IOM Advocates for Higher Levels of Nursing Education

Part 2 of a 4-part series

By Catherine Garner, DrPH, RN
Provost and Dean, Health Sciences and Nursing

In November of 2010, the Institute of Medicine (IOM) issued a special report titled “The Future of Nursing: Leading Change, Advancing Health.” It’s an in-depth look at the role nurses should play in a changing healthcare system, as the new legislative reforms are phased in over the next decade. The report contains three key messages related to nursing. Part 1 of this series looked at IOM recommendations for transforming nursing practice.

The second key message put forth by the IOM’s report on the future of nursing says that “nurses should achieve higher levels of education and training, through an improved education system that promotes seamless academic progression.”

One of the peculiarities of the nursing profession is that it has many different educational pathways that can lead to an entry level license to practice as an RN. These include a hospital-based diploma program, associate’s degree (ADN), and baccalaureate degree (BSN). The minimum education needed by nurses has been hotly debated by academics and professionals for several decades.

The IOM believes it is now clear, however, that nurses must achieve higher levels of education in order to meet the demands of a changing healthcare system. It calls for an all-BSN workforce at the entry level, in order to provide a more uniform foundation for the new models of care that will accompany healthcare reform.

Why is a higher level of education necessary in nursing? The IOM offers the following reasons:

  • Competencies needed to practice nursing have expanded greatly. Nurses now need knowledge of public health, geriatrics, leadership skills, health policy, system improvements, research, and evidence-based practice.
  • As hospital care has become more complex, nurses must make critical decisions associated with care for sicker, frailer patients and work with sophisticated, life-saving technology.
  • Nurses will be increasingly called upon to act as primary care providers. As the population ages, they’ll be asked to help patients manage chronic illnesses, in order to prevent acute care episodes and disease progression.
  • Nurses must now use complex information management systems that require skills in analysis to improve the quality and effectiveness of care.
  • The focus on multi-disciplinary care teams means nurses must collaborate with a variety of health professionals, including physicians, social workers, physical therapists, and pharmacists — most of whom hold master’s or doctoral degrees.

Specific recommendations for transforming nursing education:

  • Increase the percentage of nurses that hold BSN degrees to 80 percent by the year 2020.
  • Encourage nurses with associate and diploma degrees to enter baccalaureate nursing programs by offering tuition reimbursement, creating a culture that fosters continuing education, and providing a salary differential and promotion.
  • Expand loans and grants for nursing students at all levels.
  • Double the number of nurses with a masters or doctorate degree by 2020. (To alleviate shortages of nurse faculty, primary care providers, and researchers, a population of qualified nurses needs to be ready to advance to these levels.)
  • Ensure that nurses engage in lifelong learning, and create a culture that fosters this.
  • Develop and prioritize nursing competencies so nursing school curricula can be updated regularly. This will ensure that nursing school graduates at all levels are prepared to meet the current and future health needs of the population.
  • Increase the diversity of the nursing workforce (including gender, race, ethnicity) to ensure that nurses are able to provide culturally relevant care.

Looking ahead

Part three of this series will examine the IOM’s discussion of transformations that should be made to nursing leadership. Part one covered the recommendations for transforming nursing practice.

Be sure to see my short video on BSN or MSN – How to choose and why a nurse needs a BSN, especially today.

This article series is meant to be a brief summary of the three key messages relate to nursing that are presented in a new report by the Institute of Medicine, titled “The Future of Nursing: Leading Change, Advancing Health.” You can download the full report in PDF version or browse it for free online at http://www.nap.edu/catalog.php?record_id=12956.

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