Nurses form an integral segment of the health care system in the United States of America, and the membership is north of three million members. Being on the frontline of health care delivery to the masses, nurses play a vital role in the realization of the objectives envisioned in the 2010 Affordable Care Act. Much as nurses are well positioned to lead changes in advancing health care, they are faced with a number of challenges. These challenges act as barriers that undermine the ability of nurses to effectively and efficiently respond to the dynamic and ever-changing health care system. The 2008 report by Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) was founded on the need to assess and transform the nursing profession. The two-year initiative was spearheaded by a committee appointed by IOM whose sole purpose was to compile a report that would come up with a blueprint for the future of nursing.

The settings that nurses operate in are numerous and varied. The settings include clinics, nursing homes, community, public health centers and battlefield. Depending on the level of education and competency, nurses can be involved in direct patient care or in research that helps to improve nursing practice. In this committee’s effort to envision the future of the nursing profession, the Committee considered different nursing roles, across different setting and different levels of education. After thorough deliberations and deep considerations, the committee came up with four key recommendations that will guide the future of the nursing profession. This essay will seek to explain and summarize the key messages that are contained in the IOM report on the future of nursing and the impact on nursing workforce.

The first key message contained in the report is that nurses should practice in accordance with their education and training level. Nurses have different levels of education and training ranging from basic to advance. While most nurses are registered, a good number have advanced training are termed as advanced practice registered nurse. These include individuals with master and Ph.D. level training, midwives, nurse anesthetists and nurse practitioners. Regardless of the level of training, regulations regarding the scope of practice for nurses vary across states. For instance, in some states, nurse practitioners can diagnose and prescribe medication for clients without consulting a physician. This, however, is not the case in some states. The extent to which nurses can practice is not determined by their level of education but by the varying state regulation that govern the scope of practice of nurses. On this premise, the report recommends that nurses be allowed to practice in accordance to the full extent of their training and education level.

The second vital message that was proposed by the IOM report on the future of nursing is that nurses should achieve high education level facilitated by an improved education system that promotes academic progression. To guarantee quality care that is patient-oriented, nurses need to be competent. Competency is a product of quality education and residency that ensures a smooth transition from school to clinical practice. The needs of patients have become complex and dynamic. To better respond to these needs, nurses need to attain high levels of quality education. The competencies that nurses must have include teamwork, evidence-based practice, community, and public health, health policy and health system improvement, research and inter-cadre collaboration. Nurses should aim at achieving advance levels of education such as bachelor’s degree, masters and doctor of nursing practice. The crux of the matter in ensuring that nurses remain competent lies in the diversification of nursing practice and ensuring that nurses are trained by physicians.

The third importance component of the report by IOM on the Future of the nursing profession is that nurses should work hand in hand with other health professionals in the United States in redesigning health care. Building the leadership capacity of nurses on the frontline of service delivery, arms them with the necessary skills that will improve health care service delivery and advance the nursing profession. Nurse leaders should contribute constructively to the profession, be accountable to their contribution and work in tandem with other professional leaders to bring changes in health care. In addition, nurses should take an active role in policy formulation, the decision-making process and lead implementation of policy at user level. Nurses should also play an advisory role to the relevant authority with an aim to improve health care. In order to prepare nurses to take up active leadership roles, nursing education programs should include leadership competency in their scope. Additionally, leadership development programs should be a common place in the nursing profession and should be harnessed to leverage on the skills of nurses.

Lastly, the IOM committee recommended that policy making requires good data and information structure. Planning for healthcare workforce requires identification of labor gaps and steps on how to fill this gap. The planning process involves identifying the number of nurses and how many will be needed to fill the gap. Creation of National Health Care Workforce Commission and National Center for Workforce Analysis is envisioned in the 2010 Affordable Care Act. The workforce commissions are mandated with monitoring the supply and demand of health care workers in different professions. To effectively carry out their mandate, the commissions need better data that brings out statistics at state and national level.

State progress report

The New Jersey state coalition is among the many coalitions that work to promote the recommendations of the IOM report on the future of the nursing profession. One of the recommendations is to increasing the number of nurses in boards. New Jersey has a number of boards and commissions whose members are directly or indirectly, through approval of the state Senate, appointed by the Governor. Appointments are based on different areas of need that include adolescent pregnancy and alcohol and drugs. The appointment process is preceded by formal applications through submission of a resume by the applicants who have to be community members. Through these boards, nurses have an opportunity to position themselves strategically to influence change in the community and the profession at large.

Conclusion

Nurses have an opportunity to influence change in the health care system of the United States of America. Much as nurses play an integral role in the transformation of the health care system, they need to work with regulatory bodies, other professions, health care organizations and the government. The outcome of this multi-sectoral collaboration is a health care system that is responsive to needs of the citizens.