Nephrology nurses have an important role in managing their patients. Sometimes, they just don’t know how important. So said Michael R. Bleich, PhD, RN, during his review of the Institute of Medicine’s report, "The Future of Nursing: Leading Change, Advancing Health," during the nursing keynote talk here for the Barbara Prowant Lectureship.

Bleich reviewed before a packed room the report's recommendations and how they might affect dialysis care. Former Health and Human Services Secretary Donna Shalala led development of the project.

“When I look around and see nurses who have an understanding of patients and families and communities, I think of you” in the nephrology nursing field, said Bleich.  Nurses must unify to express the message of how vital they are to patient care, he said. “We are the sole health discipline that approaches health, disease, illness, and chronic care management with knowledge drawn from a model of holistic care. We make decisions, provide treatments, and take other critical action based on independent observation and team-based plans. We are the sole discipline that hardwires the perspective of the patient/client with the context of family and community, and care is coordinated and managed according to this context.”

The Institute of Medicine report examines the nursing workforce, with recommendations focusing on the “critical intersection between the health needs of diverse, changing patient populations across the lifespan and the actions of the nursing workforce,” according to the IOM. “These recommendations are intended to support efforts to improve the health of the U.S. population through the contributions nurses can make to the delivery of care.”

The eight recommendations offered in the report are centered on four main issues, said Bleich:

  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 seamless academic progression.
  3. Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States.
  4. Effective workforce planning and policy making require better data collection and information infrastructure.

The report is available for a free download at

Bleich told nurses during his keynote that it was a “landmark” report; “it was not written for nurses, it was written for the public” to help them understand the role of nursing. “Nurses are trusted by the public because they are everywhere—at life, at death. We show up at the clinical table, time after time.”

Bleich said there were some important takeaways from the report:

  • States need to remove scope-of-practice barriers. “Nurses should practice to the full extent of their education and training. You are smarter than what you are able to do, but you need to push the boundaries.”
  • Nurse residency programs need to be implemented. “It’s not about the degree, its about the competencies that we derive from the degree,” he said.
  • Increase the proportion of nurses with a baccalaureate degree to 80% by 2020.
  • Double the number of nurses with a doctorate by 2020. “Education gives you new language, new competency, new self-assurance,” said Bleich.
  • Expand opportunities for nurses to lead and diffuse collaborative improvement efforts. “Nurses should be full partners, with physicians and other health care professionals, in redesigning health care systems in the U.S. We don’t want to run the health care system; we want to be heard equally,” said Bleich. When you go to lunch, he said, “take your CFO with you so they understand what you are dealing with” in your patient care environment.