E D I T O R I A L

The future of nursing and health care: Through the looking glass2030

Dr. Loretta Ford in her Editorial last month (Ford, 2010)talked about creating a vision for the future. As we cele-brate the 25th anniversary of the American Academy ofNurse Practitioners, we see that vision materializing overthe next 25 years. Whatever awaits us in the next twodecades in health care in the United States will involve achange in the way we conceptualize health, health care,and the roles of nurses, in particular nurse practitioners(NPs). Gazing into the crystal ball, we see a future brightwith promise for Americans, all of whom will finally haveaccess to health care. Health care will be a right, not theprivilege of those lucky enough to be able to afford pre-miums out-of-pocket or through their employers. Thosewho have been covered by government programs—suchas the elderly, dependent children, persons with dis-abilities, and pregnant women—will continue to receivecare regardless of their employment status, that of theirparents, guardians, or spouses, or their ability to payout-of-pocket. We predict that the future will includesingle-party-payer health care so that our health caredollars will be spent as wisely as possible and we will notcontinue to spend more than one-third of our health caredollars on overhead costs (Centers for Medicare & Med-icaid Services, 2009). Health care for all has long beenthe dream of many nurses and we predict it will finallybecome a reality in our lifetime.

Nurses will still constitute the largest single group ofheathcare professionals on the front lines and will havea profound impact on the quality and effectiveness ofhealth care. They will be major players in the newhealthcare system, both as leaders and as providers ofcare across all levels of care settings. They will be the‘‘glue’’ of the healthcare system and remain the care-givers closest to the patient and assume a lead role in theeffective use of information technology in the quality andefficiency of healthcare services. Nursing-sensitive careperformance measures (National Quality Forum [NQF],2009), endorsed by the Joint Commission for Transform-ing Health Care (2010), will be in place in all settings.

Nursing informatics will be an essential role in newtechnology innovation (Health Information and Manage-ment System Society [HIMSS], 2009). ‘‘The future ofnursing depends on a profession that will continue toperform an instrumental role in patient safety, changemanagement, quality improvement, and usability ofsystems as evidenced by quality outcomes, enhancedworkflow, and user acceptance.’’ (Robert Wood John-son Foundation, 2009, p. 5). Nurses will play a leading

role in improving health outcomes. Patients and families

will have access to the best evidence-based health infor-

mation, with health education services in tailored patient-

appropriate learning environments and formats. Patient

education of utmost quality will enable patients and their

families to manage their own health care. Nurses will be

leaders in developing resources and addressing patient

health literacy.

All Americans will have a true, up-to-date, reliable

personal electronic health record (EHR) that will be

used by clinicians across disciplines in the provision of

care. Providers will electronically access critical health-

care information in the event of a catastrophic healthcare

emergency. Emergency room personnel will electroni-

cally access essential healthcare data on critically ill or

injured patients. Communities will share data among

providers to facilitate the efficient provision of care

(Fried, 2008).

All Americans will have a ‘‘smarter’’ healthcare home

so that fragmentation and duplication of care will be

minimized. The heart of this health care home will be

a primary care provider who will coordinate care with

the patient. Nurse practitioners and primary care physi-

cians will be the primary care providers, the majority of

these being NPs, already the largest group of primary care

providers in the country. We will finally have achieved

consensus on credentialing and establishing regulation

for advanced practice nurses (Stanley, Werner, & Apple,

2009). We believe that the primary care provider will

be a part of a team or network of providers, with inter-

operability of EHRs. Patients will carry their personal

health records (PHRs) in their own portable electronic

devices or retrieve the records through the Internet so

that access to appropriate care will be as seamless as

possible, regardless of location. Patients will own their

records, rather than healthcare institutions or providers

controlling these records, restricting access, and requiring

that patients sign consent or release forms. Thus, patients

will be able to grant selective access to healthcare profes-

sionals who need the information to partner with them in

their care. Most patients will be well informed about their

health issues and concerns through the health portals and

other Web services such as the Mayo Clinic, Cleveland

Clinic, and National Institutes of Health sites. Empowered

by knowledge, the power in patient–provider relation-

ships will shift to a partnership and more patient-centered

care.

