Impact of the Institute of Medicine on Nursing Practice, Education and Leadership The Institute of Medicine of the National Academics in Conjunction with the Robert Wood Johnson Foundation launched a campaign to provide solutions in response to the need for evaluating and alteration of the nursing profession. Future needs of our growing population from diverse cultures and demographics dictate the need for registered nurses to adapt and transform in response to advances in health care. This is done by promoting health with most favorable, efficient patient outcomes centered on patient care. The limitation of nursing practices today prevents nurses from effectively responding to the continuously evolving, rapidly changing, health care system which compromises patient safety and optimal outcomes.
The IOM and RWJF determined four key messages in their discussions. Nurses should practice to their full potential regarding education and training. Higher levels of education and training should be attained through an improved and seamless academic program. Nurses should play an important role along with medical doctors and other health care professionals in reforming health care. Health care informatics and data collection need improvement to facilitate development of policy and efficient workforce planning. These suggested reforms will certainly impact nursing education, nursing practice, and the nurse’s role as a leader ( IOM, 2011). The foundation of the IOM’s report is to restructure nursing roles to become more efficient, cost effective, and adaptable in response to the growing population and technological advances seen in health care. Education is the key to preparing nurses for the new roles and responsibilities they will encounter.
The expanded roles and expectations of the nurse call for educational reform as well. Incorporation of competencies at the educational level include leadership, basic health policy, evidence based care, quality improvement, and systems thinking ( IOM, 2011). The goal of the IOM is to increase the number of nurses with Bachelors Degrees to eighty percent by the year 2020. Some bariers to this goal are as follows. There is a shortage of faculty, placement for students to perform clinical duties is limited, lack of competent programs to prepare nurses for higher degrees and technological advaces in patient care, and lack of workforce planning. Workforce planning is the competence of an organization to meet emerging needs. Educational institutions are not meeting these needs due to cost and qualified fculty (Wikipedia, 2014). As a result clinical experience is imperitive for fulfilling educational needs. The advent of the Affordable Care Act of 2010 endorses a shift from treatment of patients in an acute care setting to focusing on management and prevention of chronic illness.
There is evidence based practice to suggest a more holistic approach which involving patient and family centerd care is more effective in treating patients rather than the hospital or healthcare model (Holmes, 2011). Due to this new model the IOM encourages nurses to advance education to the fullest extent, continue and maintain education to develop new competencies, and reform nursing school curriculum to meet these new patient care delivery models (Holmes, 2011). The IOM suggests that it is imperitive that nurses are able to practice to the full extent of their education and training ( IOM, 2011). As the population grows, physicians will not be able to perform at a competent level and provide complete patient care without a substantial number of nurses. Reliance on nurses is necessary to reform the health care system. Barriers such as regultatory restrictions regarding scope of practice, professional resistance by physicians, and insurance company reimbursment pactices hinder RN’s and Advanced Practice Nurse’s from practicing to the full extent of their education and compromise patient outcomes (Richard Ridge, 2011).
Autonomy is an issue in some states regarding APN’s role. Some states require physician oversight to diagnose, treat, prescribe, or make referrals. Compensation for services is also an concern. Independent insurance providers, Medicaid, and Medicare compensate APN’s at reduced rates or not at all and may not cover prescribed prescriptions unless a physician signs off. Professional resistance is also an problem. The Scope of Practice Partnership lobbies against state expansion of the APN’s role stating they lack medical education, clinical knowledge and cognitive and technical skills which are acquired only in medical school ( IOM, 2011).
These restrictions make it difficult to meet the demands of patient care. Outdated insurance practices also pose an obstacle by restricting insurance reimbursement to APN’s. Some recommendations to remove these barriers include conforming scope of practice regulations from state to a national level. Enlighten medical doctors on the future of health care and the need for autonomous APN’s. Providing information about successful patient outcomes as well as the decrease in hospital readmissions may sway the opinion of doctors regarding APN practice. Include Medicare and private insurance coverage of APN’s.
Refer to evidence based practices to justify coverage. In order to institute IOM’s reform it is imperative the role of the nurse also transition into that of a leader. The development of leadership skills should be instilled at every level of nursing education and clinical mileu. The educational curriculum needs to incorproate theory and business practices, exposure to political dynamics, and management of multifocal relationships to ensure competency in high level collaborative skills (O’Grady, 2011). We will be responsible for assessing and implementing change in patient centered care systems which requires full partnership with other disciplines to reform policy.
It is time for nurses to shape policy rather than conforming to it. As the population grows, and demographics shift to include a vast number of geriatric patients, the need for health care reform is imperative to provide optimal patient care. The IOM’s report recognizes the integral role nurses play in our healthcare system. The IOM suggests changes in areas such as education, leadership, and scope of practice to safegaurd the future of healthcare. Implementing these suggestions will transform the role of the nurse into a competent leader who is responsible for health policy change, and an educator to patients, family, and community. It is time we take responsibility for change rather than accept it for what it is.
Holmes, A. M. (2011, April). Future of nursing special: Transforming education. Nursing Management, 42. 34-38. Retrieved October 16, 2014, from Lippincott Nursing Center: http://www.nursingcenter.com/lnc/pdfjournal?AID=1150962&an=00006247-201104000-00008&Journal_ID=&Issue_ID= IOM (Institute of Medicine). (2011, October 05).
The future of nursing: Leading change, advancing health. Retrieved from http://iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx O’Grady T. P. (May, 2011). Future of nursing special: Leadership at all levels. Nursing Management,42. 32-37. Retrieved October 19, 2014, from Lippincott Nursing Center: http://www.nursingcenter.com/lnc/journalarticle?Article_ID=1163290
Ridge, R. (2011, June). Future of nursing special: Practicing to potential. Nursing Management, 42.32-37. Retrieved October 16, 2014, from Lippincott Nursing Center: http://www.nursingcenter.com/lnc/pdfjournal?AID=1176058&an=00006247-201106000-00008&Journal_ID=&Issue_ID= Wikipedia, The Free Encyclopedia. (2014, September 27). Retrieved October 19, 2014, from Workforce planning: http://en.wikipedia.org/w/index.php?title=Workforce_planning&oldid=627275816