IOM Recommendation on Nursing Education
IOM Recommendation on Nursing Education
The American population is increasingly diverse and aging. This demographic shift has implications for the health care system. Chronic disease experienced as comorbidities with attendant disability among older adults increases the demand for acute and long-term care. Chronic disease is also prevalent in the younger population and increasing among children. In addition, there are issues regarding the safety and quality of care with the high incidence of preventable complications in many health care settings. The disease burden accounts for the U.S. being one of the countries with the highest spending in health care.
The Accountable Care Act of 2010 addresses these concerns through a transformation of the health care system. Enhancing the role of nurses is pivotal to achieving patient-centered, safe, and high-quality care. Towards this end, there is a need to reorient and improve nursing education. The Institute of Medicine, following a study, recommended that “nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression” (IOM, 2010, p. 1). Education must be lifelong beginning in pre-licensure and continuing into the workplace.
In a health care system focused on treatment, the nursing curriculum has been geared to educate nurses in providing acute care. Thus, competency is wanting in the areas of public health, primary care, and long-term care. The complexity of chronic illnesses compels patients to cycle through one level of health care to another. They also require the services of a variety of professionals. However, nurses are ill-prepared to effectively coordinate care, facilitate transitions, and collaborate with members of the team (Gregory, Bolling & Langston, 2014).
Nursing education further does not prepare nurses to assist patients in navigating programs and services or to advocate on their behalf because of a lack of understanding of the underlying policies. Improving the curriculum entails an integration of competencies in “leadership, health policy, system improvement, research and evidence-based practice, teamwork, and collaboration” (IOM, 2010, p. 2). Nursing education must also develop competency in public health, community, and geriatric nursing. At the same time, there are many opportunities to expand the nursing role such as information management.
Having different pathways to nursing also impacts the quality of nursing education. Licensure can be through a diploma in nursing, associate’s degree, or bachelor’s degree. While the bachelor’s degree allows for learning more of the aforementioned competencies, majority of nurses are educated at the associate’s degree (AACN, 2010). Further, few nurses pursue post-graduate education. As a consequence, not enough are sufficiently prepared for the faculty role creating a bottleneck in the nursing education pipeline. This is the background that led to specific proposals and targets toward improving the educational preparation of nurses.
The current advocacy is spearheaded by the Robert Wood Johnson Foundation (RWJF) and the IOM. Improvements in nursing education are within the context of a wider effort to improve many aspects of the nursing profession including addressing the labor shortage and high turnover. The effort is outcome orientated because of the targets set within a defined timeframe. The IOM intended the recommendation to inform legislation especially at the state level as this will address the particular issues with nursing programs in the state context. The National League for Nursing Accrediting Commission (NLNAC) and the Commission on Collegiate Nursing Education (CCNE) are also called upon because they are in the best position to require nursing programs to develop the best pathways to BSN and postgraduate education (IOM, 2010).
Health care organizations are further asked to motivate non-BSN RNs among their staff to seek a bachelor’s degree. The role of grant funders in stimulating innovations in improving the curriculum and expanding nursing programs to increase diversity and the number of graduates was highlighted as well. Finally, the federal government and states are asked to provide financial support to nurses seeking to improve their education (IOM, 2010). Partnerships between nursing programs and other disciplines are encouraged to promote collaboration through joint learning activities. Lastly, nursing program partnerships with health care organizations are promoted to foster learning between clinicians and the academe. The RJWF partnered with the American Association of Retired Persons (AARP) to launch the Future of Nursing – Campaign for Action (RJWF, 2012).
Perspective of Stakeholders
The recommendation increased awareness of the important role of nurses at the national level so that it became everyone’s concern. The Tri-Council for Nursing consisting of the American Nurses Association (ANA), American Association of Colleges of Nursing (AACN), National League for Nursing (NLN), and American Organization of Nurse Executives (AONE) endorsed the recommendation (Tri-Council for Nursing, 2010). The American Hospital Association (AHA) and the Joint Commission also voiced alarm over the nursing crisis. Many legislators at the state level supported actions related to improving nursing education. The Future of Nursing-Campaign for Action, a nationwide initiative to realize the IOM report targets, made possible large-scale multisectoral partnerships between nurses, physicians, non-profit organizations, academe, researchers, consumer groups, communities, and business (Campaign for Action, 2014). Funding for initiatives was a common barrier at the onset but is slowly being overcome because of financial support from diverse stakeholders currently amounting to $6 million.
