The Future of Nursing

In October 2010, the Institute of Medicine (IOM) released its highly anticipated report, The Future of Nursing: Leading Change, Advancing Health (the complete report is accessible at www.iom.edu/nursing). In a nutshell, it calls for new and expanded roles for nurses in a redesigned, patient-centered healthcare system. The report presents 4 key recommendations.

The first recommendation is that nurses practice to the full extent of their education and training. This doesn’t mean that nurses arbitrarily expand their scope of practice; what it means is that nurses should be able to fully use their knowledge and skills. State licensing laws determine a nurse’s scope of practice, and nurses must practice within this scope. Unfortunately, many nurses discover a disconnect between the skillset their education has equipped them with and what they’re authorized to do at their healthcare facility.

Nursing education is the focus of the IOM’s second recommendation. The Institute proposes that nurses achieve higher levels of education and training through an improved education system that promotes seamless academic progression. This is music to the ears of nurses who want to advance their education but have encountered barriers. Nurses have told me that admission criteria varies and often there is little to no recognition of coursework already completed, especially for nurses returning to school several years after earning their nursing degree.

According to the IOM, the renewed focus on nursing education should promote a more diverse nursing workforce, particularly in the areas of gender and ethnicity. This last point is one that should be emphasized, since 94% of nurses are women. Unlike with flight attendants and teachers, in which both genders are represented, nursing remains a female-dominated profession.

The third IOM recommendation is that nurses should be partners with physicians and other healthcare professionals in redesigning healthcare in the United States. Nursing education programs must integrate leadership development, and leadership development opportunities must be available to nurses practicing at all levels. Nurses also need to take personal responsibility for their own professional growth by developing or strengthening leadership competencies and demonstrating those competencies across all care settings.

The IOM’s final recommendation is that effective nursing workforce planning and health policy require better data collection and an improved information infrastructure. Workforce data must be collected and analyzed, and made publicly available. Reliable data will enable researchers to accurately predict future nursing workforce needs.

As its suggestions demonstrate, the IOM recognizes that nurses represent the largest segment of the healthcare workforce and work on the frontline of patient care. Nurses can—and should—play a fundamental role in the transformation of healthcare. Unfortunately, not everybody agrees. The American College of Physicians (ACP) and American Medical Association (AMA) promptly released responses to the IOM report. Both organizations noted that although many of the recommendations are consistent with their positions, the IOM report also contains some elements that concern them. These include the role of nurses (especially advanced practice nurses) in providing primary care. The ACP asserts that internists are well suited to providing comprehensive care and that patients may be best served by internists or other physicians who work with a team of healthcare providers that may include advanced practice nurses. The ACP notes that advanced practice nursing cannot substitute for nor replace primary care medical practice. The AMA asserted that only physicians can lead healthcare teams because they are more educated than nurses.

So the turf war in healthcare continues. Unfortunately, this struggle is destined to focus less on what patients need and more on publicizing contentious disagreements. Thus, the IOM report is another step forward for the nursing profession, but the medical community’s response is a half step backward. Regardless, the patients themselves will ultimately decide who they want their healthcare providers to be. For my part, I’m hoping that they’ll choose well-educated nurses who practice to the full extent of their education and training.