The impact of institute of medicine (IOM) report on Transforming Nursing Education, Practice, and Leadership.
Nursing profession is an indispensible part of the healthcare system and the opportunities for a nursing career are limitless, one may choose from a number of career paths, including clinical practice, education, research, management, administration and leadership. In the midst of all these career paths, clients are the center of practice and they have wide variety of healthcare needs, experiences, vulnerabilities, and expectations. This is what makes nursing both challenging and rewarding. In other to respond and adapt to changes evolving in the health care system, there must be a transformation in nursing education, practice and leadership. Based on these changes and transformation, the Institute of Medicine (IOM), released the report “The Future of Nursing: Leading Change, Advancing Health.”
This comprehensive report explores the need of the profession to adapt to changes and prepare to meet challenges that will occur as a result of the health care reform. With the recent passage of the Affordable Care Act (ACA), millions of Americans who were previously uninsured now find themselves with the opportunity to have access to medical care that was previously denied to them. With large number of individuals who are now able to receive primary care, there is concern as to whether or not there will be enough providers available to handle the massive increase in patient load. The reformed health care system now brings on new challenges and these challenges offer nurses the opportunity to practice with more freedom in order help close the gaps within our health care delivery system.
The IOM committee formulated key messages that structure its recommendation for this transformation, focusing on the delicate ground of nursing practice, nursing education, and nursing leadership. The report has it that nurses should be able to practice their full potential and extent based on the training and the education (Transforming Practice); the nurses should be able to achieve excellence in improved system of education and as well training (Transforming Education); and nurses should partner in full with doctors and professionals in health care in the redesigning of practices (Transforming Leadership). The report based on the need to transform practice states that “Nurses should practice to the full extent of their education and training.” (Institute of Medicine, 2010)
There is the need to allow nurses who have obtained the appropriate education, such as a masters or doctorate degree, also referred to as advanced practice registered nurses (APRNs) to provide primary care and not be restricted by state laws and regulations. Guidelines should be set based on their experience and competency. Transforming the practice of nursing will be beneficial in future. It will enhance quality, easy access to care, reduce waiting lines, promote health, prevent illness, and care for people of all ages and ethnicities. The ability for people to seek quality, affordable health care means nurses will be taking on new roles. The center of the health care system will be changed to primary care and prevention and will allow more advanced practice registered nurses (APRN) to take on the primary care role.
Nurses will expand their scope of practice and increase their responsibilities through teaching and counseling patients about their health care problems. They will coordinate care, act as patients advocate and be able to refer patients to physicians especially those that need specialist care. One concept involved in this transformation, is providing patient-centered care in all aspects. The IOM report refers to this as nurse guided care. “The nurse providing guided care offers eight services: assessment; planning care; monitoring; coaching; chronic disease self-management; educating and supporting caregivers; coordinating transitions between providers and sites of care; and facilitating access to community services, such as Meals-on-Wheels, transportation services, and senior centers.” (IOM, 2010, p.95) This holistic approach enables the nurse to provide a level of continuity of care throughout the entire process.
On the impact on education, the report stated that “the current health care system was molded around caring for individuals in acute care illness and injury situations, but as time evolves and the population ages, we have begun to notice that care has shifted to a heavier and wider variety of chronic illnesses” (National League for Nursing, 2010). It is for this reason that the IOM’s report suggest that nurses should achieve higher levels of education and training, through an improved education system that promotes seamless academic progression (Institute of Medicine, 2010). The first suggestion to transform nursing education involves an effort being made to encourage associate degree nurses to obtain BSN degrees by the year 2020. The report recommends five competent categories to be integrated in the nursing education. They are, patient centered care, working with other interdisciplinary teams, emphasize practice based on evidence, seeking improvement in quality, and informatics.
Computer skills and information management are required for nurses in order to keep up with the technological advancement in the medical field. Higher nursing degrees provide nurses with more critical thinking skills; this will create efficiency and improved quality of care for the patient. In order to increase nursing competence, it is paramount that there is an improved education system that promotes continuous academic progression as opposed to the current disjointed system that is both archaic and ineffective. As well as increasing the percentage of nurses who attain a Baccalaureate in the Science of Nursing (BSN) to 80% by 2020, having at least 10% of BSN nurses to enter a master or doctoral program, and doubling the number of nurses who pursue doctoral degrees, the profession should institute residency training in addition to currently instrumented internship programs for novice nurses. Well trained nurses with seasoned knowledge will be able to handle the massive increase in patient load.
The reformed health care system now brings on new challenges and these challenges offer nurses the opportunity to practice with more freedom in order help close the gaps within our health care delivery system. On the leadership front, the report calls on nurses in different levels ranging from student nurses, frontline nurses, community nurses, chief nursing officers, Nurse researchers, to the nursing organizations to acquire leadership skills and competencies to work in conjunction with doctors and other health care professionals in reform effort across the healthcare settings. Nurses are called to be actively involved in leadership at all levels, to be involved in decision making and also effect policy changes in the country.
This leadership skill will start as early as in school to the practice settings. Finally, this transformation on the healthcare delivery system began with the issue of change. Change threatens many, but also opens up opportunities for improvement. The ultimate issue in designing and delivering healthcare is ensuring the health of the population by widening and improving the scope of nursing practice through the use of APRN in delivering primary care.
Many clients do not receive continuity of care, many clients are now able to access care since the passage of the Affordable care act, so nurses in all levels and settings should be better prepared to deal with the challenges in healthcare. Many healthcare organizations are changing how they provide their services, reduce unnecessary cost, improve access to care and try to provide high quality client care. Professional nursing is an important player in effecting these changes listed above through transformation in their education, practice and active participation in leadership as advocated in the report.
American Association of Colleges of Nursing (2011). Essentials of Baccalaureate Education for Professional Nursing Practice. Washington, DC: Author Cresaia, J., & Friberg, E. (2010) Conceptual Foundations: The Bridge to professional Nursing Practice. (5th ed). St Louis, MO: Elsevier. Institute Of Medicine. (2004). In the nation’s compelling interest: Ensuring diversity in the health care workforce. Washington, DC: The National Academies Press. Institute Of Medicine. (2010) “The Future of Nursing: Leading Change, Advancing Health (2010).” Retrieved November 8, 2012 from http://iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx National League for Nursing. (2010) Nursing education research: Graduations from RN programs. Accessed November 8, 2012 from http://www.nln.org/research/slides/topic_graduations_rn.htm
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