The Impact on Nursing of the 2010 Institute of Medicine Report on the Future of Nursing The Institute of Medicine (IOM) report: The Future of Nursing: Leading Change, Advancing Health; was a product of collaboration between the IOM and the Robert Wood Johnson Foundation (RWJF). They worked together to research viable solutions for the current healthcare systems problems. The IOM is an American non-profit , private organization. Providing national advice on medical and health topics, with the goal of improving the health of the nation, is the purpose of the IOM. The RWJF is a privately funded organization that focuses on solutions for health care problems, in an effort to improve the health of all Americans.
This study by the IOM was published in 2010, close to the time that Congress passed the Affordable Care Act (ACA). The ACA dictates extensive reforms for America’s current healthcare system. The aim of this study was to examine how the nursing profession could grow and change to help provide quality care. The IOM report has had an impact on nursing education, nursing practice, and nurse’s role as leaders. The Impact of the IOM On Nursing Education
The IOM report envisions more nurses with higher degrees and restructured education programs that allow for ease in obtaining all levels of nursing degrees. The process of increasing the number of nurses, to provide an additional 285,000 workers by 2020 and having 80% of all nurses achieve a bachelor’s of science in nursing (BSN) degree by 2020 has to start with recruiting a diverse future student population. Efforts to entice high school students into the nursing field need to be strengthened. The University of Texas at Arlington School of Nursing piloted and implemented a unique program called STARS. STARS stands for: stimulating interest in nursing, tutoring and mentoring students, assisting with career and financial resources, recruiting and retaining pre-nursing and upper-division students, and strengthening the healthcare community with BSN prepared nurses from diverse backgrounds. This program could be replicated nationwide to increase the ranks of future nurses. Also, the website, DiscoverNursing, features steps students can take toward beginning a career in healthcare. The next step is to encourage current and future nurses to obtain a BSN or higher level degree. Many hospitals and other places of employment offer incentives to procure a higher level degree.
The Oregon Consortium for Nursing Education (OCNE) is an innovative program that provides convenient access to college and an uncomplicated option to continue for a BSN. OCNE is a joint effort of five campuses of Oregon Health and Science University and eight surrounding community colleges. Students who were concerned about traveling long distances or a prolonged time period before being able to enter the workforce, enjoy the advantages offered by OCNE. Nurses need to be trained appropriately for the transition from student to care provider. Experienced nurse preceptors and competency check lists help ease this role change and promote retention of staff. After investing in recruiting high school students, assisting them through college and placing them in the workforce; then nurses need to be motivated to acquire masters or doctorate degrees. Nurses with these advanced degrees can become future teachers or future independent care providers. The ACA has provisions for up to $35,000 in loan repayments and scholarships for eligible nurses who complete an advanced degree and are willing to be a faculty member at an accredited school for a set amount of time. The Impact of the IOM Report on Nursing Practice
The main message from the IOM regarding transforming nursing practice is that nurses should practice to the full extent of their education and training. Currently advanced practice registered nurses (APRN) can only practice in sixteen states without some form of physician oversight. Insurers are less likely to reimburse APRN’s in states that mandate physician supervision. Nurses need to push for reform of the regulations governing APRN;s. The ACA includes four initiatives designed to provide increasingly patient centered care. Primary care nurses could see job locations or job descriptions changes with the implementation of these initiatives. These initiatives include Accountable Care Organizations (ACO), Medical Health Home (MHH), Community Health Centers (CHC), and Nurse Managed Health Centers (NMHC). An ACO are groups of healthcare providers who work together to provide cost efficient care for Medicare patients. Nurses will help an ACO by functioning as a care coordinator of Quality Improvement Manager. Care coordinators will have to manage care with doctor offices, hospitals, rehab centers, and home settings, Quality Improvement Managers will focus on analyzing data and promoting evidence based practices. The MHH is a team of healthcare providers who supply healthcare services. The goal is to increase access to care, improve quality of care, and decrease costs.
The main components to achieve these goals are health information technology and payment revision. Nurses will need to be competent with technological venues such as electronic medical records and be advocates for reform regarding payment regulations. An example of a CHC is Community Health Center, Inc. (CHCI) in Connecticut. CHCI is comprised of twelve primary health centers, school clinics, homeless shelters, and mobile dental sites. Care is delivered by teams called “pods”. A pod consists of two doctors, a nurse (RN or LPN), and two medical assistants. A study of the work performed by the registered nurses found that only fifteen percent of their duties would be classified as care coordination. Yet, ten percent of their time was spent giving vaccinations. It would be helpful if the nurses role at CHCI could be reorganized so that they could spend more time with care coordination activities. However, an obstacle to the revision of the job duties, is that Connecticut law does not permit vaccinations to be administered by a medical assistant. NMHC’s are operated by nurse practioners. They are often linked to a college, federally qualified healthcare center, or independent non-profit healthcare agency.
The typical cadre of healthcare workers unite to provide primary care to patients with limited access to care. The Impact Of The IOM Report On The Nurse’s Role As A Leader The core concept of the IOM report regarding transforming nurse leadership is that nurses should be full partners in redesigning healthcare. Polls suggest that nurses are viewed by the public as trusted sources of healthcare information, but the public feels nurses have little effect on healthcare reform. Nurses are responsible to identify problems and coordinate solutions. This may involve collaboration with other professionals, even outside of the healthcare realm. It also requires nurses to be involved in forming new policies and changing antiquated regulations. Nurses need to take the lead in researching trends in healthcare and anticipating what healthcare services will be required in the future and how that can be done cost effectively. Managers of nurses need to have adequate leadership training and inservices to boost their skill levels as leaders. Nurses need to acquire positions on boards and committees to have input and have influence on the future of healthcare.
References
(http://www.hrsa.gov/about/news/pressreleases/nhscscholarship.html)
(http://www.discovernursing.com/nursing-students#.Unb3MhC7bTo)
(http://www.minoritynurse.com/article/recruiting-and-retaining-hispanic-nursing-students)
(http://www.ocne.org/about.html)
(http://www.naqc.org/Main/Resources/NursesRole-AccountableCareOrg.pdf)
(http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-16-2011/No2-May-2011/Patient-Centered-Care-in-a-Medical-Home.html)
(http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No2-May-2012/Primary-Care-Nursing-Role-and-Care-Coordination.html)
(http://www.aacn.nche.edu/government-affairs/FY13NMHCs.pdf)
(http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-august-2013/)