IOM Report: Nurses Can Improve Healthcare, but Need Help

Troy Brown, RN

December 04, 2015

There is much nurses can to do improve healthcare in the United States, but they cannot do it alone, according to a progress report on the future of nursing from the Institute of Medicine.

"Nurses are already committed to delivering high-quality care under current regulatory, business, and organizational conditions. But the power to change those conditions to deliver better care does not rest primarily with nurses, regardless of how ably led or educated they are; it also lies with governments, businesses, health care institutions, professional organizations and other health professionals, and the insurance industry," writes the Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine.

The newly published report describes progress and changes made since the previous report on nursing was published in 2010. As a result of its deliberations, the committee formulated four key messages that structure the discussion and recommendations presented in this report:

1. Nurses should practice to the full extent their education and training allows.

2. Nurses should achieve higher education and training levels through an improved education system that enables seamless academic progression.

3. Nurses should be full partners with physicians and other healthcare professionals in the United States in redesigning healthcare.

4. Improved data collection and information infrastructure require effective workforce planning and policy making.

Nurses Are Uniquely Positioned to Improve Healthcare

"By virtue of its numbers and adaptive capacity, the nursing profession has the potential to effect wide-reaching changes in the health care system. Nurses' regular, close proximity to patients and scientific understanding of care processes across the continuum of care give them a unique ability to act as partners with other health professionals and to lead in the improvement and redesign of the health care system and its many practice environments, including hospitals, schools, homes, retail health clinics, long-term care facilities, battlefields, and community and public health centers," the authors write. "Nurses thus are poised to help bridge the gap between coverage and access, to coordinate increasingly complex care for a wide range of patients, to fulfill their potential as primary care providers to the full extent of their education and training, and to enable the full economic value of their contributions across practice settings to be realized," the authors add.

More Diversity on Many Levels Needed

The practice of nursing encompasses a broad continuum that includes health promotion, disease prevention, care coordination, cure when possible, and palliative care when cure is impossible. This practice continuum reflects the needs of the American population, but the nursing profession still has numerous challenges.

The nursing population lacks the diversity it needs with respect to race, ethnicity, sex, and age to provide care that is culturally relevant to all populations. Many nurses need additional education and preparation to quickly adopt new roles in response to healthcare settings and a healthcare system that are changing and evolving rapidly.

The abilities of the nursing profession to give and improve both general and advanced care are undermined by restrictions on scope of practice, policy- and reimbursement-related restrictions, and professional tensions.

Transformations in the work environment, scope of practice, education, and numbers of America's nurses will be required to produce a healthcare system that provides patient-centered, accessible, evidence-based, sustainable care at the right time, the authors explain.

Report Recommendations

The report authors recommend the following:

Recommendation 1: Remove scope-of-practice barriers. Allow advanced practice registered nurses to practice to the full extent of their education and training.

Recommendation 2: Expand leadership and collaborative improvement opportunities for nurses. This includes expanding opportunities for nurses to lead and manage collaborative efforts with physicians and other healthcare team members to conduct research and improve practice environments and health systems.

Recommendation 3: State nursing boards, accrediting bodies, the federal government, and healthcare organizations should establish nurse residencies to support new nurses transitioning to the clinical practice environment.

Recommendation 4: Academic nurse leaders should work to increase the proportion of nurses with a baccalaureate degree from 50% to 80% by 2020. Nurse leaders can do this by partnering with education accrediting bodies, private and public funders, and employers.

Recommendation 5: Double the number of nurses with a doctorate degree by the year 2020, with attention to increasing diversity. This will require support from private and public funders, academic administrators and university trustees, and accrediting bodies.

Recommendation 6: Ensure that nurses continue with lifelong learning so they can develop the necessary competencies to care for diverse populations across the lifespan.

Recommendation 7: Educate nurses to assume leadership positions across all levels to advance health at the same time that public, private, and governmental healthcare decision makers ensure that leadership positions are available to and occupied by nurses.

Recommendation 8: Develop an infrastructure to support collection and analysis of interprofessional data on healthcare workforce requirements. The National Health Care Workforce Commission should lead this effort with oversight from the Government Accountability Office and the Health Resources and Services Administration and collaboration with state licensing boards, state nursing workforce centers, and the Department of Labor.

"The recommendations presented in this report are directed to individual policy makers; national, state, and local government leaders; payers; health care researchers; executives; and professionals — including nurses and others — as well as to larger groups such as licensing bodies, educational institutions, and philanthropic and advocacy organizations, especially those advocating for consumers," the authors write. "Together, these groups have the power to transform the health care system to provide seamless, affordable, quality care that is accessible to all, patient centered, and evidence based and leads to improved health outcomes."

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