Implementation of the IOM

“The Future of Nursing Leading Change, Advancing Health”

In 2008 The Institute of Medicine (IOM) and Robert Wood Johnson Foundation (RWJF) joined forces to develop a report to address the important issues facing nursing and healthcare in the future. “The Future of Nursing Leading Change, Advancing Health” was the product of this partnership and made several recommendations intended to shape the future of nursing to meet the current and future health care needs of the United States The report made several recommendations which include: nurses beginning to practice at the level of their education background, nurses should seek higher levels of education, and nurses should be partners in healthcare working together with physicians and health care providers to redesign healthcare to meet the needs of the future.

The IOM Report and the Nursing Shortage

The United states is currently facing significant nursing shortage in the several years and with this ongoing and expected shortage the effects of healthcare are far reaching. From 2008- 2020 Over 50% the nursing workforce are expected to leave the profession at time when healthcare demands increase with the aging population of the baby boomers (US Nursing Workforce, 2013).

With so many of the nursing workforce expected to retire and many new nurses leaving the workforce prematurely the IOM report is recommending ways to better prepare these nurses for to function in the role and possible decrease burn out and possible early exit from the nursing workforce. One of these recommendations includes a nurse residency programs. Not unlike physicians that complete residency programs to prepare them for practice and nurse residence program could better prepare and nurse to transition from school life to actual practice, better preparing highly skilled nurses to meet the more intensive demands in health care (Institute of Medicine 2011).

Nursing functioning at the Level of their Education

With the aging population and more people having access to healthcare largely due to the Affordable Health Care Act and a focus on prevention and wellness more and more people are seeking care and nursing must respond to that need. Nursing practice must change to help meet future demands. The IOM report in alignment with the recommendation that the entry level of RN increases to BSN level but also that all nurse must continue their education beyond the BSN and that nurses must be able to function at the level of their education. At this time many state legislatures do not allow for Advanced Practice Nurses and Certified Nurse Midwifes to function at their level of education. Adjusting legislature and the nursing scope of practice in these states will increase the number of primary care providers available to care for this increased population needs (IOM,2010).

To this end several suggestions were made to state governments to make these recommendations a reality. Nursing boards should adjust scope of practice to allow nurses to practice at a level of their education, this would be especially important for Advanced Practice Nurses in allowing them to take an active part in the primary care of the state’s population. The IOM report also suggest that the entry level of education should be of Baccalaureate trained nurse. The report recommends that at least 80% of the American nurse’s workforce should be made up of bachelor’s degree or higher nurses by 2020. (Creating a More Qualified, 2015).

Nurses as Leaders

The IOM report states “Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States” (IOM 2010). Throughout history nurses have played key roles in advocating for patients and carrying out the orders of physicians. With the ever increasing complexity and demands of health care nurses need to work as a full partner with other multidisciplinary teams to create policies and programs to continue to provide safe healthcare in this increasingly demanding healthcare environment.

State Based Efforts to Support Future of Nursing: Campaign for Action

Many states are striving to make changes to do their part in advancing nursing goals. These coalitions are critical to make changes in nursing practice and meet the needs of future healthcare. New Mexico not unlike many states in the United States face critical nursing shortages now and increasing in the future. The New Mexico Center for Nursing Excellence (NMCNE) was established in 2002. Their main goal is to advocate for nursing profession to better meet the healthcare needs of New Mexico Residents and achieve the recommendations of the IOM report.

One of the projects to help support the implementation of IOM recommendations in the states is working with the University of New Mexico to better understand the effects of nursing shortage on the State of New Mexico. The NMCNE has initiated a study to examine the current and future projected needs of the nursing workforce in the state as more and more of the workforce plans to retire and needs of healthcare increases. Current Studies reveal that the increase in entrants to nursing profession trend should cover the number of nurses retiring and will help to maintain an even number of registered nurses. While the number of nurses remain stable the current number of nurses still will not meet the future needs of an aging population. Problems are noted with not having enough qualified nursing instructors to continue to train new nurses. As nursing wages have increased it was noted that the pay of nursing instructors has not. This imbalance leads to not having enough qualified nursing instructors therefore limiting the number of new nurses allowed into the programs throughout the state.

In 2010 the New Mexico Board of Nursing and the New Mexico Center for Nursing Excellence sponsored a report to the House that prescribed a statewide plans for nursing education. This plan identified the need for more instructors to teach and nursing schools in response to the shortage of qualified instructors. This plan also included the need to increase the number of Baccalaureate trained nurses in the state which support the IOM recommendations of having at least 80% of Nurses with BSN or higher in the workforce. The New Mexico Center for Nursing Excellence (NMCNE) has worked to developed partnerships with community colleges and four year universities to develop a curriculum that supports the BSN trained Registered Nurse.

New Mexico Nursing Education Consortium (NMNEC) has worked to develop a curriculum which has 2 tracks. One track starts with an Associate Degree program and the other is in 4 year universities. Unlike many where many nurses complete a 2 year ADN program then end with licensing as a registered nurse at which time the nurse has the option to go back for higher learning at a later date. The NMNEC curriculum provides a continued progression toward the BSN without leaving the community college and community they reside in. Unlike many 2 year plus 2 year programs the student works simultaneously for their ADN and BSN program but attends school at the 2 years college in their home area. This is accomplished by attending bachelor level courses that are taught in the community college. This has far reaching goals of offering BSN programs where no 4-year university exist, allowing more students to study and graduate that do not reside in big metropolitan cities. Currently the programs are available in the Santa Fe Community College, New Mexico Junior College, San Juan College. The Goal is that by fall of 2017 this curriculum will be available in all public institutions. These programs aims to increase the number of BSN trained Registered nurses in the state which is one of the IOM report recommendations (Evans-Prior, Morton, & Brady, 2014).

Conclusion

Overall the IOM report recommendations have the ability to completely change the landscape of nursing in the United States. These changes are needed for the nursing community to keep up with allow healthcare in the united states to thrive. Increasing the level of education and training while allowing nurses to work at their educational potential will only help healthcare in a time when healthcare and the lives of Americans is at stake. Nurses play a key role as leaders in making these changes a reality.