Nursing Purpose.
The Institute of Medicine (IOM) report examines how nurses’ roles, responsibilities, and education should evolve to meet the needs of an ever-changing health system (Campaign, 2013). The report focuses on the health needs of our diverse patient population and the readiness of the nursing work force to provide that care. The goal is to improve the health care for all Americans. In 2008, The Robert Wood Johnson Foundation (RWJF) and the IOM launched a two-year initiative to respond to the need to assess and transform the nursing profession. (NASEM, 2010). The committee developed four key messages:
- Nurses should practice to the full extent of their education and training (NASEM, 2010).
- Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic profession (NASEM, 2010).
- Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States (NASEM, 2010).
- Effective workforce planning and policy making require better data collection and information infrastructure (NASEM, 2010).
Nursing Practice.
The advancement of the health-care system and the changing profile of the population of patients has required a transition to patient-centered care. IOM defines patient-centered care as “Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that the patient values guide all clinical decisions” (Oneview, 2015). This requires delivering more primary care as opposed to specialty care. Nurses provide primary care services in all aspects of health-care across the world from hospitals to home care. Patients, in all settings, deserve care that is focused on their unique needs and not what is most convenient for the staff involved in their care.
The nursing profession unfortunately has many obstacles that interfere with our progression. Some examples are strict regulatory laws and policies, abnormal nurse turnover rates and a soon to be shortage because of the rate of retiring nurses. In order to be a valuable asset to the patient, a nurse should be allowed to practice to the full extent of their education and training. Regulatory barriers are the biggest problems for nurses. An example would be advanced practice registered nurses (APRNs). States independently determine what tasks an APRNs are allowed to perform (NASEM, 2010). It is not based on their education and training but determined by the groups and individuals that govern rules and regulations. This is an on-going battle with physicians, states, and other regulatory boards that manage the nursing scope of practice. APRNs are well trained and very capable of providing primary care to their patients. APRNs are not being used to their full potential.
High turnover rates among nursing staff at hospitals result in the loss of talent and dollars from repeated training of nurses that never evolves into a well-experienced nurse. Many hospitals have developed a nurse residency program to assist in the transition from school into the actual work-force. The program provides a set of learning opportunities that focus on institutional and departmental practices, policies, procedures and standards of care (ANA, 2018). An orientation that includes a residency program improves communication skills, builds confidence of one’s skills and increases accountability. The program allows new nurses to try different units/floors that may be of interest in order to find their perfect niche. Participating in such a program provides new graduates with the opportunity to evaluate their weakness and strengths. The nurses that complete a residency program have an easier transition into the units and floors than a traditional orientation nurse. Such programs have been shown to dramatically reduce the number of registered nurses who leave the profession.
The aging population also affects the nursing organization. The shortage of nurses has been a topic of conversation for many years. Over the next few years there will be a large number of nurses to retire which will dramatically increase the shortage of nurses. These well-trained and highly experienced nurses are often the front-line, bedside nurses who are veterans in the field. Their absence with greatly decrease the number of skilled nurses available in the field.
Nursing Education.
The nursing profession is the largest segment of the nation’s health care workforce (ANA, 2018). A strong and highly educated nursing workforce is the key to a healthier America. Nurses are the ones working on the front lines of patient care. One of the goals of the IOM report is to increase the number of higher educated nurses. This can be done by increasing tuition reimbursement, offering more scholarships and loan forgiveness programs for nurses. It has been proven that increased education results in increased patient outcome and satisfaction. Advanced degrees are allowing nurses to advance in other areas of nursing such as leadership, research, public health and informatics. The campaign to educate 80 percent of nurses to bachelor’s degree level by 2020 and to double the number of doctoral nurses continue to be promoted (Campaign, 2013). There is an enormous need for more education funding for nurses to advance their degrees and also a need for employers to provide work schedules that are more conducive to the pursuit of advanced degrees. Student loan debit is growing exponentially. Many nurses have families and cannot afford to pay for additional schooling and training.
Nursing Leadership.
Nurses should be the primary ones that transition from the bedside to the leadership roles (NASEM, 2010). Nurses have the bedside knowledge and can acquire the leadership skills from proper schooling and training. Nurses are very capable of managing and leading others throughout the healthcare systems. From the bedside to the boardroom, nurses can serve as full partners with leaders from all entities of the health care system. Nurses must be involved in all divisions of the leadership process which includes improvement, patient safety, ethics, cost management, and policy making. Nurses must begin to see themselves as partners in the health system and educate themselves accordingly. Leadership training should be offered to all who are interested. The IOM report recommends that “Nurses, nursing education programs, and nursing associations should prepare the nursing workforce to assume leadership positions across all levels of healthcare. Public, private and governmental healthcare decision makers should ensure that leadership roles are available and filled by nurses.” (NASEM, 2010)
Conclusion.
Health care is a complex and evolving system. Nursing is one of the most vital and versatile occupations within the health-care workforce. Nurses are the back-bone of the health-care systems and the responsibilities of nurses will continue to increase over the years to come. Nursing education should be tailored to meet the needs of an ever-changing population. Nursing research and practice must continue to identify and develop evidence-based improvements to patient care while nursing leaders must translate new research findings into practice and policies. Front-line nurses have the responsibility of implementing the practice and policies. Nurses play a key role in transforming the health care system to create a high-quality and patient focused environment for all.
The IOM report has changed my vision of nursing. I am more aware of the changes and expectations of the nurse role in the future of healthcare. I want to be an advocate for my patient and provide the best care in all aspects of health-care possible. In order to provide such services, I must equip myself with additional knowledge, education, and skills to ensure that my patients can have the best outcome possible. My ultimate goal is to be the best nurse I can be for my patients and families. With the continued advancements in the field overall, I expect to receive the same should I ever become the patient. I can only provide these services by educating and preparing myself. I also have to become more involved in the leadership roles and the decision making of my unit and hospital. I need to have a voice in my future because my patients depend on it and so does the future of nursing.
References
Institute of Medicine: The Future of Nursing (2018). Retrieved from
https://www.rn.ca.gov/careers/iom.shtml
IOM Future of Nursing Report, American Nursing Association (2018). Retrieved from
https://www.nursingworld.org/practice-policy/iom-future-of-nursing-report/
“The Eight Principles of Patient-Centered Care.” (May 2015) Retrieved from
https://www.oneviewhealthcare.com/the-eight-principles-of-patient-centered-care/
“The Future of Nursing IOM Report.” (May 2013). Retrieved from
“The Future of Nursing: Leading Change, Advancing Health, Institute of Medicine.” (October
2010). Retrieved from
http://nacns.org/wp-content/uploads/2016/11/5-IOM-Report.pdf
“The Future of Nursing: Leading Change, Advancing Health.” The National Academies of
Sciences, Engineering Medicine (NASEM). (October 2010). Retrieved from
https://nationalacademies.org/hmd/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health/Infographic.aspx