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ADVANCE Perspective: Nurses

The IOM Report on the Future of Nursing—3 Years Later

Published February 18, 2014 10:23 AM by Guest Blogger
Elaine Keavney, is director of the nursing program at American Public University

The Institute of Medicine (IOM), working with the Robert Wood Johnson Foundation, released its landmark report, The Future of Nursing: Leading Change, Advancing Health in October 2010. With changes in the entire healthcare system anticipated as a result of healthcare reform, the IOM report said that nurses need to be prepared for changing and evolving roles in caring for patients and leading change.

The report contained eight clear recommendations for change:

  • Remove scope of practice barriers
  • Expand opportunities for nurses to lead and diffuse collaborative improvement efforts
  • Implement nurse residency programs
  • Increase the proportion of baccalaureate-prepared nurses to 80% by 2020
  • Double the number of nurses with a doctorate by 2020
  • Ensure that nurses engage in lifelong learning
  • Prepare and enable nurses to lead change to advance health
  • Build an infrastructure for the collection and analysis of healthcare workforce data

In the three years since the IOM report was released, exciting changes continue to take place throughout the country in support of these recommendations. There had been discussion of all of these topics at one time or another for years, but no previous work has had the impact of the IOM report. The clear messages in each of the eight recommendations have provided structure and specific goals. 

As an example, there has been discussion of associate vs. baccalaureate education as a professional entry point almost since the first associate degree program was developed.   But, a specific target number-80 percent of nurses with baccalaureate degrees by 2020-is achievable in most areas, and has completely eliminated the politically-charged conversations about whether nurses should be baccalaureate-prepared as they enter the profession.  

The IOM also led to the formation of Action Coalitions in all 50 states.  Each coalition is unique and is working within its own state nursing culture to evaluate needs and work toward the implementation of the IOM recommendations.  Some are supported by grants from The Robert Wood Johnson Foundation.

A recent three-year review by the Robert Wood Johnson Foundation provides other examples of activities spurred by the IOM report:

  • Seven states have removed major scope of practice barriers, primarily to advanced practice registered nurses (ARNP)
  • The Federal Trade Commission has challenged limits to nursing scope of practice in a number of states
  • The American Academy of Nursing has developed an initiative to advocate for the appointment of nurses to influential leadership positions
  • Many states report work on dual enrollment in associate and baccalaureate degree nursing programs and other initiatives to enhance seamless academic progression
  • Medicare is paying to support nursing education with a $200 million demonstration project in five hospital systems

There is much work that remains to be done.  But, for the first time, there is significant momentum move nursing forward, to recognize its considerable contributions to the health of the nation, and to place nurses in positions to truly lead change and advance health. It is indeed an exciting time to be a nurse in 2014!



posted by Guest Blogger


What is the role of the LPN?  Are their numbers expected to climb?

Fran, LTC - RN February 18, 2014 1:27 PM
Palmyra NJ

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