Impact of the IOM (2010) report on nursing education, practice, and leadership
With a membership of more than 3 million, nursing is the largest healthcare workforce in the United States (US) (Smith, 2011). Due to their close proximity to and intimate knowledge of patients, nurses can play a significant role in the transformation of the US healthcare system. Nurses, however, are prevented from fully participating in the transformation of the healthcare system by numerous barriers (Institute of Medicine (IOM), 2010). The IOM in its 2010 report entitled “The Future of Nursing: Leading Change, Advancing Health”, made recommendations on the future of nursing with a focus on the areas of nursing education, practice, and leadership.
The IOM (2010) report makes several recommendations with respect to nursing education. These recommendations include an increment in the number of baccalaureate trained nurses to 80% by the year 2020, doubling of the number of nurses with graduate degrees by the year 2020, fostering of life-long learning for nurses, and implementation of nurse residency programs for nurses transitioning from school to practice. The IOM committee posits that due to shifts in patient care needs and demographics and an increase in the complexity of care environments, nurses need to acquire requisite competencies for them to deliver safe and high-quality care. The competencies referred to include leadership, research and evidence-based practice, system improvement, decision-making, and teamwork and collaboration. The report also contends that nurses also need to acquire competencies in specific content areas like geriatrics, informatics, and community health. In order for this to be achieved, the report cites a need for the re-examination, updating, and enhancement of the flexibility of the nursing curricula. The report further posits that the baccalaureate degree equips nurses with the widest range of skills and competencies for nursing practice across different settings. Consequently, it recommends an increase in the proportion of nurses trained at this level. The report notes that certain changes need to be made for this objective to be achieved. These changes include an increase in the number of faculty, increased funding for baccalaureate programs to support the development of necessary infrastructure, and expansion in the capacity of nursing schools to enroll students (IOM, 2010).
Viewed together, the likely impact of the IOM recommendations with regards to nursing education include designation of the baccalaureate degree as the entry-level condition for professional nursing practice in the near future. Other likely impacts include increased innovation in the areas of nursing academia and practice and a shift in the focus of nursing education from acute care to primary and long-term care. In addition, there will be increased emphasis on including educational content that equips nursing students with competencies required for safe and effective practice in the 21st century such as leadership and quality improvement (Holmes, 2011). Lastly, the report will improve access to baccalaureate programs for nursing students by stimulating changes that will improve the infrastructure of nursing schools and create pathways for students upgrading to the Bachelor of Science in nursing degree.
Regarding the impact of the IOM (2010) report on nursing practice, the report notes that all registered nurses including advanced practice nurses in primary care face a number of historical, cultural, regulatory, and policy barriers. These barriers limit their ability to practice to the full extent of their training, education, and competence. In particular, nurse practitioners in primary care are limited in their practice by scope-of-practice restrictions. Most state legislations and regulations that define what nurses can legally do in care provision are outdated or vague and restrictive. In addition, nurse practitioners face other barriers such as professional resistance to their having expanded roles from physicians who feel that they will infringe on their autonomy and economic domains, outdated insurance policies that do not reimburse nurse practitioner services, and fragmentation of the healthcare system. The IOM report contends that primary care provided by nurse practitioners is no less effective than that provided by physicians. It argues that states that have expanded the scope-of-practice of nurse practitioners have not experienced any worsening of patient care. Consequently, the IOM report calls for the elimination of scope-of-practice barriers affecting nurse practitioners as well as other organizational and cultural barriers by relevant state and federal entities. This elimination of barriers should be done with a focus on enhancing collaborative teamwork. Therefore, implementation of the IOM recommendations for nursing practice will greatly transform nursing practice. In particular, registered nurses and nurse practitioners will be able to play a more expanded role as well as take on new roles in the provision of primary care and in the management of chronic diseases. These roles include assessment of patients, prescription of medications, and ordering and evaluation of tests.
On the impact of the IOM (2010) report on the nurse’s role as a leader, the report contends that transformation of the US healthcare system requires strong leadership. The report further highlights the need for nurses at all levels of the profession to actively participate in leadership and be full partners with the other health professions in delivering high-quality care. Identifying the roles each can play, the report calls on bedside nurses, nurse researchers, nursing organizations amongst others to play a role in leadership. The roles that can be played by nursing leaders include translation of evidence-based research findings into practice, identification of problems as well as areas of waste, design and implementation of quality improvement initiatives, evaluation of project outcomes, patient advocacy, and shaping of health policy. In a nutshell, therefore, the IOM report is supportive of nursing leadership and is likely to increase the recognition of nurses as leaders (Smith, 2011). Further, the report provides a basis for re-conceptualization of the nurse’s role as leaders. The report if fully implemented positions nurses to advance and lead change.
In summary, the 2010 IOM report will have significant impacts on nursing education, practice, and leadership if fully implemented. With regards to nursing education, it will influence increased student enrollment for baccalaureate degree programs in nursing, increased funding of such programs, innovations in nursing curricula and teaching methods amongst a host of other changes. With respect to nursing practice, the report if its recommendations are fully implemented will lead to the expansion and redefinition of the roles of advanced nurse practitioners in primary care. Nurse practitioners will be able to carry out and be reimbursed for services that were previously the reserve of physicians. Lastly, the IOM report is advocating for increased involvement of nurses at all levels in leadership. It is, therefore, likely to lead to the re-conceptualization of the leadership roles of nurses.
Holmes, A.M. (2011). Transforming education. Nursing Management, 42(4), 34-38.
IOM (2010). The future of nursing: Leading change, advancing health. Retrieved from http://www.iom.edu/~/media/Files/Report%20Files/2010/The-Future-of- Nursing/Nursing%20Education%202010%20Brief.pdf
Smith, M. A. (2011). Specialty focus-Magnet hospital: Are you a transformational leader? Nursing Management, 42(9), 44-50.