The Future of Nursing - Johns Hopkins Nursing Magazine (2024)

Nursing in America is changing. Bigtime. While the healthcare industry is simultaneously coping with the aging-patient “silver tsunami,” increasingly complex insurance procedures and loopholes, and implementation of healthcare reform, one thing is clear: healthcare is facing unprecedented challenges, and nurses must play a major role in meeting them.

In a new report, The Future of Nursing: Leading Change, Advancing Health, the Institute of Medicine and the Robert Wood Johnson Foundation examine what it’s going to take – from nurses, hospitals, administrators, government, and other members of the healthcare team – to satisfy future demands for care. Chaired by Donna Shalala, the former Secretary of the U.S. Department of Health and Human Services (see page 3), the report committee offers specific recommendations for the future of the nursing profession.

At Johns Hopkins, Dean Martha N. Hill, PhD, RN, thought “it would be valuable to look at the report recommendations and ask: How do we measure up? What is special about academic health centers in general and about Hopkins in particular? And, what might we do as a step forward?” She invited an interdisciplinary group of university and hospital leaders to do just that.

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Our Growing Knowledge

The report’s recommendations center around four themes: improving and increasing nursing education, supporting nurses in practicing to the fullest extent of their education and training, creating a culture and systems in which nurses act as full partners with other healthcare professionals, and collecting better nursing workforce data.

The Future of Nursing recommendations are “not surprising,” said Steven Wartman, MD, PhD, a Hopkins alumnus and President and CEO of the Association of Academic Health Centers. In a boardroom full of Hopkins VIPs, Wartman’s voice brought a wider perspective to the conversation. “What concerns me is the bigger picture or the context in which these recommendations might or might not be implemented on a national scale.”

Take, for example, the suggestion to increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020. Today, only 50 percent of U.S. nurses meet this criterion. And while it may make sense to increase nurses’ education, says Wartman, “nursing has been described as a fractured profession. If that is still true, the fracture, the fault line, is between the two-year programs and the baccalaureate programs.” In this light, he wondered whether this educational goal is attainable.

Karen Haller, PhD, RN, believes it is – and that the nursing profession is divided no longer. “We’ve well earned our reputation as a fragmented profession, but I don’t want the myth to outlive the reality,” pointed out Haller, who serves as Vice President of Nursing and Patient Care Services at Johns Hopkins Hospital.

“One of the appendices in this report is the consensus model, a model about licensure, accreditation, certification, and education requirements. All of the nursing organizations have signed on to it in addition to the 50 state boards of nursing,” she noted. The support of baccalaureate-level education, she said, is unanimous.

So how does Hopkins measure up? At the Hospital, “we’re at 78 percent of nurses with a bachelor’s,” said Haller. “I’ve got to step that up two percentage points over the next few years here.”

And at the School of Nursing, “the vast majority of our students, more than 80 percent, already have a college degree when they come to us,” added Hill.

The report also recommends doubling the number of nurses with a doctorate degree by 2020 and ensuring that nurses engage in lifelong learning through continuing education and training.

Fulfilling Our Potential

Increased education will only be useful, however, if nurses can fully use their knowledge to improve practice. But nurses often confront government regulations and institutional policies that prohibit them from performing at the top of their ability.

“State regulations that support advanced practice nursing are very uneven across the United States,” explained Hill. The laws permitting (or forbidding) advanced practice nurses to independently examine patients, order and interpret lab tests, prescribe drugs, admit patients in a hospital, or provide other such services vary widely from state to state.

Wartman pointed out that, “dealing with a complex regulatory environment at a time when states’ rights are becoming very powerful and very important presents a serious challenge. How do you transition to a more national framework?”

As we look toward the future, the need for consistent advanced practice nursing laws will be even greater. Hill noted that “as increasing numbers of people have insurance or require primary care, we’re going to need more providers who are qualified in skill that can lead it in practice.”

But not everyone agrees that advanced practice nurses should step up to the role of primary-care providers. Edward Miller, MD, Dean of the School of Medicine, said that the report’s recommendations, taken “to the ultimate,” would be for nurses to conduct independent practice. He asked, “Is that way the right way to go? I’m more partial to the team concept. I think the recommendations go a little too far, to tell you the truth.”

