The Institute of Medicine [IOM], 2010) released a report that outlines the role nurses should take in changing our healthcare system in response to the legislative reforms being phased in over the next several years. In terms of expanding the scope of practice for the profession of nursing, this report definitely envisions big goals. This paper discusses the IOM (2010) report in the context of transforming practice, education, and leadership in the nursing profession, the barriers to this transformation and the subsequent impact this report has had. The paper closes with a discussion of change initiatives in current practice which might potentially help meet the goals as outlined in the IOM report.
The IOM report was published during the time when Legislation was passed in 2010 providing insurance for over 32 million more Americans. This Legislation created a demand on the health care system in accommodating the needs of these people. The committee that developed the IOM report to determine what roles nurses could assume to address the need for high quality health care. The IOM works under the assumption that nurses can fill new and expanded roles but they need to be able to practice according to their training and education, but engage and collaborate with physicians and other healthcare professionals, and assume leadership roles.
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"Professional Development of Nursing".
Transforming Practice
The authors of the IOM report outlined four main messages, three of which directly deal with nursing practice. These messages state nurses should be able to practice to the full extent of their education and training, and should achieve higher levels of education and training with a seamless academic progression and should be partners with physicians and other health care professionals in restructuring the health care system in the United States.
Transforming Education
The second message in the IOM report states that nurses should achieve higher levels of education by way of an improved system of education that facilitates in a seamless academic progression. The nursing profession is unusual because there are different paths that lead to entry level licensure to practice as an RN. These paths include diploma programs that are hospital based, associate’s and bachelor’s degrees (BSN). Professionals and academics alike continue to debate about the minimum educational requirements that nurses need. The IOM asserts nurses must strive for higher levels of education in order to meet the demands required in the ever changing health care system. The IOM further calls for a more uniform foundation for all BSNs at the entry level. This is important, as stated by the IOM because nursing practice has expanded and new competencies are needed, care is becoming more complex and will be called upon to act as primary care providers, and nurses must learn information management systems, and they must learn to work in multi-disciplinary teams. The goals of the IOM in terms of nursing education are to increase the number of nurses holding a BSN by 80% by 2020, encourage nurses with an associate’s degree to obtain their BSN, expand loans and grants for students, and double the number of nurses with masters or doctorate degrees by 2020.
Transforming Leadership
The IOM calls for a new style of leadership as the old style where leaders spout orders and expect them to be followed is not currently relevant. This calls for a style of leadership that allows nurses to partner with other healthcare professionals in a respectful collaboration. This type of collaboration is related to improved patient outcomes, less medication errors and increase staff satisfaction, as cited by the IOM (2010). Traditionally, nurses have carried out tasks delegated by physicians. The IOM calls for nurses to be strategic thinkers in order to act independently. In this way, nurses should start to view themselves as partners and must be educated for this new role. The IOM also calls for more mentorship programs to accomplish the transformation to leadership roles.
Report Impact
The impact of the IOM report has been demonstrated in nursing education, practice and in nursing leadership roles. Today, there are significantly more graduates of BSN nursing programs than associate degree programs (Buerhaus, Auerbach, & Staiger, 2016). There has also been an increase in graduate doctorate degrees since the IOM report. However barriers exist in other areas.
Barriers
The report indicates that nurses have the potential to initiate strategies in order to improve the current health care system. Unfortunately, the healthcare industry is not utilizing this potential because nurses are not practicing to their full extent because of barriers, such as an aging workforce, nurse burnout, transitioning problems from school to practice and a fragmented health care system. Probably the biggest barrier to nurses practicing to their full extent is the fact that the scope of nursing practice is regulated by state-by-state laws. For example, some states allows nurse practitioners (NP)s to work independently without physician supervision such as writing prescriptions, ordering tests and patient assessments. Most states however do not allow this practice without physician supervision.
Practice Initiatives
In my current practice I would advocate for removing licensing restrictions for nurses. Licensing restrictions impeded the geographic mobility of nurses (Benefiel, 2011). Because the nursing shortage is reaching pandemic proportion, it is important to legislate for removing licensure barriers in order to better utilize the trained nurses already in practice. Cross-state licensing barriers impede technology related to health care delivery, especially relevant for telehealth (Evans, 2015). Single-state licensing restricts the advancement of telehealth technology because it does not allow nurses to practice across state lines.
The nursing license compact (NLC) enables a nurse licensed in one compact state to practice in other compact states without having to get a separate license for the other state (Benefiel, 2011). States that do not support the nursing license compact (NLS) are restricting nurses from being able to provide care to patients in all situations in which they are qualified to do so because it impedes geographic mobility. The Department of Treasury Office of Economic Policy and the Department of Labor and Council of Economic Advisers indicate these licensing restrictions reduce employment opportunities, and increase costs to consumers (U.S. Department of the Treasury Office of Economic Policy, Council of Economic Advisers, and the Department of Labor, 2015). According to this report, states should recognize licenses from other states.
- Benefiel, D. (2011). The story of nurse licensure, Nurse Educator, 36(1), 16-20.
- Buerhaus, P.I., Auerbach, D.I., Staiger, D.O. (2016). Recent changes in the number of nurses graduating from undergraduate and graduate programs. Nursing Economics, 34(1), 46-49.
- Evans, S. (2015). The nurse licensure compact: A historical perspective. Journal of Nursing Regulation, 6(3), 11-18.
- Institute of Medicine. (2010). The future of nursing: Leading change, advancing health.
Retrieved from http://books.nap.edu/openbook.php?record_id=12956&page=R1 - U.S. Department of the Treasury Office of Economic Policy, Council of Economic Advisers, and the Department of Labor. (2015). Occupation Licensing: A Framework for Policymakers. https://www.whitehouse.gov
