By Catherine Garner, DrPH, RN
Provost and Dean, Health Sciences and Nursing
Part 1 of a 4-part series
If you were going to dream big, what changes would you make to your profession, as a practicing nurse?
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. And it definitely “dreams big” in terms of expanding the scope of the nursing profession, stating that:
A number of barriers prevent nurses from being able to respond effectively to rapidly changing health care settings and an evolving health care system. These barriers need to be overcome to ensure that nurses are well-positioned to lead change and advance health.
Three points about nursing leadership
The committee that authored the report developed four key messages that form the basis for the discussion and recommendations presented within it. The first three deal directly with nursing practice, and these are as follows:
- Nurses should practice to the full extent of their education and training.
- Nurses should achieve higher levels of education and training, through an improved education system that promotes seamless academic progression.
- Nurses should be full partners with physicians and other health professionals, in redesigning health care in the United States.
So how does the IOM’s vision for the future affect you, as a practicing nurse, nurse manager, or nursing student? To help you decipher all this, I’m going to summarize what the report has to say about each of these key messages, in a series of four articles.
Here, let’s look at key message number one: Nurses should practice to the full extent of their education and training.
A summary of the issue
The IOM report states that “nurses have great potential to lead innovative strategies to improve the health care system.” However, it found that the healthcare industry is not tapping into nurses’ potential, and nurses are not practicing to the full extent they should be, due to a variety of barriers that include:
- regulatory and policy barrier
- fragmentation of the health care system
- high rates of turnover among nurses
- difficulties for nurses transitioning from school to practice
- an aging workforce and other demographic challenges
Regulatory: the biggest barrier
Regulatory barriers are the most serious problem. The scope of nursing practice is regulated by laws that vary widely from state to state. While some states allow nurse practitioners to work independently (i.e. assessing patients, writing prescriptions, and ordering tests without physician supervision), most states do not. The IOM sees this as a political decision, and not one that is related to patient safety or a nurse’s ability and training.
It also views these limits on nursing practice as anti-competitive conduct within the healthcare market, and suggests that the Federal Trade Commission (FTC) look into reforms that will ensure “the widest choice of competent, cost-effective health care providers.”
Once regulatory reforms allow nurses to expand their scope of practice, the IOM states that Medicare and private insurers should authorize nurse practitioners to provide patient care and make clinical decisions, and should reimburse them directly for their services.
High turnover means lost talent
Another barrier cited by the IOM is the high turnover rate among newly graduated nurses – in other words, the industry is losing key talent before it is fully developed. The report suggests we need a greater focus on managing the transition from nursing school to practice.
It reiterates a recommendation made by the Joint Commission in 2002 for the development of nurse residency programs – defined as “planned, comprehensive periods of time during which nursing graduates can acquire the knowledge and skills to deliver safe, quality care that meets defined standards of practice.” Nurse residency programs have been shown to dramatically reduce the number of registered nurses who leave the field after practicing for only 12 to 24 months.
A final recommendation is that insurers, healthcare organizations, and nursing schools should expand opportunities for nurses to conduct research and lead practice improvement efforts. The goal is to create “models of payment and care delivery that use nurses in an expanded and leadership capacity to improve health outcomes and reduce costs.” Since nurses are the largest segment of the healthcare workforce, they should be playing a vital role in realizing healthcare reforms.
For more information
This article series is meant to briefly summarize the three key messages related 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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