IOM Report on the Nursing Profession and Healthcare Reform

The Institute of Medicine (IOM) is an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public. It asks and answers the nation’s most pressing questions about health and health care through studies, their expert consensus committees, and convening a series of forums, roundtables, and standing committees, as well as other activities.

These facilitate discussion, discovery, and critical, cross-disciplinary thinking. Their aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely (IOM, 2012). In 2010, Congress passed and the President signed into law comprehensive health care legislation, collectively referred to as the Affordable Care Act (ACA), which gives the United States an opportunity to transform its health care system to provide higher-quality, safer, more affordable, and more accessible care.

Recognizing that the nursing profession faces several challenges in fulfilling the promise of a reformed health care system and meeting the nation’s health needs, Robert Wood Johnson Foundation (RWJF) and the IOM completed a 2 year initiative on the future of nursing. The report contains recommendations for an action-oriented blueprint for the future of nursing, including changes in public and institutional policies at the national, state, and local levels.

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The passage of the ACA, the IOM report, and its recommendations have an immense impact on nursing education, nursing practice - especially in the primary care setting, and the roles of nurses in leadership. The emergency department in which I work is progressively changing its practice to meet the goals of the IOM report. It is important that nurses achieve higher levels of education and training as well as practicing to the full extent of their education and training (IOM, 2012). Major changes in the U.S. health care system and practice environment will require equally profound changes in the education of nurses both before and after they receive their license. An improved education system is necessary to ensure that the current and future generations of nurses can deliver safe, quality, patient-centered care across all settings, especially in such areas as primary care and community and public health. Recommendations in the IOM report have a huge impact on nursing education (IOM, 2012).

My hospital, which is a Magnet facility, is now mandating that all employed nurses obtain their BSN in nursing by 2018, which is two years earlier than the IOM’s recommendation that 80 percent of registered nurses nationwide have their BSN by 2020. The IOM also recommends that diploma and ADN nurses obtain their BSN earlier in their careers. Studies found that BSN graduates reported significantly higher levels of preparation in evidence-based practice, research skills, and assessment of gaps in areas such as teamwork, collaboration, and practice (Kovner et al, 2010).

A more educated nursing workforce would be better equipped to meet the demands of hospital settings that continue to grow more complex, and nurses must make critical decisions associated with care for sicker, frailer patients. Higher levels of education for nurses have an impact on nursing practice. As seen in the IOM reports recommendations, nursing practice is being affected by the following barriers: Fragmentation of the health care system.

There is a disconnect between public and private services, between providers and patients, between what patients need and how providers are trained, between the health needs of the nation and the services that are offered, and between those with insurance and those without (Stevens, 1999). Without the presence of nurses in decision-making positions in new entities, the legacy of undervaluing nurses, will carry over in to new systems. Nurses must be properly and transparently valued so that their contributions can fully benefit the entire system.

High rates of turnover among nurses. High turnover rates have been shown to be related to personal or family reasons (especially for nurses younger than 50), work environment (staff shortages, increasing workloads, poor improvement processes), disruptive behavior (verbal abuse, physical assault, sexual harassment). Difficulties for nurses transitioning from school to practice. New nursing students need programs that place a greater focus on managing the transitions from school to practice.

Studies show a need to develop skills in ways to organize work and establish priorities, communicate with physicians and other professionals as well as their patients and their families, and develop leadership and technical skills in order to provide quality care (Beecroft et al. , 2001, 2004; Halfer and Graf, 2006). Demographic challenges. The combination of age, gender, race/ethnicity, and life experiences provides individuals with unique perspectives that can contribute to advancing the nursing profession and providing better care to patients. AACN,2010a). Although the number of younger RNs has recently begun to grow, the increase is not expected to be large enough to offset the number of RNs anticipated to retire over the next 15 years (Buerhaus et al. , 2009b). Although more men are being drawn to nursing, especially as a second career, the profession needs to continue efforts to recruit men. Their unique perspectives and skills are important to the profession and will help contribute additional diversity to the workforce.

To provide more culturally relevant care, the current nursing workforce will need to become more diverse by increasing the diversity of the nursing student body. Regulations defining scope-of-practice limitations. Practice boundaries are constantly changing with the emergence of new technologies, evolving patient expectations, and workforce issues (Daly, 2007). The shift towards expansion of scope-of-practice regulations and been incremental and variable. The nursing profession has evolved more rapidly than the public policies that affect it.

State and federal policies and regulations need to continue to expand the legal authority of health care workers to provide health care that accords with their education, training, and competencies (AARP, 2010a). The IOM committee believes that now is the time to finally eliminate the outdated regulations and organizational and cultural barriers that limit nurses’ abilities. Strong nursing leadership is needed to help with the changes that are being enacted with the passage of the ACA.

Strong nursing leadership is needed to help with the changes that are being enacted with the passage of the ACA. All nurses, from students, to bedside and community nurses, to CNOs and members of nursing organizations, to researchers, must develop leadership competencies and serve as full partners with physicians and other health professionals in efforts to improve the health care system and the delivery of care. Being a full partner requires leadership skills and competencies that must be applied within the profession and in collaboration with other health professionals.

Nurses must see policy as something they can shape rather than something that happens to them. They should have a voice in health policy decision making and be engaged in implementation efforts related to health care reform. Nurses also should serve actively on advisory committees, commissions, and boards where policy decisions are made to advance health systems to improve patient care (IOM, 2012). With the passage of the ACA and the IOM reports recommendations, nursing in healthcare will continue to be transformed as the system in overhauled.

Continued and higher nursing education, transforming nursing practice that overcomes barriers, and nursing leadership based with the belief that they are the shapers of their professions destiny will ultimately help to bring the vision of the IOM report to reality.

References

1. AACN. 2010. Enhancing diversity in the nursing workforce: Fact sheet updated March 2010. http://www. aacn. nche. edu/Media/FactSheets/diversity. htm (accessed July 1, 2010).
2. AARP. 2010a. AARP 2010 policy supplement: Scope of practice for advanced practice registered nurses. ttp://championnursing. org/sites/default/files/2010%20AARPPolicySupplementSco peofPractice. pdf (accessed September 10, 2010).
3. Beecroft, P. C. , L. Kunzman, and C. Krozek. 2001. RN internship: Outcomes of a one-year pilot program. Journal of Nursing Administration 31(12):575-582. Buerhaus, P. I. , D. I. Auerbach, and D. O. Staiger. 2009b.
4. The recent surge in nurse employment: Causes and implications. Health Affairs 28(4):w657-668. Daly, R. 2007. Psychiatrists, allies defeat psychology-prescribing bills.
5. Psychiatric News 42(16):6. IOM. 2010. A summary of the December 2009 Forum on the Future of Nursing: Care in the community. Washington, DC: The National Academies Press. Kovner, C. T. , C. S.
6. Brewer, S. Yingrengreung, and S. Fairchild. 2010. New nurses’ views of quality improvement education. Joint Commission Journal on Quality and Patient Safety 36(1):29-35. Stevens, R. 1999.
7. In sickness and wealth, American hospitals in the twentieth century. Baltimore, MD: The Johns Hopkins University Press.

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