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The Institute of Medicine (IOM) in its Future of Nursing report stated that there is a need for nurses to be able to practice to the full extent and scope of their education and training (IOM, 2010). In doing so, the belief was that this would increase access to care and provide nurses with the opportunity to practice as they were trained. O’Brien (2003) notes, after all, that the whole reason APRNs began being trained in the latter half of the 20th century was to fill the gap being left behind by primary care physicians as they left their primary care practice to go work for specialized medicine. Today, however, nurses are still bound by regulations that require them in many states to work under the supervision of physicians even though the nurses have the training to treat patients independently of doctors.

Still, the recommendations of the IOM are being used in states like Oklahoma to push for new legislation that would allow nurses to be nurses as they were intended to be. If this indeed comes about in Oklahoma and in other states across the country, the practice of nursing will grow and change. Continuity of care, accountable care organizations (ACOs), medical homes and nurse-managed health clinics—all of these will be impacted.

By growing the field of nursing, continuity of care will be improved as it will ensure that nurses are more coordinated less over-burdened: they will be able to engage in patient-centered care, communicate with one another effectively, and coordinate so that when a patient is handed off to the incoming nurse there is no lapse in quality of care delivered to the patient. ACOs will also be impacted, since they focus on delivering collaborative, holistic care to patients and rely on a range of medical specialists and health care professionals. Nurses will be able to play an instrumental role as ACO professionals, providing assistance with health literacy education, preventive care and so on (Korda & Eldridge, 2011). Medical homes, like ACOs, also focus on providing patient-centered holistic care for the whole patient and here nurses can also play a critical part in collaborating with other health care professionals to maintain a high degree of quality care for the patient. For marginalized and vulnerable populations, Nurse-managed health clinics can be started, and if nurses can practice independently of physicians they can manage these in order to increase access to care for those populations that hitherto have not be adequately served by the health care industry. As the American Nurses Association (2010) notes, “nurses, especially nurse practitioners, have the skills and opportunity to reframe how primary care is delivered” via nurse-managed health clinics (p. 7). With these innovative health care models to...…a good step forward. She said that if costs could not be brought down it would not matter what nurses attempted to do for the marginalized and underserved populations, because they would not come for care believing the costs to be high and coverage to be for others but not for them.

The third nurse colleague of mine stated that she was surprised there were so many options as she was not really clued in to any of them. She wanted to know a bit more about what was going on in the nursing industry and had more questions about the medical homes as she thought those sounded like something she would like to be in. However, she was also interested in the idea of nurse-managed health clinics. She said she did not know why nurses were not permitted to practice independently in some states and that she thought it was kind of an injustice that nurses had to practice under supervision of physicians if they have been trained to be on their own. She did not understand why that was the case and she thought it should be addressed especially if it could help to improve access to care. Overall, she thought that the nursing industry was heading in the right direction and she was appreciative for my sharing these thoughts with her.