the Robert Wood Johnson Foundation charged the Institute of Medicine in 2008 with the primary mission of producing recommendations for an action-oriented blueprint for the future of nursing. The question posed was, "What role can nursing assume to address the increasing demand for safe, high quality and effective health care services?"

The Institute of Medicine noted that "nursing brings to the future a steadfast commitment of patient care, improved safety and quality and better outcomes and that the challenges speak to the traditional and current strengths of the nursing profession."

On October 2010 the report was released and the following four key messages were presented:

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

n Nurses should achieve higher levels of education and training through an improved education system that promotes seamless and academic progression.

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

n Effective workforce planning and policy making require better data collection and an improved information infrastructure.

The Institute of Medicine then provided the "blueprint" or eight recommendations to realize the four key messages together with ideas of how to proceed with each. The recommendations are intended to support efforts to improve the health of the U.S. population through the contributions nurses make to the delivery of care and include:

1. Remove scope-of-practice barriers.

2. Expand opportunities for nurses to lead and diffuse collaborative improvement efforts.

3. Implement nurse residency programs.

4. Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020.

5. Double the number of nurses with a doctorate by 2020.

6. Ensure that nurses engage in lifelong learning.

7. Prepare and enable nurses to lead change to advance health.

8. Build an infrastructure for the collection and analysis of interprofessional health care workforce data.

Following the release of the Institute of Medicine report "The Future of Nursing: Leading Change, Advance Health," the Campaign for Action was launched. The objectives of the Campaign for Action are based on the eight recommendations.

Under the leadership of AARP and the Robert Wood Johnson Foundation, applications for State Action Coalitions were accepted in 2011. These organized groups of both nursing and nonnursing leaders and stakeholders are responsible to work at the local, state and regional levels to transform health care through nursing by implementing the Institute of Medicine recommendations. The mission of the Action Coalition is to:

n Set clearly defined goals (aligned with the Institute of Medicine recommendations).

n Form and mobilize key stakeholders representing a variety of sectors to build a blueprint for action.

n Educate policymakers and other decision makers.

n Reach out to philanthropies/funders to seek financial support for Action Coalition efforts.

n Gain visibility through the media and other outlets.

n Work to advance key recommendations.

Nevada, represented by the Nevada Health Care Sector Council and the Nevada Alliance for Nursing Excellence, submitted an application to the Robert Wood Johnson Foundation in January 2012 and received notification of Action Coalition status in March 2012.

The Nevada Health Care Sector Council was established in response to Nevada Senate Bill 239. This legislation required industry sector councils to convene for the purpose of identifying job training and education programs to best meet regional economic development goals.

Working closely with the Nevada State Workforce Investment Board, the council identifies and seeks federal funding to provide grants to fund those job training and education programs. The council is charged with informing the Governor's Workforce Investment Board of health care organizations that have the greatest likelihood of meeting regional workforce development and economic goals.

The mission of the Health Care Sector Council is to:

n Engage with health care industry leaders in seeking to define and address their workforce challenges and solutions;

n Identify the need for skilled workers in health care industries and assist the Governor's Workforce Investment Board in aligning such skills with workforce demands;

n Promote collaboration among competitors and stakeholders in the health care marketplace;

n Encourage the private sector to take ownership and invest in solutions that address health care challenges;

n Formulate inputs that will help ensure the long-term competitiveness of health care regional sectors and their important contributions to Nevada's economic vitality and health.

The Nevada Alliance for Nursing Excellence is a professional nursing organization that aims through its vision to develop "a premiere system for nursing education and practice providing for expertise and optimal capacity of the nursing workforce to ensure a health Nevada."

These two organizations have developed short- and long-term Action Coalition goals to begin working on the Institute of Medicine recommendations within the state of Nevada. An organizational structure is in the process of being developed and members are being recruited for the Nevada Action Coalition board and the executive committee.

The board membership will consist of some of the more than 60 stakeholders, including education, labor, business, banking and health care institutions who wrote letters of support for the formation of the Action Coalition. Dr. Debra Toney, an Robert Wood Johnson executive nurse fellow, will lead the executive committee. Toney was a member of the original Robert Wood Johnson committee in Washington, D.C., and worked to provide the guidelines for "The Future of Nursing: Campaign for Action."