Journal of the American Academy of Nurse Practitioners 22 (2010) 233–235 © 2010 The Author(s) 233Journal compilation © 2010 American Academy of Nurse Practitioners

Editorial Editorial

The models of nursing care demonstrated to be mosteffective in helping patients achieve their highest pos-sible level of wellness will be replicated across settings,as appropriate. For example, EverCare will be the modelof care for long-term and hospice care across age spans(Abdallah, Fawcett, Kane, Dick, & Chen, 2005; Ryan,1999). Group healthcare visits will become more com-mon. Several models have already been developed forwell-baby care annual health examinations, prenatal care,and for persons with chronic diseases and conditions suchas diabetes, chronic pain, hepatitis C, various cancers,urinary tract dysfunctions, osteoporosis, and lipid man-agement (Morse, 2009). Discharge planning for everyhealthcare setting will always be driven first by patientand family needs for support and assistance and byevidence-based practice. Nurses will be involved at all lev-els of interdisciplinary research to recognize and designe-health modalities of care that are both best for thepatients and cost effective.

The technological revolution that we in health carehave been somewhat slow to embrace will enhance ourability to provide the highest quality of care at the low-est cost (Kaiser Family Foundation, 2009). In addition toEHRs and PHRs, communications with our patients willoccur via e-mail, Twitter, social networking websites, on-line teaching modules, and interoperable consultationswith other healthcare providers via electronic sharing ofdata and imaging, and the incorporation of technologicalinnovations for the identification and administration ofmedications and other interventions. A transformation inrural health care will occur through information tech-nology: personal EHRs, telehealth, telehomecare, socialnetworking, distributed e-learning, and care managementteams will be possible through its use (Effken & Abbott,2009). Nurses will increasingly complete their nursingdegrees and mandatory continuing education require-ments on-line.

Nursing administrators will expect nurses to be profi-cient in the use of new and emerging health informationtechnologies. All nurses will be computer literate andfacile in the ability to access and retrieve electronic datanecessary for patient care, to facilitate communication,manage data sets, and to solve patient care problemscreatively (Utley-Smith, 2004).

Mills (2009) has asserted that NPs are at the heartof healthcare reform. As the care providers known forempowering and partnering with patients, we can helppatients control their health risks by changing theirlifestyles; and by judicious use of medications; we canhelp them take charge of their health, their health data,and improve their chances of avoiding catastrophic healthproblems (Mills). Currently, 75 cents of every healthcaredollar is spent on chronic illness whereas only 8 cents is

spent on prevention. We predict a shift in these numbersby the year 2030.

NPs will provide a vital component to the maintenanceof access to health care for all Americans. We have demon-strated that we can provide accessible, high-quality, andcost-effective care (Bauer, 2010; Gallagher et al., 2009).We will continue to provide the greatest share of primarycare in the country, leaving high technology, tertiary careto physician experts whose long and expensive educationis best used in caring for the most sick and most medicallycomplicated patients.

All NPs will be educated at the practice doctorate levelor grandmothered/fathered for credentialing as we shifttoward this new model of education. Other professionssuch as speech and language therapy, dietetics, physi-cal and occupational therapy, and social work will havemoved or be moving toward the practice doctorate, asthe knowledge explosion continues. As has been true inthe bench sciences for decades, the expectation will bethat students in the health sciences will fast track throughbaccalaureate education to the practice doctorate. Thedream for nursing to have the baccalaureate as basicentry into the profession will become a reality. To do this,we need far more faculty than are presently available.Moving to the baccalaureate or master’s degree as thebasic entry into nursing will help lessen faculty shortage,as the time from qualification as a registered nurse—nowpossible at the associate and baccalaureate level—to thedoctorate will be shorter. Adjustments will have takenplace in healthcare economics to level the playing fieldbetween salaries of doctorally prepared nurses in health-care institutions and those in academic positions. Forgingpartnerships with clinical agencies will also help to bridgethese salary disparities. Fast-track programs from entrythrough the doctorate such as exist in other fields willalso help lessen faculty shortage (Trossman, 2009).

As we celebrate the accomplishments of our past, wewill know how accurate we are with these predictionsin two decades. We expect there will be technologicaladvances we have not yet even dreamed about. But, wehope for the most part that we are accurate.

Rebecca Koeniger-Donohue, PhD, APRN,WHNP-BC

Clinical Associate ProfessorSchool for Health Studies, Nursing Programs

Simmons College, Boston, MassachusettsJoellen W. Hawkins, PhD, RN, WHNP-BC,

FAANPProfessor Emerita

William F. Connell School of Nursing, Boston CollegeWriter in Residence, Nursing Department, Simmons College

Boston, Massachusetts

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Editorial Editorial

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