Future of Professional Nursing Development: Impact of the Institute of Medicine Report Future of nursing: Leading Change, Advancing Health (2010) is a report issued by the Instituted of Medicine, which “calls on nurses to take a greater role in America’s increasingly complex health care system” (American Nurses Association [ANA], n.d., para. 1).
It gives an in-depth look into the future of the profession, while addressing four key messages, the first three of which are directly related to the nursing practice, education, and leadership. According to the report, “Many members of the profession lack the education and preparation necessary to adapt to new roles quickly in response to rapidly changing health care settings and an evolving health care system” (IOM, 2011, p. 25). This is alarming because nurses comprise a large portion of the system and are often those who provide most of the direct patient care. Education is addressed in one of the report’s key messages, which calls for increasing the number of baccalaureate level nurses to 80% by the year 2020 and doubling the number of doctorate degrees (Rosenberg & Pfeifer, 2012, p. 18).
New York State (NYS) nursing leaders are lobbying for a bill that can lead this trend, requiring all nurses to receive a bachelor’s degree within ten years of licensure, which, according to Barbara Zittel, former executive secretary of the NYS BON, can ultimately have a cascade effect on other states (Crowley, 2011). As the health care system changes, nurses are providing care outside of the traditional environment and must be able to assume responsibility in a variety of settings.
In anticipation of this even greater responsibility, the IOM recognizes the need for improved nursing education, which, with its multiple points of entry, has been a topic of debate for years. As stated by the IOM, ADN programs continue to be the most common start (IOM, 2011). For example, out of every 8,000 new RNs licensed each year in NYS, 5,000 are prepared at the ADN level (Crowley, 2011). This may be due to the shorter length of education, as well as its lower cost. In fact, cost may be a big factor for some nurses deciding to continue to achieve a BSN. However, new graduates do not have much choice but to find a way to fund their education further as having a BSN for entry into practice is becoming a requirement in many places.
Being aware of this issue, the Robert Wood Johnson Foundation has been asked to investigate it further, although, “In the end, the committee decided not to include detailed discussion of the costs of nursing education in this report” (IOM, 2011, p. 168). Nonetheless, some recommendations are made; one example is that health care organizations offer tuition reimbursement and stipends as an incentive (IOM, 2011). The need for financial assistance is recognized as one of the features needed “to expand baccalaureate and higher education programs” (IOM, 2011, p. 176). In light of this, the report ascertains the need to reform and improve education, including the belief that “diploma programs should be phased out over the next 10 years” (IOM, 2011, p. 175).
It is becoming undeniable that reaching at least a baccalaureate level is necessary, especially as more research studies highlight the link between higher education and better patient outcomes. Another key message addressed states, “Nurses should practice to the full extent of their education” (IOM, 2011, p. 85). The suggestion is to “lift the constraints of outdated policies, including those related to scope of practice” (IOM, 2011, p.85). The IOM advocates for a national standardization of practice that will enable advanced practice nurses (ADRN) to implement care they were trained and educated to provide, regardless of the location.
As a result, APRNs will have the same responsibilities across state lines, which will facilitate their ability to meet the nation’s changing health care needs. Many more people have become insured because of the Affordable Care Act. However, reimbursement issues are limiting the progress of APRNs to practice fully of their educational background, thus limiting “American public access to the care they want,” which is “to receive care quickly from a competent person” (Hill, 2012, p. 5). Such barriers not only limit the public’s access to care but also fragment the health care system further. This necessitates a creation of environment with a single goal in mind: patient-centered care, which can be achieved by optimizing APRNs’ role in primary care since “there are simply not enough physicians to care for an aging population” (IOM, 2011, p.112).
By expanding practice, APRNs can spend more time doing what they have been for years: patient education and coordination of care, thereby leading the system towards a collaborative approach advocated by the IOM. The above recommendations are associated with another key message: full partnership of nurses with other health professionals (IOM, 2011). According to the IOM, better patient outcomes can be achieved by working together “in a context of mutual respect and collaboration” (IOM, 2011, p. 223).
To contribute to this outcome, nurses need to acquire strong leadership skills through higher education and become more involved in issues such as those concerning health policy, thereby transforming to “thoughtful strategists” (IOM, 2011, p. 223). The report strives to empower nurses to lead “at every level and across all settings” (p. 225).
When looking at the future of nursing based on IOM’s recommendations, it is optimistic but it is also “entirely dependent on the willingness of the profession to develop the role capacities and leadership essential to make a difference” (Porter-O’Grady, 2011, p. 34). Meeting the goals remains in the hands of the profession to play its full role by advocating and participating in the necessary changes that will ultimately create and more skilled and educated workforce. References