His concern echoes that of other physicians, some of whom wrote to the editor of the New England Journal of Medicine in December. They emphasized that nurses are not interchangeable with physicians and advocated for keeping the traditional, physician-led healthcare team.

Deborah Trautman, PhD, RN, Executive Director of the Johns Hopkins Center for Health Policy, spoke to the issue of whether nurses want to step into leadership roles. “Leadership doesn’t mean they step away from the bedside, necessarily, but in some nurses’ minds that’s what they think. But having nurses continue to do what we support at Hopkins – be involved and participate beyond traditional boundaries – serves not only nursing well but serves some of our other areas equally as well.”

“The advanced practice nurse needs to have more recognition in the Hopkins Health System,” offered Margaret Garrett, Senior Counsel and Director of Risk Management for the Johns Hopkins Health System. “In community positions, we’re getting advanced practice nurses to do more of the primary care, which is excellent because we need that particular level.”

The recommendation to remove scope-of-practice barriers doesnÕt just apply to advanced practice nurses, pointed out Haller. The idea is to allow all nurses, and all levels, to perform to the fullest extent of their training. This would enable nurses to maximize their value to the healthcare teamÑand it can even help lower the cost of healthcare overall.

“The notion I find very attractive in this report is putting the work at the lowest-paid level that is trained to handle it. This means having our aides or our technicians doing certain work rather than our RNs. The report would take that idea all the way up, through every level of healthcare, including advanced practicenurses and our physicians,” said Haller.

Ronald R. Peterson, President of the Johns Hopkins Health System, noted that, “In most compensation models, as long as someone is qualified to do the job, people who are doing the same job should be compensated equally. But if we go the next step of saying that a baccalaureate-trained nurse should be differentiated in terms of scope of work versus someone who has AA, then we have a basis in my opinion for differentiating in terms of compensation.” Hopkins currently gives baccalaureate-prepared RNs more tasks, responsibilities, and compensation at the top tiers of the clinical ladder.

“We need to deliver our services in the most cost-effective way. We have to figure out a way to pay attention to the total cost given the rendering the services,” Peterson added.

Working with Our Colleagues

These kinds of changes – that reach across disciplines and affect the entire healthcare teamÑrequire an enormous amount of respect, collaboration, and communication. The challenge, Wartman pointed out, is that “all the health professions practice within the framework of a guild, and this mentality to a large extent prohibits these kinds of changes that we’d like to see happen. Maybe there are steps within the Hopkins environment that can be taken to reduce that.”

According to Hill, Hopkins is well on the path. “The guild is gone in research. It has become very collegial, very collaborative. I think faculty move that way because they understand that’s going to be the best science,” she said.

The question is how to move that interdisciplinary environment out of the research lab and into the hospital and the classroom. One major obstacle? “We have three schools [nursing, medicine, and public health] with three calendars,” said Hill. Planning interdisciplinary lectures, joint classes, or multi-school student organizations while on different schedules “presents a huge problem and weÕve got challenges there.”

“I think we work pretty well together between the schools of public health and nursing,” added Jim Yager, PhD, Senior Associate Dean for Academic Affairs at the Bloomberg School of Public Health. “But perhaps we could have a bit more sharing of some best practices. But our different academic calendars do create difficulties. I don’t know if Hopkins will ever address that issue. I mean, for us to change our calendar would be revolutionary, but not necessarily bad.”

“I think if we want to do some real good, we need a single schedule among the three schools. That would knock down a couple of barriers,” agreed Miller, speaking for the School of Medicine.

“This is a sword that no one’s been willing to fall on. And who has the authority to make it different?” asked Hill. The group paused, imagining the possibilities.

“Generally, what’s remarkable about this place is when you get people to come together, anything can happen,” said Hill. “These walls are extremely permeable.”

The Future of Nursing - Johns Hopkins Nursing Magazine (2024)


What are the four key messages from the future of nursing report? ›

During the course of this study, the committee formulated four key messages it believes must guide that transformation: (1) nurses should practice to the full extent of their education and training; (2) nurses should achieve higher levels of education and training through an improved education system that promotes ...

How hard is the Johns Hopkins Nursing School? ›

Coursework is very challenging and rigorous but rewarding. There are plenty of ways to receive academic support. As of 2020, Johns Hopkins School of Nursing is the Number One Nursing School in America. It is a prestigious program.