The IOM recommends that nurses increase the level of their education to at least the baccalaureate level with the target set to 80% of nurses with a BSN by 2020. Innovative ADN to BSN and LPN to BSN programs were created with some operating as partnerships between university programs and community colleges (AACN, 2014). Current solutions also foster a tighter collaboration between hospitals and nursing programs to ensure that nurses fulfill the entry-level expectations of the workplace. Examples of collaboration are internships at the hospital during the fourth year of study, and graduate residency (Gregory, Bolling & Langston, 2014). Employers are now giving incentives for nurses to pursue graduate education in ADN to MSN and BSN to MSN tracks. Those with an MSN are further encouraged to have their PhD.
Curriculum changes are being done to incorporate the aforementioned competencies in the context of state and regional alliances. Methods of instruction and learning are also being improved. Many states offered grants to nursing programs to stimulate innovations in teaching and to generate commitment to graduate more baccalaureate degree nurses who are likely to pass the licensure examination (RWJF, 2013). Innovations include simulations, mentorship by a nurse in the clinical setting. Increasingly, RN programs are including community nursing experiences in the undergraduate curriculum. However, efforts at the hospital level to support nurses in attaining higher levels of education is perceived as inadequate (RWJF, 2013).
Current Status in the Policy Arena
As mentioned, the IOM recommendation and the Campaign for Action spurred legislation at the state level to support nurses and the enhancement of the nursing curriculum through scholarships and funding. Recently, the Centers for Medicare and Medicaid (CMS) committed additional funding for nurses’ training (CMS, 2012). The Health Resources and Services Administration (HRSA) has also offered scholarships in response to the IOM call. At the federal level, the ANA led an initiative to get a $251-million funding that will realize the Nursing Workforce Development Programs outlined in the Public Health Service Act, Title VIII (ANA, 2013). The advocacy had the support of 84 members of Congress and 27 senators. The campaign is ongoing with hopes of generating enough political pressure for the funding request.
The IOM recommendation for increasing the education of nurses and promoting lifelong learning is appropriate given the state of nursing education. It is the first initiative to highlight the importance of nurses in transforming the health care system. Through the recommendation, national advocacies aimed at meeting the IOM targets generated support for RN education from various sectors. There are tangible results such as curriculum changes, employer encouragement, and non-traditional programs for progression into the BSN. Using the advocacy through a coalition approach to implementing the recommendation is warranted. First, there are many stakeholders in the nursing education issue who play crucial roles in its improvement and therefore need to collaborate. Policy advocacy at the state and federal levels are just part of the solution. Second, coalitions permit nurses to exercise their leadership capacity given that they compose majority of the health care workforce. The experience serves as a springboard for future advocacies for change in the health care system.
American Association of Colleges of Nursing (2014). Creating a more highly qualified nursing workforce. Retrieved from http://www.aacn.nche.edu/media-relations/fact- sheets/nursing-workforce
American Nurses Association (2013). Title VIII Nursing Workforce Development Programs. Retrieved from http://www.rnaction.org/site/PageServer?pagename=nstat_title_viii_read_more
Centers for Medicare and Medicaid (2012). Graduate nurse education demonstration solicitation. Retrieved from http://innovation.cms.gov/Files/x/GNE_solicitation.pdf
Future of Nursing-Campaign for Action (2014). Campaign progress: Advancing education transformation. Retrieved from http://campaignforaction.org/campaign- progress/advancing-education-transformation
Gregory, S., Bolling, D.R., & Langston, N.F. (2014). Partnerships and new learning models to create the future perioperative nursing workforce. AORN Journal, 99(1), 96-105. Retrieved from http://dx.doi.org/10.1016/j.aorn.2013.10.012
Robert Wood Johnson Foundation (2013). Three years later, Institute of Medicine report is fueling innovations in nursing practice and education. Retrieved from http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2013/10/three-years- later--institute-of-medicine-report-is-fueling-innov.html
Tri-Council for Nursing (2010). Tri-Council for Nursing calls for collaborative action in support of the IOM’s Future of Nursing report. Retrieved from http://nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/wor kforce/IOM-Future-of-Nursing-Report-1/Tri-Council-PR-IOM-Report.pdf