2010 Affordable Care Act, Medicare and Medicaid programs since the creation in 1965 represents a detailed health care overhaul. Many health care professionals to transform the health care system, among them a comprehensive rethinking of the role of the nurses will need safe, quality, patient-centered, accessible and affordable care to provide. To realize this vision, basic nursing education should be improved both before and after nurses receive their license. In 2008, the Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine ( IOM ) to assess and respond to the changing needs of the profession of nursing a two -year initiative. IOM nursing an action-oriented blueprint for the future that will make recommendations for the purpose of producing a report, with the IOM, on the RWJF Initiative on the Future of Nursing at the committee is appointed. As part of its report, The Future of Nursing: Leading Change, Advancing Health, the Committee to advance nursing education system and the system that will be required to address some of the many challenges that face is considered. The nurses that promotes seamless academic progression through a better education system should achieve higher levels of education and training that set.

In the 21st century health challenges facing the country have shifted dramatically. The US population of older Americans 65 and older more not only with respect to race and ethnicity but also other diverse cultural and socio-economic factors, as well as in 2030 will be about 20 percent of the population. In addition to the changes in the demographics of the country, also said that the nation’s health care needs have changed. Most health care today, in part because of the country’s population growth and increasing levels of obesity complicated by diabetes, high blood pressure, arthritis, heart disease, and chronic conditions such as mental health conditions, is related. Chronic conditions account for most of the care needs of today, while the US health care system is mainly serious illnesses and injuries, major health challenges of the 20th century was built around treatment. The nurses were educated during the 20th century , which is no longer in the way of health care in the 21st century are sufficient to deal with the realities. Patient needs and care environments have become more complex, nurses competencies required to deliver high quality care needs to get. These competencies such as community and public health and geriatric leadership in specific content areas, health policy, system reform, research and evidence-based practice, and teamwork and collaboration, as well as merit . Expanding the role of nurse to fill the cooperation and coordination of health care teams of professionals to master the technical tools and information management system is being called. To respond to the increasing demand, IOM committee calls for nurses to achieve higher levels of education and better prepare them to meet the needs of the population would be educated in the ways that reveal .