What is the acceptance rate for Johns Hopkins nursing? ›

Nursing School Acceptance Rates in the US
SchoolAcceptance rateGRE
Indiana University School of Nursing78%Not required
Johns Hopkins University18%Not required
Louisiana State University Health Sciences Center64%Required
Medical University of South Carolina29%Required
25 more rows
5 May 2023

What is the aim of the future of nursing report? ›

The ultimate goal is the achievement of health equity in the United States built on strengthened nursing capacity and expertise. By leveraging these attributes, nursing will help to create and contribute comprehensively to equitable public health and health care systems that are designed to work for everyone.

What are the 4 P's of nursing? ›

It's structured around four themes – prioritise people, practise effectively, preserve safety and promote professionalism and trust. Each section contains a series of statements that taken together signify what good nursing and midwifery practice looks like.

What are the 4 C's of nursing? ›

Explore the 4c's of Enhancing Physician/Nurse Interprofessional Practice: Communication, Collaboration, Culture of Safety and Compassionate Care.

Does Johns Hopkins pay nurses well? ›

Average The Johns Hopkins Hospital Registered Nurse hourly pay in Baltimore is approximately $37.52, which is 6% below the national average.

What is the hardest nursing degree to get? ›

Bachelor of Science in Nursing (BSN) has been chosen as the TOUGHEST courses of all other courses including MBBS, BCOMM, Bca, IAS, IPS, and engineering by the Guinness book of world records on 18 May 2011. It has 64 university exams + 164 series exams + 174 assignments within 2 years (max 1000 working days).

What is the hardest nursing major? ›

Pharmacology, Microbiology, and Anatomy & Physiology each have a well-earned reputation for being difficult to pass. Some students may find Cardiology, Chemistry, or even Mental Health especially trying.

How much does Johns Hopkins pay new nurses? ›

$71K. The estimated total pay for a New Grad RN at The Johns Hopkins Hospital is $70,568 per year. This number represents the median, which is the midpoint of the ranges from our proprietary Total Pay Estimate model and based on salaries collected from our users. The estimated base pay is $70,568 per year.

Is Hopkins prestigious? ›

The University ranked seventh in the nation according to the 2022–2023 U.S. News & World Report national university rankings published Sept. 11. This is a jump from the university's previous position at ninth, which it maintained for two consecutive years. Hopkins is now tied with the University of Pennsylvania.

Is Johns Hopkins nursing good? ›

Located in Baltimore, the Johns Hopkins School of Nursing is a globally-recognized leader in nursing education, research, and practice. In U.S. News & World Report rankings, the school is No. 1 nationally for its master's and DNP programs.

What is the biggest challenge facing nursing in the next ten years? ›

The nursing workforce will be tested in a variety of ways over the next decade, including responding to an aging population that has more complex and intense medical needs, demand for more primary care capacity, and the need to bridge medical and health care with the social factors that influence people's health and ...

What is the theme for nurses Day 2023? ›

International Nurses Day 2023 Theme

The theme for 2023 is "Our Nurses. Our Future." According to the International Council of Nurses, the theme will be a global campaign that sets out what how nursing in the future should address global health challenges and improve global health for everyone.

What does IOM mean in nursing? ›

Practice & Advocacy

HMD previously was the Institute of Medicine (IOM) program unit of the National Academies.

Is Johns Hopkins a good school for nursing? ›

The Johns Hopkins School of Nursing (JHSON) is the No. 3 nursing school in the world, according to 2023 QS World University rankings. JHSON is well ranked for its impactful scholarly publications, academic strength, employer reputation, and wide-ranging research.

Is it hard to study at Johns Hopkins? ›

It's an extremely competitive university. It boasts high success rates and it's alumni go on to do important things. The university is also quite small, and as a result they literally have no room to play around with students who aren't 100% dedicated. Because of this, it is quite difficult.

How much do Johns Hopkins BSN make? ›

$88K. The estimated total pay for a Registered Nurse at The Johns Hopkins Hospital is $87,950 per year. This number represents the median, which is the midpoint of the ranges from our proprietary Total Pay Estimate model and based on salaries collected from our users. The estimated base pay is $87,950 per year.

What is the hardest part of being a school nurse? ›

The hardest part of being a school nurse is balancing many responsibilities. Certain times of the year can be quite busy. If you are in a district with limited resources, a heavy caseload can be challenging, especially if you have to work in multiple schools.


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