The Future of Nursing as Envisaged by the Institute of Medicine
Key Message #1
Key Message #2
Key Message #3
Key Message #4
In the recent years, nursing education and practice appear to have been influenced by the current healthcare reforms. The Affordable Care Act has introduced cross-sectional changes in the US healthcare system. For instance, it has led to an increase in the number of uninsured people by introducing universal healthcare under the reviewed health insurance plans. It is predicted that “expanding the reach of insurance coverage will place greater demands on the primary care system, as witnessed in Massachusetts” (IOM, 2010a p. 375). Consequently, the scope of healthcare services has experienced immense changes ranging from patient’s privacy protection as it is defined by HIPAA to the treatment of degenerative diseases. IOM observes “primary care medical homes and accountable care organizations (ACOs)—rely on interventions that fall squarely within the scope of practice of RNs (e.g., care coordination, transitional care)” (p.375). Owing to these changes in the US healthcare system, transient reforms in the nursing profession are deemed necessary for addressing the vast needs of the US population, and this explains the importance of the 2010 Institute of Medicine’s recommendations. Evidence indicates that, the nursing profession plays the pivotal role in the healthcare system because it accounts for the largest percentage of the healthcare workforce. As such, introducing transformations in the nursing profession appear to be as significant as the Affordable Care Act, especially regarding the improvement of healthcare service delivery. Therefore, this research paper will provide a comprehensive overview on the impact of IOM recommendations on the nursing profession including the key messages.
It is apparent that, the IOM report encompasses an array of aspects related to the nursing profession. These aspects seem to have a direct contribution to the recent reforms in the US healthcare reforms that are intended for promoting access to high quality healthcare services. Despite the fact that, some of the elements of healthcare reforms are meant to address the issue of increased healthcare costs in the US healthcare system, there are some elements that aim at improving service provision. As such, transforming the nursing profession appears to play a pivotal role in aligning the Affordable Care Act requirements in the US healthcare system. This is why IOM highlighted on four significant messages.
Key Message #1
The first key message is that, transforming the nursing practice requires nurses to employ their professional potential in the service delivery, in the healthcare system. This will be done through ensuring that nurses use their educational and training experience to the full extent. IOM (2010a) states “federal and state actions are required to update and standardize scope-of-practice regulations to take advantage of the full capacity and education of APRNs” (p. 29). This approach will ensure that, the nurses’ contribution to the transformation of the US healthcare are maximized leading to enhanced access to quality healthcare services by all the American citizens. In accomplishing these requirements, it is suggested that states and insurance companies are supposed to carry out transient changes in their regulatory, policy and financial frameworks. In addition, it is reported that the nature of care in the US is likely going to experience a significant shift from the hospital to community settings. As such, transformation in the nursing practice needs to be done, in order to align it with the future changes. It is observed that, nurses are still confined in the acute care setting that is expected to change in the foreseeable future (IOM, 2010a).
Key Message #2
The second message in the IOM report is that, nurses should “achieve higher levels of education and training through an improved education system that promotes seamless academic progression” (p. 30). IOM observes that, changing the US healthcare system will require transient changes in the nursing education. It is believed that, nursing education plays a significant role in determining the quality of services provided by nurses in the care settings. Therefore, it is apparent that any significant change in the nursing education will lead to remarkable changes in the entire healthcare system. This is why IOM states “An improved education system is necessary to ensure that the current and future generations of nurses can deliver safe, quality, patient-centered care across all settings, especially in such areas as primary care and community and public health” (p. 30). However, it is worth noting that the nursing education covers both the period before and after the accreditation of nurses, primarily regarding their certification with nursing licenses.
It is interesting to note that; enrollment of students into the nursing profession has increased significantly in the past few decades. This implies that, the nursing workforce is going to expand in the future, and this will enhance service provision in the US healthcare system because the nurse-patient ratio will improve although there are some limitations.
Key Message #3
Key message 3 deals with the transformation of the nursing leadership to ensure that the administration of nursing is based on the most appropriate professional approaches. IOM observes that most nurses do not aspire to become leaders as part of their nursing profession, yet the intended transformation of the US healthcare system will require extensive nursing leadership. As such, nurses in the current and future care settings are expected to play the dual roles of offering services to patients and serving as stewards in the healthcare system by demonstrating sound leadership. This is why IOM (2010a) suggests “a transformed system will need nurses with the adaptive capacity to take on reconceptualized roles in new settings, educating and reeducating themselves along the way—indispensable characteristics of effective leadership” (p. 32). Consequently, nurses are advised to focus on policy as something that they can shape, but not necessarily something that they experience. In general, IOM reinstates the need for transforming the nursing leadership.
Key Message #4
On the other hand, IOM report that an improved information infrastructure that encompasses improved data collection will enhance workforce planning for efficient transformation of the entire healthcare system. Ordinarily, the US healthcare system comprises of an array of professionals who play different roles in the system. For instance, nurses are concerned with providing nursing care to patients, whereas physicians deal with the patients’ treatment. As such, the US healthcare system involves many parties who work in collaboration to ensure that patients receive quality care for improved outcomes. Therefore, there is the need for developing reliable information system that will enhance communication between nurses and other stakeholders involved in the healthcare services delivery. It is regrettable that the current information infrastructure encompasses faults in many aspects. For instance, workforce data is not available, and this is considered as a significant drawback in workforce planning.
In ensuring a transient transformation of the US healthcare system under the ACA reforms, IOM offers 8 recommendations that will enhance the achievement of the desired targets.
Recommendation one aims at removing the scope of nursing practice barriers that seem to have hindered progress in the current healthcare system. They observe “advanced practice registered nurses should be able to practice to the full extent of their education and training” (p. 278). As such, it advices the congress and legislature to carry out the amendment of some legislation, in order to lift the existing barriers witnessed in the scope of the nursing practice. It requires the congress to carry out amendments on the Medicare program, in order to allow an extension of nursing care to patients in hospice and other advanced nursing facilities. It also requires the congress to extend the scope of nursing under the state law, more or less the same as it is the case for physicians.
On the other hand, IOM advises the state legislatures to reform the scope of nursing practice. As such, IOM (2010b) “requires third-party payers that participate in fee-for-service payment arrangements to provide direct reimbursement to advanced practice registered nurses who are practicing within their scope of practice under state law” (p. 1). It also advices the centers for Medicaid and Medicare services to extend eligibility to registered nurses.
The second recommendation deals with the expansion of opportunities for nurses. This is expected to enhance improvement efforts through collaboration. Expansion of opportunities to nurses includes their participation in research and other healthcare related investigations that are aimed at improving healthcare service delivery in the US healthcare system. As such, IOM requires the Center for Medicaid and Medicare to support the development of appropriate models of payment for registered nurses, in order to acknowledge leadership roles of the nursing professionals. This will help in reducing costs and improving health outcomes.
On the other hand, research models of care are supposed to be developed in addition to the incorporation of innovative solutions, in order to ensure the nurses’ potential is utilized for the improvement of care in a care setting. However, this requires funding from the relevant organizations including private and public funders. In achieving this objective, IOM (2010b) states “Health care organizations should engage nurses and other front-line staff to work with developers and manufacturers in the design, development, purchase, implementation, and evaluation of medical and health devices and health information technology products” (p. 2).