With the current trends and changes that are eminent in the healthcare delivery system in the United States of America and due to the additional needs required for the implementation of the Affordable Care Act (ACA) many alterations in nursing will be required in order to meet the needs of the patients. According to the Institute of Medicine’s (IOM) report The Future of Nursing: Leading Change, Advancing Health, changes in the education, practice, and leadership of nurses will be required to make available accessible, high quality, high value care for patients in the health care system (Institute of Medicine [IOM], 2011, p. 85). Although these changes will affect all registered nurses the greatest volume of these modifications will be in the policies, restrictions, and regulations regarding scope of practice for advanced practice registered nurses (APRN). With the diploma, ADN, and BSN avenues to becoming a registered nurse there are many different options for those desiring to enter the nursing field. However, there are many barriers as well including cost, availability and location of nursing schools (IOM, 2011, p. 166).
With the recommendations for nursing detailed in the IOM report many changes will need to be implemented in the education of nurses and also to ease the transition of the graduate nurse into practice (IOM, 2011). In order for nurses to fulfill the full scope of their capabilities in will be essential for them to achieve higher levels of education both before and after licensure. The need for baccalaureate educated nurses will rise significantly as a result of the increasing demand placed on nurses due to the implementation of the ACA. With an increased number of patients entering a health care system that is already exhibiting a shortage of nurses and physicians in many areas of the country it will be necessary for nurses to expand their practice and encompass more tasks and skills to provide the needed high quality care each patient deserves. These changes will require additional education and an evolution to lifelong learning on the part of both the up and coming nurses as well as those already in practice.
The educational system for nursing needs to make modifications to provide for an easier and seamless transition to allow for academic advancement. According to the IOM nursing care is linked to higher quality care and increased patient safety. The reliance on nurses to assist in the transformation of the health care system is of the utmost importance however there are many barriers that impact this ability. The fragmented health care system also makes the nursing practice difficult with regards to completing tasks such as discharge planning and implementation of home health. Regulatory policies are so diverse across the country that it will be critical to revise and standardize nursing scope of practice across the states. It is particularly imperative for APRNs to be allowed to practice independently to the full scope of their education and a capability to provide care for those living in states with vast rural areas that are severely underserved in primary care (IOM, 2011, p. 107).
The advancement of APRNs scope of practice has also been met with much resistance from physicians and the American Medical Association (AMA). In addition there is also opposition in relation to prescriptive privileges for APRNs; however the contention that APRNs are less able than physicians to deliver care that is safe, effective, and efficient is not supported by research (IOM, 2011, p. 111). It is also very difficult to determine the actual value that nurses can bring to the health care system as, “The accounting systems of most hospitals and health care organizations are not designed to capture or differentiate the economic value provided by nurses.” (IOM, 2011, p. 115). With the execution of the ACA it will be vital for nurses to be knowledgeable about cultural and ethnic diversity to implement the patient centered medical home model of healthcare. I believe the patient centered medical home model will be the most plausible tool to accomplish the evolution of the health care system.
It has been put into practice within the Military and Veteran’s Administration hospitals and clinics and has been very successful thus far. To make the essential changes in the United States healthcare system however a change in the leadership roles nurses play will be of utmost importance to bring about the necessary restructuring required. Leadership roles which in the past have been those in upper level position handing down commands will need to be reformed into a form of “leadership which flows in all directions and levels” (IOM, 2011, p. 223). The competencies and expertise of those nurses in practice will be imperative in leading the regulatory policies to contribute to the care and safety of the patients (IOM, 2011). Although nurses have never been viewed in a leadership role, and are more commonly viewed as the doers rather than the leaders a change in these views will be required not only in a collaborative situation with other members of the health care team but on all levels.
It is therefore crucial that current nurses and those of the future are equipped with the competencies not only to give high value, high quality and safe care to the patient population but also an intimate knowledge of health care delivery, ethics, and innovative ideas with the ability to provide effective patient advocacy (IOM, 2011, p. 224). Mentorship, leadership programs, and fellowship programs are the key in preparing nurses to answer the call to collaborate and lead not only the committees, and established boards but also our country in the innovation and reformation of the healthcare system (IOM, 2011).
In conclusion the role of nurses will be forced to undergo radical changes in the areas of education, practice and leadership in the transformation of our health care system. Higher education will be required to produce individuals that are better prepared to practice at the full scope of their ability and will continue to promote lifelong learning. The action of nurses in the field both in the patient centered home model as well as assuming a role of leadership in the patient care environment and in the board room will be fundamental in the future of nursing in the United States.
Institute of Medicine. (2011). The Future of Nursing: Leading Change, Advancing Health. http://books.nap.edu/openbook.php?record_id=12956&page=R2