IOM Nursing Reports

REPORT IN BRIEF Institute of Medicine DECEMBER 2015

Assessing Progress on the Institute of Medicine Report The Future of Nursing

In 2010, the Institute of Medicine (IOM) released a landmark report, The Future of Nursing: Leading Change, Advancing Health, that addressed the crucial role of nurses in a rapidly evolving health care landscape. Shortly after the release of this report, the Robert Wood Johnson Foundation (RWJF), in partnership with AARP, launched the Future of Nursing: Campaign for Action (the Campaign). The Cam- paign has since worked at the national and state levels to shepherd the report’s recommendations.

RWJF asked the IOM to convene a committee to examine changes in the fi eld of nurs- ing since the release of The Future of Nursing report and to assess progress made in implementing the report’s recommendations. The resulting report, Assessing Progress on the Institute of Medicine Report The Future of Nursing, offers recommendations that provide a blueprint for the Campaign and other stakeholders to accelerate implementation of The Future of Nursing recommendations.

CONTEXT The more than 3 million registered U.S. nurses make up the largest segment of the nation’s health care system. Nurses work in a wide variety of settings, including hospitals, public health centers, schools, and homes, and they provide a continuum of services including direct patient care, health promotion, patient education, and coordination of care.

The Affordable Care Act created new health care delivery and payment models that emphasize teamwork, care coordination, value, and prevention: models in which nurses can contribute a great deal of knowledge and skill. Indeed, the nursing pro- fession is making a wide-reaching impact by providing quality, patient-centered, ac- cessible, and affordable care. The 2010 report issued a number of recommendations aimed at helping to ensure that nurses are prepared to help fi ll the need for quality health care in a fundamentally shifting care delivery system.

The Campaign and many other stakeholders have worked to prepare nurses for new and vital roles. The current committee fi nds that the Campaign has made signifi cant

The nursing profession is making a wide-reaching impact by providing quality, patient-centered, accessible, and aff ordable care.

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progress in many aspects of its work in a short period of time. For continued progress, work in specifi c areas, as outlined below, requires more focus and attention.

AREAS OF RECOMMENDATION In a changing health care culture and landscape, with increasing importance placed on interprofessional collaboration, the Campaign, the fi eld of nursing, and stakeholders in other professions working to improve health care delivery can continue to make signifi cant contributions by addressing challenges in the areas of health care delivery and scope of practice, education, collaboration, leadership, diversity in the nursing profes- sion, and workforce data.

Removing Barriers to Practice and Care The 2010 report proposed that Advanced Practice Reg- istered Nurses (APRNs), if permitted to practice to the full extent of their education and training, could help build the workforce necessary to satisfy the health care needs of an increasing number of people with access to health insurance and contribute their unique skills to the delivery of patient-centered health care. Steps have been taken at both the federal and state levels, but barriers to expanding APRN scope of practice remain.

Collaborative models of practice, in which all health professionals practice to the full extent of their education and training, optimize the effi ciency and quality of care for patients and enhance the satisfaction of health care providers. The committee recommends that the Cam- paign work with other health professions groups, policy makers, and the nursing community to build common ground around removing scope of practice restrictions and increasing interprofessional collaboration to improve health care practice in the interest of patients.

Transforming Education Transformation in the health care system and practice environments requires a corresponding transformation of nursing education. For nurses to be prepared to meet increasingly complex patient needs, function as leaders, and advance science, they should achieve higher levels of education, at the time they enter into the profession and throughout their careers. For this reason, the com- mittee recommends expanding educational opportuni- ties, including efforts to: (1) support academic pathways toward the baccalaureate degree; (2) explore ways to create and fund transition-to-practice residency pro- grams; (3) promote the pursuit of doctoral degrees, with an emphasis on the Ph.D.; and (4) promote interprofes- sional and lifelong learning.

Collaborating and Leading Nurses are needed to lead and participate in ongoing reforms to the health care system, to direct research on evidence-based improvements to care, to translate research fi ndings into practice, to be full partners on the health care team, and to advocate for policy change. Nurses in leadership positions contribute their unique perspective and expertise on issues such as health care delivery, quality, and safety. The committee recommends that the Campaign work to expand efforts and opportu- nities for interprofessional collaboration and leadership development. The Campaign also should encourage nurses to serve in executive and leadership positions—in- cluding those at health care systems, insurance compa- nies, government agencies, and advisory committees— such that they may be involved in the redesign of health care delivery and payment systems.

Promoting Diversity The 2010 report identifi ed lack of diversity as a challenge for the profession and indicated that a more diverse

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workforce would help better meet current and future health care needs and provide more culturally relevant care. The Campaign has made diversity one of its pil- lars, and nationwide, many stakeholder organizations in health care, education, and government have taken steps to increase the diversity of the nursing workforce and that of the health professions more broadly. The committee recommends that the Campaign continue to prioritize diversity and implement a series of actions to promote it.

Improving Data There are major gaps in understanding numbers and types of health professionals, where they are employed, and what roles they fi ll. Yet this knowledge is critical to support new models of health care delivery and im- prove patient care. The committee recommends that the Campaign use its strong brand and partnerships to help improve data collection. The Campaign should play a role in convening, supporting, and promoting collaboration among organizations and associations to consider how they might create more robust data sets and how certain data sets can be organized and made available to researchers, policy makers, and planners. The federal government and states also should play a role by expanding existing data collection activities to better measure and monitor the role of nurses in the health care workforce.

CONCLUSION No single profession, working alone, can meet the complex needs of patients and communities. Nurses should continue to develop skills and competencies in leadership and innovation and collaborate with other professionals in health care delivery and health system redesign. To continue progress on the implementation

of The Future of Nursing recommendations and to effect change in an evolving health care landscape, the nursing community, including the Campaign, must build and strengthen coalitions with stakeholders both within and outside of nursing. The committee hopes that its recom- mendations will help the Campaign and other organiza- tions as they work to improve access to quality health care for all. ♦ ♦ ♦

No single profession, working alone, can meet the complex needs of patients and communities. Nurses should continue to develop skills and competencies in leader- ship and innovation and collaborate with other professionals in health care delivery and health system redesign.

Committee for Assessing Progress on Implementing the Recommendations of the Institute of Medicine Report The Future of Nursing: Leading Change, Advancing Health

Stuart H. Altman (Chair) Brandeis University

Carmen Alvarez Johns Hopkins University

Cynthia C. Barginere Rush University Hospital

Richard A. Berman University of South Florida

Karen Donelan Massachusetts General Hospital and Harvard Medical School

Suzanne Ffolkes Research!America

Paula Gubrud Oregon Health & Science University

Jack Needleman University of California, Los Angeles

Michele J. Orza Patient-Centered Outcomes Research Institute

Robert L. Phillips American Board of Family Medicine

Edward Salsberg George Washington University

George E. Thibault Josiah Macy, Jr. Foundation

Study Staff

Adrienne Stith Butler Study Director

Lauren Shern Program Offi cer

Thelma L. Cox Administrative Assistant

Lora K. Taylor Financial Associate

Andrew M. Pope Director, Board on Health Sciences Policy

Study Sponsor

Robert Wood Johnson Foundation

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