November 1, 2011
The Institute of Medicine (IOM) is an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public. It asks and answers the nation’s most pressing questions about health and health care through studies, their expert consensus committees, and convening a series of forums, roundtables, and standing committees, as well as other activities. These facilitate discussion, discovery, and critical, cross-disciplinary thinking. Their aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely (IOM, 2012). In 2010, Congress passed and the President signed into law comprehensive health care legislation, collectively referred to as the Affordable Care Act (ACA), which gives the United States an opportunity to transform its health care system to provide higher-quality, safer, more affordable, and more accessible care. Recognizing that the nursing profession faces several challenges in fulfilling the promise of a reformed health care system and meeting the nation’s health needs, Robert Wood Johnson Foundation (RWJF) and the IOM completed a 2 year initiative on the future of nursing. The report contains recommendations for an action-oriented blueprint for the future of nursing, including changes in public and institutional policies at the national, state, and local levels. The passage of the ACA, the IOM report, and its recommendations have an immense impact on nursing education, nursing practice - especially in the primary care setting, and the roles of nurses in leadership. The emergency department in which I work is progressively changing its practice to meet the goals of the IOM report. It is important that nurses achieve higher levels of education and training as well as practicing to the full extent of their education and training (IOM, 2012).
Major changes in the U.S. health care system and practice environment will require equally profound changes in the education of nurses both before and after they receive their license. 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. Recommendations in the IOM report have a huge impact on nursing education (IOM, 2012). My hospital, which is a Magnet facility, is now mandating that all employed nurses obtain their BSN in nursing by 2018, which is two years earlier than the IOM’s recommendation that 80 percent of registered nurses nationwide have their BSN by 2020. The IOM also recommends that diploma and ADN nurses obtain their BSN earlier in their careers. Studies found that BSN graduates reported significantly higher levels of preparation in evidence-based practice, research skills, and assessment of gaps in areas such as teamwork, collaboration, and practice (Kovner et al, 2010). A more educated nursing workforce would be better equipped to meet the demands of hospital settings that continue to grow more complex, and nurses must make critical decisions associated with care for sicker, frailer patients. Higher levels of education for nurses have an impact on nursing practice.
As seen in the IOM reports recommendations, nursing practice is being affected by the following barriers:
Fragmentation of the health care system. There is a disconnect between public and private services, between providers and patients, between what patients need and how providers are trained, between the health needs of the nation and the services that are offered, and between those with insurance and those without (Stevens, 1999). Without the presence of nurses in decision-making positions in new...