When the Patient Protection and Affordable Care Act entered the national conversation a few years ago, for most people, 2014 seemed distant in the future. Today, the future is at our doorstep.

If the Washington state legislature decides during this legislative session to move forward with full Medicaid expansion to ensure coverage for those with the lowest income, more than 300,000 additional people will be eligible for health care starting next year.

That prospect will put tremendous pressure on the primary care system in the next few years, especially when considering projections that indicate our state's population will become more diverse and grow from its current total of 6.7 million to about 8.5 million people by 2030. During that time, complex and chronic disease rates in the population are expected to rise as well.

There will be significant demand for a prepared, diverse nursing workforce to provide accessible and quality care to all people in Washington. The landmark 2010 Institute of Medicine report "The Future of Nursing: Leading Change, Advancing Health," recommends that by 2020, 80 percent of nurses should have at least a bachelor's degree in nursing in order to play a vital role in helping realize the vision and the objectives set forth in the Affordable Care Act.

Meanwhile, nursing workforce projections for our state paint a grim picture. The aging nursing workforce is beginning to retire—the average nurse in Washington is 48 1/2 years old and will retire within 10 years.

Furthermore, economic hardships threaten Washington nursing education programs. Consequently, we aren't educating nearly as many nurses as we will soon need. According to the University of Washington Center for Health Workforce Studies' workforce projections, unless demand adapts to the available workforce supply—or educational capacity is increased—the gap between registered nurse supply and demand will be more than 10,000 registered nurses in 2020. We just won't have enough nurses. That could translate to a lot of patients who might not get the care they need.

Only about half of nurses work in hospitals. We're going to continue to see nurses in every setting where we need care, education about our health and illness, and care coordination. From the bedside to the boardroom, nurses will affect the planning, policy, and management of care, and continue leading change to ensure our health.

The Washington Center for Nursing, the nonprofit workforce and resource center for nurses in the state, was founded 10 years ago to address a nursing shortage and ensure that we have an adequate nursing workforce that can care for our population. But what we're facing is not merely a shortage; maintaining an adequate nursing workforce in this vastly changing market is a challenge we all need to solve by working together.

WCN will continue to bring consumers, employers, policy makers, educators, health care providers, and nursing leaders to the table to make effective, sustainable changes.

Here are some things you can do to make a difference: Tell your legislator to support nursing education in our state; get involved on the board or as a volunteer for your local college's nursing program advisory committee; and get involved on a local hospital or health care organization's board.

We must remain committed to producing nurses with the knowledge and skills to teach, monitor, manage care across health care settings, and lead health care. Currently, most programs in our state turn away qualified students because of inadequate capacity. We need to create more educational capacity for nursing students, and we need to attract talented nursing faculty with rewarding salaries. Salary changes require ramping up investment—from both the private and public sectors—in nursing programs so education is accessible and affordable to all who are qualified. These investments will pay off in more jobs. And nursing careers mean economic prosperity for individuals, families, and their communities.

Collaborations between educational institutions and employers will reduce the gap between what the workforce needs and what colleges and universities provide.

Employers should encourage and assist nurses who are pursuing higher levels of education and training with flexible work schedules and tuition support. Closer alignment between two-year and four-year public and private institutions supports seamless academic progression for nursing students from associate to BSN and beyond.

We already have seen great partnerships in education, such as Washington State University's strengthened relationship with Columbia Basin College in the Tri-Cities. To expand nursing education and training, WSU Tri-Cities will open a new facility for its existing College of Nursing in Richland. There, students will be able to learn nursing skills and between the two schools, can earn degrees ranging from an associate's to a doctorate.

Another key step to maintaining primary care access is ensuring that advanced-practice registered nurses, or APRNs (registered nurses with master's, post-master's, or doctoral degrees), continue practicing to the full extent of their education and training, which includes being able to admit their patients to hospitals and other facilities and having parity in reimbursement for their work.

We're excited and hopeful about health transformation in Washington state, and we need all players at the table to help make it an effective and successful change. Everyone has been impacted by a nurse. They are a vital part of every phase of our lives, from birth until death. The health of every one of us depends on having enough nurses.