“The IOM is an independent, nongovernment organization that gives advice to people in decision-making positions… The opinions of the IOM are highly regarded and carry weight in legislative decision” (Grand Canyon University[GCU], n. d. , para. 6).
This paper will explore the impact on nursing of the IOM report, focusing on the topics of education, nursing practice, and the role of the nurse as a leader. In the chapter Transforming Education, the IOM committee identified “major changes in the U. S. health care system and practice environments will require equally profound changes in the education of nurses both before and after they receive their licenses” (Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine; Institute of Medicine [IOM ], 2011, p. 163).
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IOM recognizes studies that show a correlation between BSN prepared nurses and better patient outcomes. The committee strongly supports advanced education and recommends a goal of increasing the percentage of BSN prepared nurses to 80% by 2020. The report further calls for more advanced practice RNs, more qualified nursing instructors, and more nurse researchers educated at the doctorate level. The report stresses the “need to establish, maintain, and expand new competencies throughout a nurse’s education and career” (IOM, 2011, p. 164). “Many of todays new nurses are undereducated to meet practice demands across settings” (http://www. acn. nche. edu/media-relations/fact-sheets/impact-of-education). Increasing the overall and continuing education of nurses would have a tremendous impact on the advancement of the nursing profession. Nurses could potentially become some of the most educated and diverse members of the health care team. Increasing the diversity of the student body, as the report recommends, would improve communication and care to minorities. A higher educated workforce would further assist in the transition of nurses from the hospital to community setting that is likely to occur in the future (IOM, 2011, p. 13). The US is currently in a transition from acute care to community based care. With this, a demand is being created to build an already short primary care workforce. The IOM committee recognizes the drastic impact nurses could have in increasing access to primary care. The committee states expanding nurse’s roles could create more efficient and effective healthcare. Their key message is “nurses should practice to the full extent of their education and training” (IOM, 2011, p. 85). IOM supports redesigned roles for nurses.
The report gives specific examples of companies such as the VA, Kaiser Health, and Geisinger, which have utilized nurses in expanded roles, including using more APRN’s as primary care providers. The results have shown great improvements in patient care. The committee supports using nurses in such roles as promoting prevention and wellness, promoting health, and providing education from disease prevention to management of chronic conditions. They recommend nurses assume these roles in collaboration with physicians. With the shift to community acquired care comes a need for better coordination of care and disease management.
This role can be filled by RNs, and will create a huge opportunity for RNs to expand their practice. The committee believes nurses need to be more fully utilized in order for the transformation of healthcare to occur. This includes advanced practice RN’s. Many states do not allow advanced practice RNs to practice to the extent of their abilities. Restrictive scope of practice regulations, physician opposition, a fragmented healthcare system, and outdated insurance policies are all obstacles this country must overcome in order for APRNs to practice to the extent of their abilities.
The committee recognizes the importance of APRNs to provide the majority of primary care in the US. Increasing the number of providers would make primary care more accessible to the population. If the recommendations of the IOM are followed, nurses could be responsible for the majority of primary care for patients. The IOM has stressed the importance of the nursing role in educating patients on disease prevention, management of chronic conditions, and health promotion. This is a subject in which this author is in firm agreement. While providing patient care, it is clear there is a lack of education regarding disease process and management.
Patients frequently feel lost regarding their illness. Education will be very important when the shift from acute to primary care occurs. Education and health promotion are areas in which this author plans to transform and improve in her practice. The IOM committee calls for stronger leadership on the part of nurses. They feel this is critical in order to “implement the changes necessary to increase quality, access, and value and deliver patient-centered care” (IOM, 2011, p. 251). IOM’s key message regarding leadership of nurses would give them a voice they do not currently have.
In order for this to occur, nurses need to change their outlook and become leaders not doers. IOM states “nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States” (IOM, 2011, p. 221). The committee states nurses must collaborate with physicians and other health care professionals in order to provide better patient care. IOM states the need for nurses to reach out to “new partners in arenas ranging from business, government, and philanthropy to state and national medical associations to consumer groups” (IOM, 2011, p. 51). If nurses can gain these partners, their voices and ideas would be more widely spread. The committee encourages “leadership from nurses is needed at every level and across all settings” (IOM, 2011, p. 225). Leadership must begin with the student nurse and continue with bedside nurses, community nurses, CNO’s, nurse researchers, and nursing organizations. If nurses across the field answer this call, they will become involved in policy-making process from the hospital to the political fronts.
One can imagine the improvements in healthcare if the individuals who have the most interaction with the patient are also involved in creating policies that protect these same patients. The recommendations of the IOM are achievable. With perseverance, the IOM’s vision of “a future system that makes quality care accessible to the diverse populations of the United States, intentionally promotes wellness and disease prevention, reliably improves health outcomes, and provides compassionate care across the lifespan” (IOM, 2011, p. ) can be a reality.